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Warning Signs

Sexual Abuse
Warning Signs

When a child:
  • Reports an instance of abuse by a parent or caregiver
  • Has difficulty walking or sitting
  • Suddenly refuses to change for gym class or refuses to take part in physical activities
  • Demonstrates bizarre, sophisticated or unusual sexual knowledge or behavior
  • Becomes pregnant or contracts a venereal disease, particularly if under 14 years old
  • Runs away

    Or when a parent:
  • Shows an extreme protection toward the child, to the extent where the child cannot have contact with other children, especially with children of the opposite sex
  • Is secretive and isolated
  • Describes marital problems involving family power struggles or sexual relations

    What To Do

    The American Academy of Pediatrics says that the first important action to take if a child tells you about sexual abuse is to take what the child says seriously. Many children who report sexual abuse are not believed, and when a plea for help is ignored, the child may not risk telling again.

    If the abuser is a friend or family member, parents will often try to stop sexual abuse themselves, but the AAP reports that a parental intervention is almost always unsuccessful.

    Instead, they recommend reporting abuse to a local Child Protective Services, and also asking for crisis support help. Also, discussing the problem with the child's pediatrician, who can offer support and counseling, can help.

    After sexual abuse is reported, what happens depends on the circumstances of the case. The risk of further abuse to the child is the first concern for authorities. The offender and the entire family may be required to attend a treatment program, and the offender may even face criminal charges. If the child's safety is in question, authorities can take the offender or victim out of the home during the investigation.

    In order to prevent sexual abuse, the AAP suggests teaching children what sexual abuse is. Tell them they can and should say "no" or "stop" to adults who may threaten them sexually. Make sure they know that it's okay to talk about any attempt to molest them - no matter whom the offender may be.

    The AAP also suggests that prevention measures should begin early since a number of child abuse cases involve preschoolers. They offer these guidelines for age-appropriate topics to discuss with children.

  • 18 months: Teach your child the proper names for body parts.
  • 3-5 years: Teach your child about "private parts" of the body and how to say "no" to sexual advances.
  • 5-8 years: Discuss safety away from home and the difference between being touched in private parts of the body and other touching. Encourage your child to talk about scary experiences.
  • 8-12 years: Stress personal safety and give examples of potential problem areas: arcades, malls, locker rooms, out-of-the-way places outdoors.
  • 13-18 years: Re-stress personal safety and potential problem areas. Discuss rape, "date rape," STDs and unintended pregnancy.

  • Physical Abuse
    Warning Signs

  • Unexplained bruises, burns, broken bones and black eyes
  • Fading bruises or other marks after an absence from school
  • The child is frightened or cries when it is time to go home from school
  • The child shrinks at the approach of adults
  • Sudden changes in behavior or school performance
  • The child has not received medical help for injuries reported to parents
  • The child has learning problems that cannot be attributed to specific psychological causes

    Or when a parent:
  • Offers conflicting, unconvincing or no explanation for the child’s injuries
  • Has a history of abuse as a child
  • Uses harsh physical discipline
  • Shows little concern for the child
  • Denies the existence of the child’s problems in school or at home
  • Asks a teacher to use harsh discipline if the child misbehaves
  • Sees the child as entirely bad or worthless
  • Demands a level of perfection that the child cannot achieve

    What To Do

    If you suspect that a child is being abused or neglected, you should call your local Child Protective Services (CPS) agency or the CPS agency in the state in which the abuse occurred. As you identify the appropriate agency for making a report, remember that each state has jurisdiction over these matters, and has specific laws and procedures for reporting and investigating. In some states, all citizens are required to report any suspicion of child abuse or neglect.

    You can also call Childhelp USA, a national non-profit organization that provides contact information and counselors, at 1-800-4-A-CHILD.

    When suspected child abuse or neglect is reported, the state’s child welfare system must conduct an investigation. The system is a group of services designed to promote the well being of children by ensuring safety. Child welfare may remove the child from his or her home to be placed in a safe environment.

    As part of its "prevention initiative," the Department of Health and Human Services' Administration for Children and Families offers a wealth of information on child abuse, including numerous resources and tips for parents to help them realize where parenting ends and abuse begins. The ACF Website
    "Depression" can describe a normal human emotion, but it also refers to a mental health illness. Depression as an illness in children is when the feelings of sadness and despair interfere with a child’s ability to function. It's more than just having a "bad day," and you can't just "shake off" the feeling. The American Academy of Family Physicians says that changing homes or schools, the death of a pet or friend, an illness in the family, or the hormonal changes of puberty can trigger depression.

    Warning Signs

    The AAFP reports that infants and preschool children who are depressed have poor appetites and may lose weight. They also don't enjoy playing.

    School-aged children may be less confident or feel like they can't do anything right.

    Older children and teens may stop caring about themselves or family members, may not want to go to school and, in general, may lose interest in life activities. Older children may also show signs of erratic sleeping and eating patterns.

    In some children, the only signs of depression may be headaches, stomachaches, not wanting to go to school or losing their temper. When these signs last for several weeks, the child might be depressed.

    What To Do

    The first step is to talk to your child about his or her thoughts and feelings. It is also a good idea to talk to a doctor about your child's behavior and your concerns about depression. A doctor may be helpful because a medical problem may be causing the depression.

    The treatment for depression may involve both medicine and counseling. Most depressed children and teens should talk to a counselor, therapist, psychologist or psychiatrist about what is making them feel the way they are feeling. A family doctor can refer you and your child to someone for counseling. Common medications given to children to treat depression include Paxil and Zoloft, but there is ongoing debate over whether it benefits children to prescribe anti-depressants.

    Substance Abuse
    Warning signs can be divided into two categories: physical signs and behavior signs.

    Physical signs

  • Smelling of alcohol or marijuana
  • Vomiting
  • Change in eating and sleeping patterns
  • Impaired coordination
  • Glassy, bloodshot eyes
  • Marked changes in weight or appearance
  • Respiratory problems
  • Slurred speech

    Behavior signs

  • Friends suddenly change (be wary if new friendships are with much older teenagers or young adults)
  • Fighting
  • Erratic, unpredictable behavior and mood swings
  • Little contact or avoidance of family
  • Constant disciplinary concerns at school and home
  • Talks positive about chemical use
  • Depressed, withdrawn and hopeless attitudes or statements
  • Talks about running away from home
  • Overly preoccupied with secrecy or privacy
  • Memory problem
  • Difficulty with attention span
  • Entertains suicidal thoughts
  • Gang involvement or identification
  • Sudden outbursts of verbal abuse and abusive language or easily provoked Irresponsibility - blaming, denying, fault-finding or lying
  • Hyperactivity or nervousness
  • Trouble with the law, shoplifting, truancy, DUI, disorderly conduct

    What To Do

    By way of prevention, it seems that all experts agree that kids need to be educated at young ages about drugs and alcohol, and their dangers. The process starts when parents educate themselves about substance abuse, and then establish the family rules for drugs and alcohol.

    Then it comes down to good parenting. This means making time for kids, listening and knowing everything about them and knowing whom they hang out with.

    If prevention strategies are too late, and you think your child may be using drugs, it's best to communicate with your child about your concerns. If he or she is reluctant to talk, ask other adults in your child's life if they have noticed changes in behavior. The best place to start is at school - teachers, guidance counselors, school nurses and coaches can be helpful. Many schools have prevention specialists who can help you if you suspect substance abuse.

    Even when the signs are obvious, parents sometimes have difficulty admitting that their child could have a problem. Anger, guilt, and a sense of failure as a parent are common reactions. If a child is using drugs, it is important for parents to avoid blaming themselves, and to get help as soon as possible.

    Many young people lie about their drug use. If evidence suggests that a child is not being truthful, a doctor’s evaluation could be helpful.

    Depending upon the severity of a child's drug use, parents will probably need help to intervene. Call a doctor, local hospital, state or local substance abuse agencies, or county mental health society for a referral to a drug treatment program in the area. School districts should have a substance abuse counselor who can give referrals to treatment programs. Parents whose children have been through treatment programs can also provide information and support to help.

  • Self Mutilation
  • What It Is

    Self-mutilation is when someone intentionally injures himself or herself when under emotional stress. The injuries are often cuts or bites, or something severe enough to damage body tissue. Self-mutilation often occurs as a result of psychological disorders (such as depression or borderline personality disorder) or sexual abuse, and is also a warning sign of a potential suicide.

    A person usually begins self-mutilation at the onset of puberty, according to S.A.F.E. (Self-Abuse Finally Ends). The warning signs are fairly obvious: recurring wounds that look like they have been inflicted with scissors, knives, glass, razorblades, or belts, as well as burn marks form lighters or cigarettes. If discovered, the person will often make up excuses as to how they got the injuries. S.A.F.E. also reports that many sufferers are also struggling with eating disorders and substance abuse.

    The Bio-Behavioral Institute reports that the prevalence rate of self-mutilation in the U.S. is estimated to be about 1 to 2%, with higher rates among institutionalized individuals and survivors of childhood abuse. The acts are often a form of self-punishment that the victims feel they need to impose to feel in control of themselves.

    What To Do

    Self-mutilation is a serious condition, and effective medical treatment involves a combination of therapy and medication. There is no specific drug used to treat the condition, but there are medications that help reduce the symptoms of anxiety, obsessive-compulsive disorder, lack of sleep and depression that are prevalent in victims of the illness.
    A good starting point to get help is the S.A.F.E. program’s Web site, at

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