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You are here: Home » eGM Resources » Health Information & Resources Portal|Home » Child Abuse and Neglect


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Child Abuse and Neglect

Recognizing Child Abuse and Neglect

Child abuse affects children of every age, race, and income level. It often takes place in the home and comes from a person the child knows and trusts — a parent, relative, babysitter, or friend of the family.

Often abusers are ordinary people caught in stressful situations: young mothers and fathers unprepared for the responsibilities of raising a child; overwhelmed single parents with no support system; families placed under great stress by poverty, divorce, or sickness; parents with alcohol or drug problems.

A first step in helping or getting help for an abused or neglected child is to identify the signs and symptoms of abuse. There are four major types of child maltreatment: neglect, physical abuse, sexual abuse, and emotional abuse:

sad child


Neglect is failure to provide for a child's basic needs such as food, clothing, shelter, medical care, education, or proper supervision. Possible symptoms:

  • The child shows signs of malnutrition or begs, steals, or hoards food.
  • The child has poor hygiene: matted hair, dirty skin, or severe body odor.
  • The child has unattended physical or medical problems.
  • The child states that no one is home to provide care.
  • The child or caretaker abuses drugs or alcohol.

Physical Abuse

Physical abuse is intentional injury inflicted upon a child. It may include severe shaking, beating, kicking, punching, or burning that results in minor marks, bruising, or even death. Possible symptoms:

  • The child has broken bones or unexplained bruises, burns, or welts in various stages of healing.
  • The child is unable to explain an injury, or explanations given by the child or caretaker are inconsistent with the injury.
  • The child is unusually frightened of a parent or caretaker, or is afraid to go home.
  • The child reports intentional injury by parent or caretaker.

Sexual Abuse

Sexual abuse refers to any sexual act with a child by an adult or older child. It includes fondling or rubbing the child's genitals, penetration, incest, rape, sodomy, indecent exposure, and using the child for prostitution or the production of pornographic materials. Possible symptoms:

  • The child has pain or bleeding in anal or genital area with redness or swelling.
  • The child displays age-inappropriate play with toys, self, or others.
  • The child has inappropriate knowledge about sex.
  • The child reports sexual abuse.

Emotional Abuse

Emotional abuse may occur when a parent fails to provide the understanding, warmth, attention, and supervision the child needs for healthy psychological growth. Possible symptoms:

  • The parent or caretaker constantly criticizes, threatens, belittles, insults, or rejects the child with no evidence of love, support, or guidance.
  • The child exhibits extremes in behavior from overly aggressive to overly passive.
  • The child displays delayed physical, emotional, or intellectual development.

Osteogenesis Imperfecta (OI) vs. Child Abuse

Osteogenesis Imperfecta (OI)

OI is characterized by bones that break easily. A minor accident may result in a fracture; some fractures may occur while a child is being diapered, lifted, or dressed. It is possible for a person with OI to break a bone without being aware of it. Children who are not diagnosed at birth often suffer a series of painful fractures before health care professionals are able to diagnose the condition.

Child Abuse

Child abuse is also characterized by broken bones. In recent years, Americans have become increasingly aware of this problem and major efforts have been undertaken to protect children. Child abuse is a pattern of behavior that often is passed down from one generation to the next. Many abusive parents were themselves abused as children. Open, honest discussion of the issue not only can ensure the safety of countless children but can also encourage parents who wish to break the cycle of abusive behavior to seek the help they need.

Diagnosis: OI or Child Abuse?

False accusations of child abuse may occur in families with children who have milder forms of OI and/or in whom OI has not previously been diagnosed. Types of fractures that are typically observed in both child abuse and OI include:

  • fractures in multiple stages of healing
  • rib fractures
  • spiral fractures
  • fractures for which there is no adequate explanation of trauma

When the fracture seems incompatible with the reported cause of the injury, child abuse is often suspected. And, unfortunately, when false accusations of child abuse occur, families become victimized.

The following practical advice, together with competent legal advice from a family law attorney, is intended to help parents who have been accused of child abuse.

  1. Each state has its own policy for dealing with child abuse cases. We strongly suggest that you secure the advice and, if possible, the services of a family law attorney as soon as charges of child abuse are brought. Attorney referral services are generally offered by each state's Bar Association. If you are not satisfied with the services that your attorney is providing, don't be afraid to find another attorney to handle your case.
  2. Remember, physicians and social services case workers are doing their jobs; whoever reported the suspected child abuse to the social services authorities may be bound by law to do so. Everyone involved is concerned about what is best for the child.
  3. Seek the best medical diagnosis available. It is of utmost importance that the health care professional (including, but not limited to, an orthopedist familiar with OI) conducting the evaluation have considerable experience in both diagnosing and treating OI.
  4. A consultation with a geneticist familiar with OI may reveal a family history of mild OI if symptoms such as blue-tinted sclera (the white part of the eye), presenile hearing loss, rickets, dental problems, short stature, and/or a history of broken bones are identified.
  5. Most often, child abuse is suspected when the explanation given by the child or parent does not appear to match the injury found by the treating physicians and other medical personnel. The decisions of the social services agency are based heavily on the medical information given to the agency by the physician.
  6. Unless you advise the case worker, do not change the hospital or physicians who are providing medical services to your child. Changes made without the knowledge of the case worker may be interpreted as an attempt to hide the child abuse.
  7. Keep the case worker up to date on what is happening. Attempt to confirm with the case worker that he/she understands what you have told them. Demonstrate that you truly want to work together for what is best for your child. Resistance toward the case worker may be interpreted as guilt.
  8. If your child is being taken from your home, you may request that he or she be taken to the home of a grandparent or other relative.
  9. When the problem is resolved, insist that the charges be taken off all records, including computerized records. If this is not done, you may be registered as an abusive parent until your youngest child is 18 years of age.

Reporting Child Abuse and Neglect

If you suspect abuse, reporting it can protect the child and get help for the family. Each State identifies mandatory reporters (groups of people who are required to report suspicions of child abuse or neglect). However, any concerned person can and should report suspected child abuse. A report is not an accusation; it is an expression of concern and a request for an investigation or evaluation of the child's situation. If you suspect a child is in a dangerous situation, take immediate action. Your suspicion of child abuse or neglect is enough to make a report. You are not required to provide proof. Investigators in your community will make the determination of whether abuse or neglect has occurred. Almost every State has a law to protect people who make good-faith reports of child abuse from prosecution or liability.

How do I report child abuse or neglect?

If you suspect a child is being harmed, contact your State Child Abuse Hotline, local child protective services (CPS), or law enforcement agency so professionals can assess the situation. For more information about where and how to file a report, call Childhelp USA®, National Child Abuse Hotline (1-800-4-A-CHILD ®).

When calling to report child abuse, you will be asked for specific information, which may include:

  • The child's name and location
  • The suspected perpetrator's name and relationship to the child (if known)
  • A description of what you have seen or heard regarding the abuse or neglect
  • The names of any other people having knowledge of the abuse
  • Your name and phone number

The names of reporters are not given out to families reported for child abuse or neglect; however, sometimes by the nature of the information reported, your identity may become evident to the family. You may request to make your report anonymously, but your report may be considered more credible and can be more helpful to CPS if you give your name.

What will happen when I make a report?

Your report of possible child maltreatment will first be screened by hotline staff or a CPS worker. If the worker feels there is enough credible information to indicate that maltreatment may have occurred or is at risk of occurring, your report will be referred to staff who will conduct an investigation. Investigators respond within a particular time period (anywhere from a few hours to a few days), depending on the potential severity of the situation. They may speak with the child, the parents, and other people in contact with the child (such as doctors, teachers, or childcare providers). Their purpose is to determine if abuse or neglect has occurred and if it may happen again.

broken mirror

If the investigator finds that no abuse or neglect occurred, or what happened does not meet the State's definition of abuse or neglect, the case will be closed and the family may or may not be referred elsewhere for services. If the investigator feels the children are at risk of harm, the family may be referred to services to reduce the risk of future maltreatment. These may include mental health care, medical care, parenting skills classes, employment assistance, and concrete support such as financial or housing assistance. In rare cases where the child's safety cannot be ensured, the child may be removed from the home.

Sources: The NIH Osteoporosis and Related Bone Diseases National Resource Center and The National Clearninghouse on Child Abuse and Neglect Information

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