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Who’s most at risk for child abuse? Infants


Infants have the highest rate of child abuse in the United States, according to a recent government report. The rate was 20.6 infants per 1,000 in 2010, more than twice the rate for all children.

Overall, child abuse and neglect in the United States has declined slightly for the third consecutive year. The rate was 10 per 1,000 children in 2010, down from 10.3 in 2008.

The figures appear in the latest annual report of the U.S. Department of Health and Human Services’ Administration for Children and Families, reflecting data collected voluntarily from the states.

Experts speculate that the vulnerability of infants may be related to economic stress and lack of support for young families (CNN Health 2012). Contrast that with factors associated with the overall decline (CBS 2011):
the use of different reporting methods
increased public awareness of abuse and neglect
wider use of psychiatric medication by adults who might have abusive tendencies
greater knowledge of effective child-rearing practices among parents.


Reporting required by law
Although most states require the reporting of child abuse and neglect, the law is sometimes ignored, especially when the reputation of an institution is at stake. Such was the case with the sexual abuse and cover-up by coaches at Penn State, for example.
State law in Texas requires that abuse and neglect be reported by any person who suspects it. The law further requires that child care personnel, teachers, and other professionals who work with children be especially diligent. They must report suspected abuse or neglect within 48 hours of their suspicion.
Signs of abuse may turn up when least expected. Some possible scenarios:
You’re changing a baby’s diaper and notice bruises shaped like fingers across the child’s back. When you ask the mother, she says the infant fell off the bed.
At naptime, a 4-year-old girl in your class asks you to keep a secret: Her uncle took her aside at a family gathering and stroked her genital area.
A 6-year-old boy screams and clings to you when his mother’s new boyfriend comes to pick him up.
When school-agers are hanging up their backpacks, you overhear two boys talking about an older brother who photographed girls changing clothes after gym class and posted the photos on Facebook.

What to do? According to the Texas Attorney General, you might first talk to the child or parent a little to determine whether you understood correctly or there’s a simple explanation for the situation. You might choose to discuss your suspicions with another teacher or the director.

But as long as you have reason to believe abuse could be occurring, you must report. You cannot delegate the responsibility to another person to make the report. It doesn’t matter that you don’t know all the details or that the suspected abuser is a child’s relative, church official, coach, physician, or teacher. If in doubt, it’s better to err on the side of the child’s safety and make the report.
As long as you report in good faith, your name is kept confidential, and you are immune from lawsuits. Failure to report can result in a charge of Class A misdemeanor, which could mean up to 180 days in jail and/or a fine of up to $2,000.


How to report
Your duty is to make the report. Don’t investigate the matter, and don’t confront the suspected abuser.

To report, contact the Texas Department of Family and Protective Services by phone or online. Both methods are available 24 hours a day, seven days a week.

Phone: 1-800-252-5400

In an emergency or life-threatening situation, call 9-1-1 immediately. Or call your local police or sheriff. Don’t use the Internet option when the child needs immediate medical care, when you see serious injuries to a child younger than 5, or when a suspected sexual abuser will have access to the child within the next 24 hours.

Be prepared to provide the following information:
Name, age, and address of the child, if known
Your name and contact information
A brief description of the situation
Current injuries, medical problems, or behavior issues
Names of parents and siblings in the home, if known
A brief explanation of how you found out about the situation.

A child protection specialist will evaluate the child’s situation and decide on the next steps. Actions my include calling or visiting the child’s home, alerting the police, coordinating a response with other agencies, and recommending counseling services to the family.


Symptoms of abuse and neglect
Reporting suspected abuse and neglect can help prevent further injury to the child, long-lasting physical and behavioral disorders, and possibly even death. How do you know what to look for?

Suspect physical abuse when you see:
frequent injuries such as bruises, cuts, black eyes, or burns, especially when the child or parent cannot adequately explain the causes
complaints of pain without obvious injury
lack of reaction to pain
aggressive, disruptive, or destructive behavior
passive, withdrawn, or emotionless behavior
fear of going home or seeing parents or other persons
unseasonable clothes, such as a long-sleeved sweater in summer, to hide injuries
child’s absence of a few days and then reappearance with injuries.

Suspect sexual abuse when you see:
physical signs of sexually transmitted diseases
injury to the genital area
difficulty in sitting or walking
frequent expressions of explicit sexual activity between adults and children or between children
extreme fear of being alone with adults, especially with a certain gender
sexually suggestive behavior
sexual knowledge beyond what might be appropriate for the child’s age.

Suspect neglect when you see:
serious malnourishment
torn or dirty clothes
lack of personal hygiene
serious fatigue and listlessness
stealing or begging for food
frequent absences or tardiness from school.


Symptoms in infants
Abuse and neglect can be especially devastating to infants. Physical abuse can cause direct damage to a baby’s fragile brain and result in long-term sensory impairments as well as learning and behavior

Infants who have been physically abused may have:
bruises, cuts, and other symptoms like those above
bulging fontanel (soft spot on top of the head) or separated sutures (bony plates of the skull).

Infants who have been violently shaken may suffer brain trauma, known as shaken baby syndrome. Injuries are not always visible but symptoms may include the following:
significant changes in sleeping patterns or inability to be awakened
vomiting (more than usual)
convulsions or seizures
increasing irritability
uncontrollable crying
inability to be consoled
inability to nurse or eat.


Training resources for staff
The minimum standards for child care centers in Texas require that employee orientation includes “an overview of symptoms of child abuse, neglect, and sexual abuse and the responsibility for reporting these.” The standards also require that adults who care for children younger than 24 months have one hour of their annual training devoted to brain development, including recognizing and preventing shaken baby syndrome.

Free online resources are available:
A one-page flyer about reporting abuse, website of the Texas Department of Family and Protective Services,
An online training course (approximately one hour), Reporting Suspected Abuse or Neglect of a Child: A Guide for Education Professionals, website of the Texas Department of Family and Protective Services,
An online training course on Shaken Baby Syndrome, website of the National Center on Shaken Baby Syndrome,


Attorney General of Texas, Greg Abbott. “When You Suspect Child Abuse or Neglect: A General Guide,”
CBS Dec. 12, 2011. “Study: Child abuse on decline in U.S.”
CNN Health. Feb. 6, 2012. “Infants at Greatest Risk for Child Abuse,”
U.S. Department of Health and Human Services, Administration for Children and Families. 2010. Child Maltreatment 2010.
U.S. Department of Health and Human Services, Administration for Children and Families. April 2010. “Mandatory Reporters of Child Abuse and Neglect: Summary of State Laws,”
U.S. Department of Health and Human Services, Administration for Children and Families. 2009. “Understanding the Effects of Maltreatment on Brain Development,”
U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. “Preventing Shaken Baby Syndrome: A Guide for Health Departments and Community-Based Organizations,”