Characteristics of Child Abuse

• Most abusers were physically or emotionally abused as children
• One or both parents tend to be the abusers
• Use of drugs and/or alcohol
• Immaturity and/or preoccupation with self
• Lack of obvious feeling for the child, rarely looking at or touching the child
• Apparent lack of concern about the child’s injury, treatment or prognosis
• Open criticism of the child, with little indication of guilt or remorse for involvement in the child’s condition
• Little identification with the child’s pain, whether it is physical or emotional

Characteristics of a child who has been abused

• Crying, often hopelessly, during treatment or not crying at all
• Avoiding the parents or showing little concern for their absence
• Unusually wary or fearful of physical contact
• Apprehensive and/or constantly on the alert for danger
• Sudden behavioral changes
• Absence of emotions
• Neediness

Identifying an abused child

            Common mistakes for abuse

·         Car seat burns

·         Staphylococcal scalded skin syndrome

·         Chickenpox (sometimes thought to be cigarette burns)

·         Hematological disorders (causes of easy bruising)

Physical Examination

·         Burns and Scalds – these burns generally tend to be in certain locations such as the soles of the feet, palms of the hands, back or buttocks.

·         Fractures – sites of fractures, which is the second most common form of child abuse, include the skull, nose, facial structures and upper extremities. Children rarely have accidental rib fractures and should therefore cause a high index of suspicion for abuse.

·         Head Injuries – Scalp wounds, skull fractures, subdural hematomas and repeated contusions are head injuries commonly found in abused children.

·         Shaken Baby Syndrome – When a parent or caretaker gets frustrated with a crying infant and shakes them subdural hematomas or diffuse swelling can occur and lead to permanent brain damage, or death.

·        Abdominal Injuries – Pain, swelling and vomiting may be a sign of abdominal injuries in an abused child. This sort of injury occurs in a small portion of abuse cases, but is generally very serious.

Signs of Neglect

·         Malnutrition

·         Severe diaper rash

·         Diarrhea and/or dehydration

·         Hair loss

·         Untreated medical conditions

·         Dirty clothing or lack of clothing

·         Listless attitudes

·         Near constant demands for physical contact or attention

Signs of emotional abuse

·         Parents/caregiver ignore the child and their needs

·         Parents/caregiver reject, humiliate or criticize the child

·         Isolating the child from normal human contact or nurturing

·         Feelings of fear and anxiety due to being terrorized or bullied through verbal assaults and threats

·         Encouragement for destructive or antisocial behavior

·         Overpressure by unrealistic expectations of success

Reporting and Recording Child Abuse

As an EMS provider, it is our responsibility to report suspected cases of child abuse. Early interventions may be available and the warning signs should be noted carefully. When dealing with an abused child, conduct the examination with a partner present. Keep all reactions to yourself and record only personal observations. The final document should be objective and legible. Keep in mind that this document may be used in court or in a child custody case.