Office for Children and Families
CHILD
ABUSE AND
NEGLECT
A reference for medical professionals
Second Edition
JFS 01495 (Rev. 3/05)
, FACTS ABOUT CHILD ABUSE AND NEGLECT
Child abuse and neglect cut across all class, cultural, and educational groups.
Child abuse and neglect may be a cyclical or generational phenomenon.
Child abuse and neglect are symptoms of family dysfunction or crisis.
AN OPEN LETTER TO MEDICAL AND HEALTH PROFESSIONALS
As a member of the health profession, you may be the first professional to come into contact
with a family where abuse or neglect is occurring. In many cases, the medical professional may
be the only person who is in a position or is qualified to recognize and diagnose suspected child
abuse and neglect. Under Ohio law, you are mandated to report any suspicion of abuse or
neglect to your local Children Services Agency or law enforcement agency. The moral
commitment you have made to your chosen profession also obligates your action. In order to
begin the intervention necessary to protect the child and help the family, the medical and health
professional must be knowledgeable in recognizing cases of child abuse and neglect and the
proper methods of handling evaluation and referral. This booklet has been developed to
address the most frequent child abuse and neglect issues which confront the medical and health
professional.
We, in the Ohio Department of Job and Family Services, ask for your help in protecting Ohio’s
children through a close and cooperative working relationship among the medical, health, and
children services professions. We urge you to contact other leaders in your community to
promote professional education on the topic of child abuse and neglect.
This publication was funded by the Children’s Justice Act grant funds, awarded to Ohio by the U.S. Department
of Health and Human Services.
An online copy can be downloaded from the Ohio Department of Job and Family Services
http://jfs.ohio.gov/
or from Cincinnati Children’s Hospital Web site
www.cincinnatichildrens.org/Mayerson
Editors: Shapiro, Robert Allan, MD and Makoroff, Kathi Lynn, MD
Mayerson Center for Safe and Healthy Children, Cincinnati Children’s Hospital Medical Center
1
,Table of Contents
SECTION 1: General Information........................................................................... 1
QUIZ: How Much Do You Know About Child Abuse And Neglect? ....................... 2
THE ANSWERS ............................................................................................................ 5
Some Myths About Sexual Abuse............................................................................... 13
Definitions..................................................................................................................... 17
The Ohio Revised Code web link.............................................................................................18
SECTION 2: Identifying Child Abuse and Neglect................................................ 19
Overview ....................................................................................................................... 20
Identifying The Abuser ............................................................................................... 21
Identifying the Victims ................................................................................................ 26
Clues To Recognizing Physical Abuse.....................................................................................27
Clues To Recognizing Sexual Abuse .......................................................................................29
Clues To Recognizing Emotional Maltreatment.......................................................................30
Clues To Recognizing Neglect .................................................................................................31
Distinguishing Abusive Injuries From Accidents ..................................................... 32
SECTION 3: Reporting Child Abuse and Neglect................................................. 34
Who Is Responsible To Report? ................................................................................. 35
How Do I Determine If A Report Is Necessary? ....................................................... 36
What Specific Information Should I Report? ........................................................... 36
Will My Report Be Confidential? Can The Parents File Charges Against Me?... 37
How Will My Report Benefit The Child? .................................................................. 37
How Should I Respond To The Child Who Discloses?............................................. 38
Who Do I Contact To Report ?................................................................................... 40
Listing of Ohio County Public Children Service Agencies ......................................................40
What Happens When Abuse or Neglect is Reported? .............................................. 50
SECTION 4: For Medical and Health Professionals............................................. 54
Approaching The Problem.......................................................................................... 55
Suspected Child Abuse And Neglect Evaluation Plan .............................................................55
ii
, Interviewing The Child ............................................................................................... 56
Interviewing The Parent(s) ......................................................................................... 57
Medical Indicators of Child Abuse and Neglect........................................................ 59
Bruises/Soft Tissue Injury ........................................................................................................59
Burns ........................................................................................................................................60
Abdominal/Truncal Injuries......................................................................................................60
Head Injury...............................................................................................................................61
Eye Injuries...............................................................................................................................61
Skeletal Injuries ........................................................................................................................62
Sexual Abuse ............................................................................................................................63
Likelihood of sexual transmission of specific sexually transmitted diseases ........................64
Neglect......................................................................................................................................64
When to Admit the Child to the Hospital .................................................................. 65
Making the Report....................................................................................................... 65
"Baby Doe" .................................................................................................................. 67
Can We Recognize a Potentially Abusive Parent Before a Baby is Born? ............. 69
Munchausen Syndrome By Proxy .............................................................................. 70
SECTION 5: Policy Statements from the American Academy of Pediatrics......... 72
Assessment of Maltreatment of Children With Disabilities..................................... 73
Diagnostic Imaging of Child Abuse............................................................................ 80
Distinguishing Sudden Infant Death Syndrome From Child Abuse Fatalities ...... 87
Ethics and the Care of Critically Ill Infants and Children ...................................... 96
The Initiation or Withdrawal of Treatment for High-Risk Newborns ................. 102
Gonorrhea in Prepubertal Children ........................................................................ 104
Guidelines for the Evaluation of Sexual Abuse of Children: Subject Review...... 107
Medical Necessity for the Hospitalization of the Abused and Neglected Child.... 117
Oral and Dental Aspects of Child Abuse and Neglect ............................................ 120
Appendix I: Ohio Sexual Abuse Protocol............................................................. 127
Appendix 2: Medical Photographs of Child Abuse................................................ 128
iii
CHILD
ABUSE AND
NEGLECT
A reference for medical professionals
Second Edition
JFS 01495 (Rev. 3/05)
, FACTS ABOUT CHILD ABUSE AND NEGLECT
Child abuse and neglect cut across all class, cultural, and educational groups.
Child abuse and neglect may be a cyclical or generational phenomenon.
Child abuse and neglect are symptoms of family dysfunction or crisis.
AN OPEN LETTER TO MEDICAL AND HEALTH PROFESSIONALS
As a member of the health profession, you may be the first professional to come into contact
with a family where abuse or neglect is occurring. In many cases, the medical professional may
be the only person who is in a position or is qualified to recognize and diagnose suspected child
abuse and neglect. Under Ohio law, you are mandated to report any suspicion of abuse or
neglect to your local Children Services Agency or law enforcement agency. The moral
commitment you have made to your chosen profession also obligates your action. In order to
begin the intervention necessary to protect the child and help the family, the medical and health
professional must be knowledgeable in recognizing cases of child abuse and neglect and the
proper methods of handling evaluation and referral. This booklet has been developed to
address the most frequent child abuse and neglect issues which confront the medical and health
professional.
We, in the Ohio Department of Job and Family Services, ask for your help in protecting Ohio’s
children through a close and cooperative working relationship among the medical, health, and
children services professions. We urge you to contact other leaders in your community to
promote professional education on the topic of child abuse and neglect.
This publication was funded by the Children’s Justice Act grant funds, awarded to Ohio by the U.S. Department
of Health and Human Services.
An online copy can be downloaded from the Ohio Department of Job and Family Services
http://jfs.ohio.gov/
or from Cincinnati Children’s Hospital Web site
www.cincinnatichildrens.org/Mayerson
Editors: Shapiro, Robert Allan, MD and Makoroff, Kathi Lynn, MD
Mayerson Center for Safe and Healthy Children, Cincinnati Children’s Hospital Medical Center
1
,Table of Contents
SECTION 1: General Information........................................................................... 1
QUIZ: How Much Do You Know About Child Abuse And Neglect? ....................... 2
THE ANSWERS ............................................................................................................ 5
Some Myths About Sexual Abuse............................................................................... 13
Definitions..................................................................................................................... 17
The Ohio Revised Code web link.............................................................................................18
SECTION 2: Identifying Child Abuse and Neglect................................................ 19
Overview ....................................................................................................................... 20
Identifying The Abuser ............................................................................................... 21
Identifying the Victims ................................................................................................ 26
Clues To Recognizing Physical Abuse.....................................................................................27
Clues To Recognizing Sexual Abuse .......................................................................................29
Clues To Recognizing Emotional Maltreatment.......................................................................30
Clues To Recognizing Neglect .................................................................................................31
Distinguishing Abusive Injuries From Accidents ..................................................... 32
SECTION 3: Reporting Child Abuse and Neglect................................................. 34
Who Is Responsible To Report? ................................................................................. 35
How Do I Determine If A Report Is Necessary? ....................................................... 36
What Specific Information Should I Report? ........................................................... 36
Will My Report Be Confidential? Can The Parents File Charges Against Me?... 37
How Will My Report Benefit The Child? .................................................................. 37
How Should I Respond To The Child Who Discloses?............................................. 38
Who Do I Contact To Report ?................................................................................... 40
Listing of Ohio County Public Children Service Agencies ......................................................40
What Happens When Abuse or Neglect is Reported? .............................................. 50
SECTION 4: For Medical and Health Professionals............................................. 54
Approaching The Problem.......................................................................................... 55
Suspected Child Abuse And Neglect Evaluation Plan .............................................................55
ii
, Interviewing The Child ............................................................................................... 56
Interviewing The Parent(s) ......................................................................................... 57
Medical Indicators of Child Abuse and Neglect........................................................ 59
Bruises/Soft Tissue Injury ........................................................................................................59
Burns ........................................................................................................................................60
Abdominal/Truncal Injuries......................................................................................................60
Head Injury...............................................................................................................................61
Eye Injuries...............................................................................................................................61
Skeletal Injuries ........................................................................................................................62
Sexual Abuse ............................................................................................................................63
Likelihood of sexual transmission of specific sexually transmitted diseases ........................64
Neglect......................................................................................................................................64
When to Admit the Child to the Hospital .................................................................. 65
Making the Report....................................................................................................... 65
"Baby Doe" .................................................................................................................. 67
Can We Recognize a Potentially Abusive Parent Before a Baby is Born? ............. 69
Munchausen Syndrome By Proxy .............................................................................. 70
SECTION 5: Policy Statements from the American Academy of Pediatrics......... 72
Assessment of Maltreatment of Children With Disabilities..................................... 73
Diagnostic Imaging of Child Abuse............................................................................ 80
Distinguishing Sudden Infant Death Syndrome From Child Abuse Fatalities ...... 87
Ethics and the Care of Critically Ill Infants and Children ...................................... 96
The Initiation or Withdrawal of Treatment for High-Risk Newborns ................. 102
Gonorrhea in Prepubertal Children ........................................................................ 104
Guidelines for the Evaluation of Sexual Abuse of Children: Subject Review...... 107
Medical Necessity for the Hospitalization of the Abused and Neglected Child.... 117
Oral and Dental Aspects of Child Abuse and Neglect ............................................ 120
Appendix I: Ohio Sexual Abuse Protocol............................................................. 127
Appendix 2: Medical Photographs of Child Abuse................................................ 128
iii
