Child Abuse: Signs, Prevention Tips and Resources

Child abuse can have fatal consequences. In 2022, Child Protective Service (CPS) agencies in the U.S. confirmed 95,000 cases of physical abuse, with 677 of those resulting in death. In Tennessee, more than 8,000 cases of maltreatment were reported, nearly half of which involved physical abuse.

Dr. Erin Wade, board-certified child abuse pediatrician and member of the CARES team (Child Advocacy Resource and Evaluation Services) at Le Bonheur Children's Hospital shares important information surrounding child abuse and ways the community can help to recognize and prevent it.

Recognizing Signs of Abuse

Nationally, neglect is the most common form of child maltreatment. According to Dr. Wade, the second most common form of child maltreatment is physical abuse—which, unfortunately, she sees a good amount of in the hospital and clinic.

“We do see some children who have been sexually abused, but child physical abuse is the majority of what we're evaluating as the CARES team here at Le Bonheur,” she states.

When assessing potential child abuse, specific signs and patterns of injuries raise concern, particularly in infants and young children. Physicians use the mnemonic TEN-4-FACESp to help determine when an evaluation for child abuse might be needed in children younger than 4 years old.

• TEN: Bruising to the torso (chest, abdomen, sides, back, buttocks, genitalia), ears and neck can be a red flag for abuse.
• 4: Any bruising on a non-crawling, non-walking infant, typically 4 months and younger, is concerning for abuse since they lack the developmental ability to cause accidental bruises.
• FACES: Injury to the following areas can be a concern for abuse.
  • Frenulum: injury to the mouth’s connective tissues (such as the lip to the gums or the tongue to the floor of the mouth
  • Angle of the jaw: bruising near the jaw’s back corner by the ear
  • Cheek: bruising on the soft, fleshy part of the cheek (not over bone)
  • Eyelids
  • Subconjunctival hemorrhage: burst blood vessels in the white of the eyes
• P: Patterned injuries such as bruises or marks resembling objects (e.g., belts, spoons) point to inflicted harm, as these result from objects striking the child.

Dr. Wade also shares additional red flags to look out for. “If you have a young infant, excessive crying can be an indication something is going on, that this child has injuries or maybe even has something as serious as a brain injury that's causing them to be very irritable. Older children can show signs of anxiety. They can sometimes be clingy. They could have issues with sleep, where they don't want to go to sleep, or they're sleeping too much. They're having nightmares. They're bedwetting. We can see decreases in school performance, changes in eating patterns, even eating disorders.”

In some cases, the post-traumatic stress of physical abuse can cause ADHD-like symptoms, such as inattention, hyperactivity and aggression. Occasionally, PTSD is misdiagnosed as ADHD.

Steps for Taking Action if Child Abuse Is Suspected

If a child shows any signs of injury, it's important to have them evaluated by a pediatrician to determine the cause. Additionally, concerns about potential abuse should be reported to the Department of Children’s Services (DCS) or Child Protective Services (CPS). Proof of abuse is not required—reporting can be based on concerns alone. Reports can be made anonymously to protect the reporter's identity, even if they know the family. Once reported, DCS will investigate, interview the child appropriately and provide medical assistance if necessary.

As part of the CARES team, Dr. Wade shares the efforts she and others are making to raise awareness about child abuse. “We are trying to do outreach and expand our presence in the community so more people are aware of the signs of abuse and how to appropriately intervene when there is concern for abuse.”

Preventing Abuse from a Parent or Caregiver’s Perspective

When feeling overwhelmed or frustrated, especially with a crying infant or a challenging toddler, it's important to step away. Place the child in a safe spot, like a crib or playpen, and take a moment to calm down. Crying won’t harm the baby, but losing one’s temper might. For toddlers, ensure they’re in a safe environment before taking a short break, such as stepping outside to breathe.

If frustration persists, Dr. Wade urges individuals to seek support. Talk to a pediatrician for advice, consider therapy or counseling and explore resources like parenting or anger management classes. These tools can provide valuable help when managing stress and emotions.

Abuse Does Not Discriminate

Dr. Wade’s final piece of advice is to recognize that abuse happens no matter the age of the child, ethnicity, religion or socioeconomic status. “We see abuse in all populations. No one is immune to it. It's very important that we, as a community here in Memphis and surrounding areas, keep an eye out. We need to look out for our children and make sure we are the voice that these children aren't able to have for themselves. It takes a village to help keep children safe and protect them.”

To report suspected child abuse in Tennessee, call 877-237-0004 or visit https://www.tn.gov/dcs/program-areas/child-safety/reporting/child-abuse.html. Call 911 if there is a life-threatening emergency.