1. TYPES OF ABUSE & INDICATORS

2. 4 Main Types of Child Abuse
Physical Abuse
Sexual Abuse
Psychological Abuse
Neglect

3. Physical Abuse
Includes any non-accidental physical injury caused by the child's parent or a non- parental caregiver.
It may include injuries sustained from being burned, beaten, kicked, punched, bitten, or hit, or from other types of physical attack.
While the injury is not an accident, neither is it necessarily the intent of the child's parent or caregiver to injure the child.

4. Physical Abuse
Children younger than 5 years of age are at the highest risk for injury or death resulting from physical abuse because their bodies are not fully developed.
The areas that are bruised most commonly during normal play include the leading or bony edges of the body, such as knees, elbows, forearms, or brows.
The soft tissue areas, such as cheeks, buttocks, and thighs, are not normally injured in such circumstances.
Bruises in soft tissue areas or in distinct shapes may be indicative of physical abuse.

5. Signs of Physical Abuse
Extensive bruises, especially in areas of the body that are not normally vulnerable;
Frequent bruises, particularly on the head or face, the abdomen, or midway between the wrist and elbow;
Bruises in specific shapes, such as handprints or belt buckles;
Marks that indicate hard blows from an object like an electrical cord;
Bruises on multiple parts of the body;
Bruises or welts in various stages of healing;
Unexplained or multiple broken bones;
Major head injuries (e.g., severe skull fracture);
Extreme sensitivity to pain or complaints of soreness and stiffness;
Bald spots from hair pulling;
Adult-sized human bite marks;

6. Signs (Continued)
Burns from objects such as an iron, cigarettes, or rope;
Immersion burns from having certain body parts held in very hot water (e.g., sock- or glove-like burns on the child's feet or hands).
Note: Abuse directed to the abdomen or the head often is undetected because many of the injuries or their effects, such as dizziness, internal bleeding, or swelling of the brain, may not be externally visible. For example: shaken baby syndrome

7. Behavioral Signs Being aggressive, oppositional, or defiant
Cowering or demonstrating fear of adults;
Exhibiting destructive behaviors toward oneself or others;
Repeatedly being reluctant to go home, which may indicate a possible fear of abuse at home; 
Being described as "accident prone;" 
Wearing clothing that may be inappropriate for the season (e.g., long-sleeve shirts and pants in summer) to conceal injuries;
Having persistent or repetitive physical complaints, such as a headache or a stomachache, of an unclear cause;
Disliking or shrinking from physical contact.

8. Psychological Abuse
Includes belittling, rejecting, isolating, terrorizing, or ignoring a child.
This type of abuse typically is accompanied by other types of maltreatment and rarely occurs as a one- time incident.
Psychological Abuse is most often* indicated by the children's behavior.

9. Possible Physical Indicators
Eating disorders
Self-abusive behaviors (e.g., head banging, pulling one's hair)
Sleep disorders (e.g., nightmares)
Developmentally inappropriate bedwetting
Speech disorders
Ulcers
Failure to thrive due to nonmedical causes.

10. Behavioral Indicators
Extremes in behaviors (e.g., very aggressive or passive) 
Excessive dependence on adults 
Fear of a parent or generalized fearfulness
Belief that the maltreatment is their own fault 
Depression or crying easily 
Withdrawal or decreased social interaction with others
Numerous "I can't" statements
Running away from home
Aggression or unexplained temper tantrums
Blank or empty facial expression a great deal of the time.

11. Domestic Violence
Research has shown that children exposed to domestic violence are at an increased risk of being abused or neglected.
Although it can be difficult to detect a child's exposure to domestic violence, child care providers should be mindful of the following characteristics in a child…

12. Domestic Violence Changes in appetite Sleep deprivation
Complaints of headaches or stomachaches without an apparent medical cause 
Bullying
Fear of abandonment (e.g., being clingy)
Regressive behaviors, such as age- inappropriate bedwetting or thumb sucking
Irritability, especially among infants
Sexually acting out

13. Neglect
Usually is defined as omissions in care resulting in significant harm or in the risk of significant harm to children.
Neglect involves the caregiver's inattention to the basic needs of a child, such as food, clothing, shelter, medical care, and supervision. While physical abuse tends to be episodic, neglect tends to be chronic.
Neglect is the most common type of maltreatment that children experience and has consequences that can be just as serious as physical abuse.

14. Neglect
Approximately two-thirds of maltreatment victims were neglected, and it is the leading cause of fatalities due to child maltreatment.
Caregivers may not provide proper care for a variety of reasons, including a lack of knowledge or understanding about meeting the child's needs, an inadequate bonding with the child, or an impairment due to substance abuse or mental illness.
Living in poverty, in and of itself, does not mean that a child is being neglected.

15. Types of Neglect
Physical neglect. The caregiver fails to meet the physical needs of the child. This may include abandonment, nutritional neglect, clothing neglect, or inadequate hygiene.
Medical neglect. The caregiver fails to attend to the child's medical or dental needs when there are resources available.

16. Types of Neglect
Inadequate supervision. The caregiver fails to provide appropriate supervision for the child, exposes the child to hazards, or leaves the child with an inappropriate caregiver.
Environmental neglect. The caregiver does not protect the child from unsanitary or hazardous living conditions.

17. Types of Neglect
Emotional neglect. The caregiver fails to meet the child's needs for attention and affection. 
Educational neglect. The caregiver does not attend to the educational needs of the child.
Newborns addicted or exposed to drugs. Due to the mother's use of drugs during the pregnancy, the child is born addicted or exposed to drugs.

18. Physical Signs of Neglect
Height or weight that is significantly below the accepted standards of physical development 
Wearing inappropriate clothing for the weather
Poor physical hygiene
Scaly skin and dark circles under the eyes
Fatigue or listlessness

19. Behavioral Signs of Neglect
Refusal to go home
Stealing, begging, or hoarding food
Dependency on teachers or alternate caregivers to meet basic needs
Withdrawal and depression
Intense feelings of inferiority, guilt, embarrassment, shame, or anger.

20. When Should I Report
Child abuse can happen anywhere -- in poor, middle-class or well-to-do homes, in rural or urban areas.
According to Tennessee law, all persons (including doctors, mental health professionals, child care providers, dentists, family members and friends) must report suspected cases of child abuse or neglect.
Failure to report child abuse or neglect is a violation of the law.
What if I am unsure?
What if I am wrong?

21. To Report Child Abuse
If you believe a child has been abused or neglected call to make a report.

22. Contact Information
Tennessee Children’s Advocacy Centers:
(615)