Infliction of physical injury or allowing another to do so.

Possible Physical Indicators:

• Unexplained bruises, especially on “fleshy” areas
• Unexplained welts
• Unexplained burns
• Unexplained lumps
• Unexplained bumps
• Unexplained fractures
• Unexplained lacerations or abrasions
• Hemorrhages
• Burns by cigarettes
• Burns by immersion
• Dental/oral injuries

Potential Behavioral Indicators:

• Verbally reports abuse
• Too eager to please
• Depression
• Low self-esteem
• Behavioral extremes
• Role reversal
• Developmental lags
• Appears frightened of caretaker
• Apprehensive children cry
• Exaggerated startle response
• School absenteeism

Behavioral Indicators of Caretaker:
Harsh disciplinarian, describes child in a consistently negative manner, defensive, conceals or misleads about child’s injuries, substance abuser.

Sexual Abuse: Utilization of a child for sexual gratification by an adult or older child in a position of power, or permitting another person to do so.

Possible Physical Indicators:

• Any venereal disease
• Bruised/dilated genitals or rectum
• Pregnancy under 16 years of age
• Difficulty/pain in walking or sitting
• Foreign matter in bladder, rectum or urethra
• Pelvic inflammatory disease
• Torn, stained or bloody underclothing
• Recurrent urinary tract infections

Potential Behavioral Indicators:

• Aggressive, overt sexual behavior
• Drawing pictures of people with genitals or vagina
• Cruelty to animals without physiological basis
• Pre-mature knowledge of explicit sexual acts
• Sleep disorders
• Taking frequent baths
• Starting fires
• Self-inflicted injuries
• Expresses fear of a particular person or place
• Reports sexual abuse

Behavioral Indicators of Caretaker:
Extremely protective of family privacy, does not allow child to be involved in extra-curricular activities, does not want child to engage in developmentally appropriate activities i.e. dating, encourages child into prostitution, substance abuser.

Non-contact sexual offenses:

• Indecent exposure/exhibitionism
• Exposing children to pornographic material
• Deliberately exposing a child to the act of sexual intercourse
• Masturbation in front of a child

Touching sexual offenses include:

• Fondling
• Making a child touch an individual’s sexual organs
• Any penetration of a child’s vagina or anus – no matter how slight by a penis or any object that does not have a valid medical purpose

Sexual exploitation of a child is also an offense and can include:

• engaging or soliciting a child for the purposes of prostitution
• using a child to film, photograph or model pornography

What are long-term effects of child sexual abuse?
Child sexual abuse may have lifelong effects on children resulting in serious emotional problems including depression, anti-social behavior and identity confusion. Children may lose trust in adults in their lives, suffer feelings of guilt or develop self-abusive behaviors. The memories of abuse may even be suppressed until later in their adult lives.

What can we do to protect children?

Parents can help to protect their children by teaching them that they can say “no” to a person who touches them in a way that makes them uncomfortable. Parents can make sure that their children know that they can report inappropriate behavior to them or another trusted adult and that they will be believed. Promptly reporting suspected abuse of any child is important.

Professionals should be aware of the physical and behavioral indicators of abuse. Many professionals have the opportunity to be positive role models for parents and caregivers. In addition, professionals can encourage victims of abuse to seek support groups and therapy.

Parents need to become educated around Protective Factors. It is an adult’s responsibility to protect a child. You can learn more by going to www.d2l.org

Emotional Neglect – Chronic failure by the caretaker to provide support and affection necessary to develop a sound and healthy personality. When a child is emotionally neglected, he or she is being hurt by what is not there.

Potential Behavioral Indicators:

• Low self esteem
• Difficulty forming positive relationships
• Eating disorders
• Elimination problems
• Speech disorders
• Inability to trust
• Sleep problems
• Sadistic, masochistic
• Apathetic
• Suicidal
• Withdrawal
• Anxiety, fear
• Developmental lags
• Reports emotional maltreatment

Behavioral Indicators of Caretaker:
Rejecting, ignoring, terrorizing, isolating, corrupting

Emotional neglect may include:

• Habitual lack of attention, affection, emotional support or supervision
• Refusal of treatment or services recommended by school or medical personnel
• Punishing indiscriminately without teaching right from wrong
• No “family time” for shared social experiences such as meals, discussions about feelings or family outings
• Showing no interest in a child’s schoolwork, grades, hobbies or friends
• Lack of supervision with no established expectations for behavior

Emotional abuse is a chronic attitude or act of a caretaker that is detrimental to the child’s development of a sound and healthy personality. Emotional abuse is often expressed in verbal abuse, making a child feel that he or she is worthless and unworthy of attention and love.

Emotional abuse may include:

• Verbal threats of bodily harm
• Mis-socialization of a child into harmful behaviors such as lying or stealing
• Demeaning a child with comments such as “you’re stupid,” “you’re no good,” “you’re ugly,” or “I hate you”

Effects of Emotional Maltreatment

• Low self esteem
• Difficulty in forming positive relationships
• Defiant behavior
• Inability to trust
• Poorly developed ability to empathize with others
• Apathy
• Elimination disorders
• Speech disorders
• Eating disorders
• Derives pleasure from hurting others
• Suicide attempts

What Can We Do To Prevent Emotional Maltreatment?

Teach parents and caregivers to set limits, communicate directions and provide structure for children and youth with loving, rather than hurting, words.

Tell children and youth that they are special, important, lovable, likeable and talented.

Provide support and education to parents and caregivers who are adult supervisors of maltreatment to help break the cycle of abuse.

Medical neglect: even minimal health care is not being obtained for a child. This lack of health care can lead to serious harm and even death. For example, an untreated cold or flu can result in pneumonia, which can be fatal.

Signs of medical neglect include:

• Adult does not use emergency services at all, even with severe injury or illness
• When medicine is prescribed, the prescription is not filled
• Dental needs go untreated
• Regimens recommended for treatment of chronic illness not followed
• Prescribed psychological help not obtain

Failure to thrive: Failure to thrive is a significantly underweight child, usually less than 18-months-old. Any child suffering from failure to thrive should be reported as a potential victim of neglect. Approximately 30 percent of failure to thrive cases have an organic cause and require the adult to seek medical attention for the child.

Warning signs include:

• Prominent ribs
• Thin buttocks
• Much wrinkled skin
• Spindly arms and legs

If you suspect a child is suffering from medical neglect, contact Indiana Department of Child Services. If you have questions about the health of your or any other child, contact your local health care provider, or visit the links below:

American Academy of Pediatrics provides expertise and tips for child safety and health

Indiana Family Helpline: 1.800.433.0746 is staffed Monday through Friday, 7:30 a.m. to 5:00 p.m. and has an answering machine at all other times. Staffed by the Department of Health, they will help you locate and receive information on a range of health questions

Sources: “Child Maltreatment: A Clinical Guide and Reference,” A.E. Brodeur & J.A. Monteleone; “Field Guide to Child Welfare,” Judith Rycus & Ronald Hughes; Child Welfare Information Gateway

Commercial Sexual Exploitation of Children (CSEC) is the recruitment, harboring, transportation, provision, or obtaining of a person for the purposes of a commercial sex act, in which the commercial sex act is induced by force, fraud, or coercion, or in which the person induced to perform such an act has not attained 18 years of age.

Warning signs that an individual is being trafficked:

• Signs of physical abuse such as burn marks, bruises or cuts
• Unexplained absences from class
• Running away from home/placement
• Less appropriately dressed than before
• Sexualized behavior
• Overly tired in class
• Withdrawn, depressed, distracted or checked out
• Brags about making or having lots of money
• Displays expensive clothes, accessories or shoes
• New tattoo (tattoos are often used by pimps as a way to brand victims. Tattoos of a name, symbol of money or barcode could indicate trafficking)
• Shows signs of gang affiliation? (ie: a preference for specific colors, notebook doodles of gang symbols, etc.)

If you suspect a person is being trafficked call the National Human Trafficking Resource Center (NHTRC): 1-888-3737-888