1. University of Maryland School of Medicine – Mini Med School Child Abuse and Neglect Howard Dubowitz, MD, MS Professor of Pediatrics University of Maryland School of Maryland

2. Why is child abuse and neglect so important?

3. Child abuse and neglect are common Over 700,000 children abused or neglected each year 1 in 5 girls and 1 in 10 boys sexually abused during their childhood Numbers for abuse have come down, but still high

4. Outcomes of Child Maltreatment Physical Health Cognitive Development Social Development Emotional Health

5. How do we define child abuse and neglect?

6. Where do you draw the line between corporal punishment & abuse?

8. Please be careful. Not all bruises are due to abuse.

9. Bruises over bony surfaces Common Not inflicted

10. Mongolian spots – most African-Americans - no swelling, not tender

11. “Reasonable” corporal punishment or abuse?

12. Some of the Evidence on Corporal Punishment More anti-social behavior 2 yrs. later – 807 mothers of 6-9 yr olds, national sample Straus et al, Arch Pediatr Adolesc Med. 1997; Aug;151(8):761 More psychopathology Suicidal ideation (over twice as high) – 1197 Baltimore African-Americans, aged ~ 20 Koenig et al, Child Abuse Negl. 2002;26(12):1209

13. Definition of Child Sexual Abuse All sexual contact or conduct that is: –unwanted by a child, or –exploitative, or –outside developmentally appropriate play –by a parent, caregiver, household or family member –does not require injury

14. Definition of neglect Neglect occurs when a child’s basic need is not met, resulting in potential or actual harm. Basic needs include adequate: –Food- Clothing –Supervision- Protection –Health care- Education –Love & nurturance- Housing

16. How can you identify a child who may be abused or neglected?

17. Ways Sexual Abuse May Present Physical signs: injury or infection Child’s disclosure – to another child, parent, therapist, or trusted adult Child sexually abuses another child Child uses sexually explicit language, behavior - beyond normal development

18. Sexualized Behaviors that Raise Concern Excessive focus on sexuality, knowledge beyond normal development Inappropriate sexual behavior despite redirection Sexual behavior/exploration/coercion with much older/younger children Drawings with genitals predominating

19. How neglect might appear Physical – not enough food, always hungry, poor growth, inadequate clothing, hygiene Medical/dental – not getting necessary care Emotional – appears sad or anxious, emotional problems, not getting necessary care Inadequate supervision – home alone, multiple injuries

20. Why are children abused and neglected?

21. Child Parents Family Community Society Contributors to Child Maltreatment Belsky, Psychological Bulletin. 1993;114:413 Professionals

22. What should you do if you think a child is being abused or neglected? And what to expect from the systems

23. Progression to/through CPS Abuse Identification Report Investigation Substantiation 40% screened out 70% unsubstantiated Family Services Removal of Child Prosecution

24. How can we help families where children are abused or neglected?

25. Help, when maltreatment identified Report child abuse and neglect Support families where this occurs

26. How can you help prevent child abuse and neglect?

27. Prevention Identify contributors and help address them Support community programs that strengthen families Advocacy

28. Rights and rights

29. Any questions?

30. Thank You! hdubowitz@peds.umaryland.edu