Don’t Look Away: How to Recognize Child Abuse

Child abuse and neglect cases are more widespread than most people realize, with at least one in seven children experiencing maltreatment. The stresses caused by the COVID-19 pandemic, from the rise in unemployment to social isolation to school closures, could be making a bad problem even worse, according to James Metz, MD, a board certified child abuse pediatrician who oversees the Child Safe Program at the University of Vermont Children’s Hospital.

“We know that during times of stress, incidence of abuse goes up,” explains Dr. Metz, who is also an assistant professor of pediatrics at the UVM Larner College of Medicine. “Unfortunately, there’s no reason to believe it will be different this time.” 

Decreased in-person contact during the pandemic between children and mandated reporters, such as teachers, school nurses or day care providers, may be adding to the risk. A  report by the Centers for Disease Control and Prevention (CDC) compared data from 2020 to 2019 and found the total number of emergency department visits related to child abuse and neglect decreased, but the percentage of such visits resulting in hospitalization increased. “The pandemic has affected health care–seeking patterns for child abuse and neglect, raising concerns that victims might not have received care and that severity of injuries remained stable or worsened,” the CDC concludes. 

Here Dr. Metz answers questions about child abuse prevention and the community’s role in keeping kids safe.

Why does child abuse happen?

Unfortunately, child abuse and neglect is a huge problem with lots of different avenues to explore. Social factors play a big role: poverty, social stressors like losing a job, or economic hardship. A 2011 study found an increase in cases of abusive head trauma, or shaken-baby syndrome, during the 2007 to 2009 recession. We know that during times of social stress for families and society in general, the levels of abuse go up.

Which children are most at risk for abuse and neglect?

One of the risk factors is when a child has higher medical needs. We know that children who are premature, twins and children with disabilities have a higher risk of child abuse. We also know that teenage parents have a higher risk of perpetrating child abuse. So, there are specific factors that make child abuse more common in certain populations.

What are the symptoms of child abuse and neglect?

When I think about cases of abuse, I think about what we call “sentinel injuries,” or injuries that are subtle and a harbinger of worse injuries in the future.

• A small bruise on the face of a two-week-old infant is cause for concern, because two-week-olds don’t move around a lot and spend most of their time eating and sleeping.
• When a child comes to school with a bruise on their ear or a bruise on their arm, those are physical indicators of some sort of abuse and should be looked into.
• Signs of neglect include a child who isn’t meeting their developmental milestones or their weight goals. Those kind of things make us concerned that they’re not getting the nutritional support that they need.

Are there behavioral signs?

This is hard because children’s behavior is variable, and trying to understand why they’re acting out in the way that they are is difficult. Yes, there are behavioral signs that we look at, but we try to look to physical findings. In the case of sexual abuse, when a child is exhibiting oversexualized behavior or behaviors that are not appropriate for that age group, we get worried that either they’re being exposed to inappropriate content or they are being abused.

What are the long-term effects of child abuse and neglect?

Abusive and adverse experiences early on in childhood lead to physical, psychological and other problems later on in life. We call these experiences ACEs, or adverse childhood experiences. Child abuse, whether it’s physical, sexual or neglect, fall under ACEs. We know that those can be causally linked to depression, alcoholism, suicide and cardiovascular risk factors later on in life.

What can we do to reduce the risk of child abuse and neglect?

We all want to somehow be a part of the solution, and I think the first step is to recognize that child abuse happens. I think we lose sight of how widespread the problem is. In 2014, state agencies across the nation found more than 702,000 victims of child maltreatment—enough to fill 10 football stadiums.

Dedicating resources to the problem and addressing the different underlying causes of child abuse are also important. Working with families on food insecurity, employment issues and all of the social stressors that families experience may ease the burden and cause less stress on families, helping prevent child abuse.

How do you and the Child Safe Program work with the community to identify and treat children who may have been abused?

A large part of what we do is education. We educate physicians, teachers, Department of Children and Families workers and all those who work with children to identify the signs of maltreatment. Early identification is key to protecting a child from further harm. Once maltreatment is identified, our goal is to ensure the safety of the child while supporting the family.

What would you say to somebody who suspects that child abuse may be happening?

Because it’s not something that we like to think about, we probably miss it more than we should. By the time you suspect it, it’s important to report it. Remember that for reporting you don’t have to know for certain that a child has been abused, you just have to have a suspicion that something is not right or that a child may have been abused. I would encourage everyone to step into the problem instead of stepping away from the problem, and see it as a civic duty to protect children.

In New York, get in touch with Child Protective Services. In Vermont, get in touch with the Department for Children and Families.