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Palmetto Health Children’s Hospital Offers Tools for Recognizing Signs of Child Abuse and Neglect
09/06/2012
As children transition to a new school year, Olga Rosa, M.D. wants teachers, parents and neighbors to be attentive to possible signs of neglect or child abuse. Dr. Rosa practices at Palmetto Health Children’s Hospital and is director of forensic pediatrics for the University of South Carolina School of Medicine Department of Pediatrics.

According to Dr. Rosa, one in 80 children in South Carolina is a victim of child abuse or neglect. “For every story that we hear about in the news, there are more than 300 children we never hear about,” she says.

She cautions that it is important to recognize that every case of child abuse is individual and that no single warning sign proves that child abuse is present. When warning signs appear repeatedly, or in combination, it should prompt a closer look at the child, as they are an indication that something may be wrong—something that may or may not be an abuse-related condition.

The following are changes in behavior a parent or guardian may observe after abuse may have occurred. It is important to note that none of these signs prove that child abuse is occurring, only that the possibility should be considered among other possible diagnoses.

If the child is two years old or younger, you may see:
• Increased clinging
• Biting, hitting
• Temper tantrums
• Throwing things
• Becoming agitated

If the child is 2–6 years old, you may see:
• Nightmares
• Acting Out
• Becomes anxious when separating from you
• Becomes withdrawn
• Loss of appetite or overeating
• Goes backward on already acquired skills (toileting accidents in children already trained, baby talk, thumb-sucking, temper tantrums, etc.) and no physical cause is found

If the child is 6–10 years old, you may see:
• Difficulty concentrating, which will affect school performance
• Complaints of frequent headaches, stomach aches and no physical cause is found
• Sleeping difficulties such as nightmares, trouble falling or staying asleep, sleeping long hours
• Loss of appetite or overeating

If the child is 10–14 years old, you may see:
• Anger
• Mood swings
• Being very critical of themselves
• Withdrawal from family, friends and school
• Complaints of frequent headaches, stomach aches and no physical cause is found
• Loss of appetite or overeating

In the case of babies, Dr. Rosa says that if you see an injury on a baby that is too young to walk or crawl, this is a red flag that something may be wrong. “If you can’t cruise, you don’t bruise,” she says. “A child too young to walk or crawl should not have bruises.” She adds that adults should be especially attentive if there are patterns to bruises in the shape of a household item, such as a belt, a coat hanger or an electrical cord.

“If you are a neighbor and notice that a young child often is left alone or in the care of a young sibling, this may be a sign that requires further investigation. If you see that a child is often dirty, hungry or improperly dressed for the weather, this should raise concern about the welfare of this child and his home life,” says Dr. Rosa. She also says that seeing a young child alone outside late at night is cause for concern.

A teacher who suspects possible neglect or abuse should empower the child to talk about what is happening and should ask the child, “What can I do to help you?” If there are significant and persistent changes in a child’s behavior, appetite, or school performance, this should prompt a closer look.

“As responsible adults, it is our civic duty to intervene to protect children from abuse,” says Dr. Rosa. “If you are concerned that abuse may be occurring, contact the local office of the Department of Social Services or the police department.”

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About Children’s Hospital
Palmetto Health Children’s Hospital is the state’s first and only freestanding children’s hospital. Each year, Palmetto Health Children’s Hospital treats more than 80,000 sick and injured children. As a major pediatric referral center, Children’s Hospital maintains more than 30 medical subspecialties devoted strictly to children.

About Dr. Rosa
Olga Rosa, MD, FAAP practices at Palmetto Health Children’s Hospital as a child abuse subspecialist. She is assistant professor of pediatrics at the University of South Carolina School of Medicine and is director of the Division of Forensic Pediatrics. She also is director of the South Carolina Children’s Advocacy Medical Response System.

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