Ken Paxton

What We Can Do About Child Abuse

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Part One: What Is Child Abuse?

  1. Recognizing Physical Abuse
  2. Emotional Injury of a Child
  3. The Sexually Abused Child
  4. What Is Neglect?
  5. Who Are the Child Abusers?

Part One: What Is Child Abuse?

Texas law provides a definition of child abuse. In addition, the law provides criminal sanctions for assaults, sexual assaults, and other acts that may be committed against children. The definition of child abuse, which is part of the Texas Family Code, is the basis for civil actions to protect a child from an abuser (such as removal of a child from the home). The Penal Code provides the basis for the criminal prosecution of a person who assaults or otherwise commits a crime against a child. The definition of child abuse and some relevant sections of the Penal Code can be found in the appendix to this handbook.

According to Chapter 261 of the Family Code (recodified in 1995), child abuse is an act or omission that endangers or impairs a child’s physical, mental or emotional health and development. Child abuse may take the form of physical or emotional injury, sexual abuse, sexual exploitation, physical neglect, medical neglect, or inadequate supervision.

The law specifically excludes “reasonable” discipline by the child’s parent, guardian, or conservator; corporal punishment is not in itself abusive under the law. An act or omission is abusive only if “observable and material impairment” occurs as a result, or if it causes “substantial harm,” or exposes the child to risk of substantial harm.

Neglect, like physical and emotional abuse, hinges on substantial harm or observable and material impairment. The law excludes from its definition of neglect any failure to provide for the child that is due to lack of financial resources. A child living in poverty is not a victim of neglect under the Texas Family Code except in cases where relief has been offered and refused by the child’s parent, guardian, or conservator.

Accidental injury or harm is also excluded from the definition of abuse. However, a person commits abuse if s/he places a child, or allows a child to be placed, in a situation where the child is exposed to “substantial risk” of injury or harm. The law also clearly states that a person commits abuse if s/he fails to make a reasonable effort to prevent another person from abusing a child. This provision applies to all forms of abuse, including physical and emotional abuse, sexual abuse, and neglect.

A. Recognizing Physical Abuse

Physical abuse typically occurs when a frustrated parent or caregiver strikes, shakes, or throws a child because of anger. Other forms of deliberate assault that may be physically abusive include burning, scalding,biting, kicking, cutting, poking, twisting a child’s limbs, deliberately withholding food, binding, gagging, choking, or hitting the child with a closed fist or other instrument. Any form of corporal punishment may be abusive if it results in injury.

The indicators described below may be helpful in identifying possible child abuse victims. However, suspicious-looking injuries can occur accidentally, as the result of an unusual medical condition or birthmark, or even sometimes as the result of a non-abusive folk remedy for a medical condition. The investigation of child abuse should be performed by specially trained professionals. The indicators below can be used advisedly by persons who have frequent contact with children to identify possible victims.

Later sections of this handbook will describe a person’s legal responsibility to report suspected abuse and will suggest appropriate ways that the non-investigating non-specialist might be able to help a child who may be abused.

Physical injuries resulting from child abuse can run the gamut from bruises, burns, and lacerations, to head injuries, broken bones, broken teeth, and damage to internal organs. Symptoms may include pain, swelling, internal or external bleeding, impaired mobility, delayed development, malnutrition, convulsions, coma, or even death. Any of these injuries or symptoms can occur because of accidents or medical conditions. Context, circumstances, and the exact nature of the wounds usually set apart the injuries resulting from abuse. Specially trained professionals must make the determination whether a child has actually been abused or not.

No reasonable explanation for the injury

In some cases, the injured child or an adult will attribute the injury to abuse. More often, the explanation for the injury is insufficient, incongruous, or altogether lacking. The child may try to hide the injuries by wearing unseasonable clothes. Injuries may appear on a child who has been unexpectedly absent from school or day care for several days. The child's parents may seem unconcerned about an injury and their stories may be inconsistent with the injuries or contradictory. Any of these circumstances indicate possible abuse.

Unusual injuries for the child ’s age

Injuries that are easily explained by typical childhood activities are probably accidental. Children tend to bruise and scrape their knees and elbows, for example. Fractures found in children under the age of about four are more likely to be the result of abuse, whereas fractures found in school-age children are more likely to have occurred accidentally. Any fracture found in an infant of twelve months or younger is suspect. It is also unnatural for an infant to have multiple bruises on various parts of the body. And young children do not ordinarily suffer internal injuries, broken bones, or head injuries from falling off furniture.

Location of wounds

Inflicted injuries are likely to occur on the back surface of a child’s body, from the neck to the knees, or on the face. If a child’s injuries have been inflicted from many directions, the pattern is not so likely to be the result of an accidental fall or collision. Wounds resulting from abuse may also take a “defensive” pattern: if the child holds up his or her arms or hands as a shield, the blows will fall on the backs of the arms or on the backs of the hands.

Multiple or frequent injuries

Multiple injuries of different ages may be indicators of abuse, depending also on the nature of the injury. When a child has a broken bone, x-rays might reveal other fractures that have healed. The age of a bruise is roughly indicated by its color. The injury is initially red, turning blue after six hours or so, then black or purple after 12-24 hours; within a few days the bruise turns greenish, fading to yellow or brown in about a week.

Bruises that form an unusual pattern

The outline of a hand may be visible on a child’s face as the result of a hard slap. The marks of fingerpads may appear opposite the single bruise from a thumb if the child has been tightly gripped by the shoulder; choking may produce a similar pattern on the neck. Pinching may cause two crescent-shaped bruises, and fingernail marks may be visible. If the child is struck with an object, bruising may assume an identifiable shape.

Distinctive marks and lacerations

An adult human’s bite mark can often be identified by its size, together with its distinctive shape. Welts in various linear patterns result from whipping with a strap, ruler, or belt; belt buckles may cause unusual repeated patterns of laceration. Where has occurred, frequent and excessive punishment may be suspected. Marks circling the wrists may indicate that a child has been tied up, and marks on the sides of the mouth may result from the use of a gag.

Unusual burns on a child

Cigarette burns are generally circular, and although they may appear on any part of the body, most often they are found on the palms, soles of the feet, or buttocks. Other suspicious burns may show the outline of the hot object used: an iron, for example, or the coils of an electric burner. A child instinctively withdraws immediately from something hot, and a clear imprint suggests “branding,” or forceful application.

Unusual patterns of scalding

By the same token, a child who accidentally sits in too-hot water will naturally struggle and splash, possibly burning the hands as well as the buttocks and legs. The scalding that results will be irregular. A child who is forcibly immersed in hot water will more likely show clear markings on the reddened skin, such as “gloves” or “socks” on immersed hands or feet or an immersion line around the waist. White creases (“zebra” marks) may be visible where the skin folds. White circles may form on red buttocks (“doughnut” marks) where the child’s weight presses the skin against the floor of the bath tub.

Suspicious-looking marks not caused by abuse

Suspicious-looking marks can be caused by medical conditions not related to abuser. “Mongolian spots,” for example, are fairly common and look very much like bruises. Non-abusive but suspicious-looking burn marks can be caused by hot seat belt buckles, car seats, or skin disorders. Some children do bruise easily, so the location of the bruises and the explanations for them should be taken into account.

Accidental wounds from falls and collisions are most likely to appear on bony prominences of the body: in addition to knees and elbows, these include shins, chin, and forehead. Trained investigators and medical professionals can usually determine whether a mark or injury has been inflicted.

Head injuries

Head injuries are involved in most abuse-related deaths of small children. A serious head injury may not be externally visible. Head injuries may occur in all degrees of severity, with symptoms ranging from dizziness, vomiting, lethargy, and confusion to coma and death. It may be difficult to determine the cause of a head injury in a small child; however, children who are too young to stand or walk are unlikely to inflict such injuries on themselves by accident. For the professionals who investigate cases such as these, inconsistencies and improbabilities in the parents’ accounts of the injury are particularly important.

Unexplained death of a child

Any unexplained death of a child must be investigated from the start as a homicide. Investigators must observe the scene and interview all persons with access to the child at the time of death to determine whether smothering or any other form of abuse or neglect may have occurred. It is good investigatory practice to order an autopsy in any unexplained death of a child. An autopsy cannot always determine the cause of death, however. Investigators may have to rely upon crime-scene observations and the full case history to determine whether a child has been killed by abuse or neglect or has died of a non-abuse-related medical condition such as Sudden Infant Death Syndrome (SIDS). Investigators should proceed, bearing in mind the very painful position of a non-abusive parent whose child has died of SIDS.

Shaken Baby Syndrome

When a child is held by the shoulders or chest and shaken violently, often no external injury is visible. However, the impact of the brain on the inside of the skull may prove damaging or even fatal, especially if the child is less than two years old or is shaken repeatedly. Symptoms of injury include vomiting and seizures. An infant who is violently shaken may suffer convulsions, permanent brain damage, and death. A young child who survives a severe shaking episode may be blind, deaf, or otherwise disabled as a result. Even less violent shaking of older children may cause neurological deficits, as well as learning and behavioral disorders.

Behavioral indicators of physical abuse

In cases where there is little definite physical evidence of physical abuse, behavioral indicators may help tell the story. The child may frequently complain of pain without obvious injury or, alternatively, show an abnormal lack of reaction to pain. The child may display aggressive, disruptive, and destructive behavior; or at the other extreme, s/he may seem markedly passive, withdrawn, and emotionless. These vague and somewhat contradictory indicators may or may not be significant; however, when a child exhibits these characteristics to a noticeable degree, abuse is a possibility. People who come into contact with the child should be alert for other, more direct indicators, such as fear of going home or seeing parents, frequent absences from school or physical education class, and, of course, all the physical indicators described above.

B. Emotional Injury of a Child

The law recognizes the existence of both physical and emotional injury. Physical abuse is almost invariably accompanied by emotional injury to some degree; it is difficult to imagine that a child could suffer “substantial harm” as the result of a deliberate assault by a caregiver and not also be psychologically harmed. Moreover, angry parents who physically assault their children are likely to assault them verbally, too.

Although many physically abused children suffer emotional injury, actual emotional abuse as defined law has occurred only if the child’s “growth, development, or psychological functioning” shows “observable and material impairment.” Emotional injury is more subtle than physical injury, and the fact of emotional abuse is not as readily established. Emotional abuse, when it is not accompanied by some other form of abuse, is not often the basis for an investigation or legal action. Yet it can be devastating. It is psychological and emotional injury that link child abuse to some of its costliest long-term effects: substance abuse, crime, suicide, and the perpetuation of violence within families.

Forms of verbal assault

Emotional injury is inflicted on children by verbal assaults that may take the form of belittling, name-calling, screaming, threatening, blaming, and sarcasm. Other damaging verbal habits are referring to a child only as “it” or repeatedly telling the child that s/he is “worthless” or “bad.” The mere fact that a caregiver verbally assaults a child (e.g., calls the child names, screams at the child) on a particular occasion is not sufficient to establish emotional abuse; the assaults must be frequent, excessive and, above all, clearly and substantially damaging to the child. Because the effects of verbal assaults are subtle and their exact cause is difficult to pinpoint, substantiating emotional abuse as part of a case requires detailed observation and testimony about the abuser ’s words and actions toward the child over a period of time.

Unpredictable responses, unreasonable demands

A child may suffer emotional harm when subjected to extremely unpredictable or inconsistent responses from caregivers. Unreasonable expectations and demands can also be harmful. A child may suffer from being continually surrounded by negative moods and family discord. In some situations a child may be forced to make painful choices, perhaps between quarreling family members. Divorcing parents sometimes use their children as pawns in their own marital conflicts, and this can be damaging to the children. A child may suffer serious psychological harm from being rejected, terrorized, ignored, or isolated emotionally.

Signs of emotional injury

Signs of emotional injury include many general symptoms that could result from causes other than emotional abuse. They include withdrawal, depression or apathy; behavior problems or “acting out;” or a child who is overly rigid in conforming to instructions from teachers, doctors, and other adults. A child’s behavior problems may be a fulfillment of the negative labels the abuser has applied to the child: a child is “no good” or “a slut” because that is what s/he has always been told about him/herself. An emotionally abused child may refuse verbal or physical communication with others, or express feelings of being bad or worthless. Symptoms such as these can be produced by emotional abuse, but because they may arise from other causes, they must always be considered in context.

Emotional deprivation

Emotional deprivation occurs when a child’s parent or guardian withholds or withdraws affection and approval. The child may receive no attention at all, or may receive attention only when s/he does something “bad” (and then the attention is negative). In either case, the child feels unloved and unworthy. Emotional deprivation may occur when a child’s caregiver abuses alcohol or other substances.

However, it cannot be presumed that a child is abused just on the grounds that his or her parent(s)have alcohol or substance abuse problems; it must also be clear that the child is suffering substantial harm.

Indicators of emotional deprivation

A child suffering from emotional deprivation may refuse to eat adequate amounts of food and fail to thrive.

S/he may be unable to perform normal learned functions for a given age (e.g., walking, talking). A child who receives only negative attention may become passive and withdrawn in order to avoid abuse, or s/he may deliberately misbehave, preferring negative attention to being completely ignored. As a result, s/he may be observed to be abnormally unresponsive, sad or withdrawn, or antisocial and obviously delinquent. Another sign of emotional deprivation is constant seeking of attention and affection from other adults such as teachers and neighbors. An emotionally deprived child may also display exaggerated fears and clinging behavior. Like other indicators of emotional abuse, the symptoms of emotional deprivation must always be taken in context.

C. The Sexually Abused Child

Sexual abuse is defined in the Family Code as any sexual conduct harmful to a child's mental, emotional, or physical welfare as well as failure to make a reasonable effort to prevent sexual conduct with a child. A person who compels or encourages a child to engage in sexual conduct commits abuse, and it is against the law to make or possess child pornography or to display such material to a child.

Sexual abuse may consist of a single incident or many acts over a long period of time. Boys and girls of any age can be victims of sexual abuse. The molester can be just about anyone, but most often, it is someone known to the child. The abuse may escalate over time, particularly if the abuser is a member of the child's own family. The child's non-abusing caregiver(s) may be unaware of the abuse or may be in a state of denial.

Child sexual abuse includes fondling, lewd or lascivious exposure or behavior, intercourse, sodomy, oral copulation, penetration of a genital or anal opening by a foreign object, child pornography, child prostitution, and any other "sexual conduct harmful to a child's mental, emotional, or physical welfare." These acts may be forced upon the child or the child may be coaxed, seduced, and persuaded to cooperate. The absence of force or coercion does not diminish the abusive nature of the conduct, but, sadly, it may cause the child to feel responsible for what has occurred.

It is extremely difficult for a child to report sexual abuse. A very young child may not understand that what has happened is not normal or accepted. More importantly, the abuser almost always discourages the child from telling anyone about the abuse. The strategies for silencing a sexual abuse victim are as ruthless as they are varied. The abuser may be someone whom the child depends upon and trusts; s/he may use the child's dependency and affection to extort a promise of secrecy. A more brutal perpetrator may threaten to harm and even kill the child or other family members or pets. Or the abuser may tell the child that the family will be broken up, the child blamed, or the child taken away from home if the secret becomes known. These are not altogether unrealistic fears for the child, unfortunately.

For many people, an allegation or disclosure of sexual abuse is indeed hard to accept. This is particularly true when the perpetrator is a family member or an otherwise law-abiding, respectable, and seemingly "nice," "normal" person. Many adults have a tendency to overlook, discount, minimize, explain away, or simply disbelieve allegations of sexual abuse. Yet children rarely lie or invent stories on their own about being sexually abused. The fact that children can sometimes be manipulated or coached should not dissuade anyone from reporting a child's revelation of sexual abuse. All responsible adults, but particularly those who work with children, should be aware that sexual abuse occurs and should be alert for the opportunity to aid a child who attempts to disclose abuse. The child's need for support and protection must come first.

Recognizing disclosure of sexual abuse

Physical and psychological effects of sexual abuse are sometimes observable, but often they are not.

Physical signs may be altogether lacking and psychological symptoms may be too vague to suggest their actual cause. Very often, the only way sexual abuse is revealed is by the child's own reporting. This may be offered so obliquely and tentatively that it is simply overlooked. Adults who frequently talk to children should be alert and aware that these disclosures are often indirect ("I have a friend who.." or "What if...?"). It is also important to recognize that disclosure tends to be a process rather than an event; a child who offers a tentative hint on one occasion may need a series of conversations over time to develop the trust and confidence s/he needs to fully reveal what has happened. A full disclosure that occurs over an extended period of time should be handled by a trained professional for a number of reasons: to best attend to the child's psychological and emotional needs, to avoid tainting the child's testimony, and to adequately document the case for possible legal action.

Sexual assault by a stranger versus a family member

Sexual assault of a child is a violation of the Penal Code, regardless of whether the perpetrator is a stranger or family member. Assault by a stranger and assault by a family member may involve similar criminal charges. In addition, an assault by a family member, especially one who lives in the household with the child, may be the basis for a civil action such as removal of the child from the home. In fact, assaults by strangers are much less common than assaults by persons known to the child. Perhaps the most common scenario for child sexual assault involves the male partner of a young girl's mother (the girl is assaulted by her father, stepfather, or her mother's boyfriend).

Physical indicators of sexual abuse

Sexual abuse may result in physical injury (though most often it does not). A child who is physically injured as a result of sexual abuse may display difficulty in sitting or walking, report pain when urinating or defecating, or complain of stomachaches. S/he may report pain or itching in the genital area or a discharge. Injuries to a child's genitalia may or may not leave lasting marks; other physical evidence, such as semen, is certainly ephemeral. A child, therefore, needs to be examined as soon as possible if there is reason to suspect sexual abuse. The physical examination of a possible victim of child sexual abuse should be performed only by a qualified medical professional who is specifically trained to examine children who have been sexually assaulted. Other persons should not attempt any kind of physical examination; they should immediately report the abuse, using procedures outlined later in this handbook.

Sexually transmitted disease and pregnancy

Other physical indicators of sexual abuse include symptoms of sexually transmitted disease (STD) as well as pregnancy. STD and pregnancy are by themselves indicators that a child is sexually active; they do not by themselves establish abuse or assault. In a preteen child, abuse is strongly indicated by STD (except that infants may contract some STDs from their mothers at birth). In a teenager, further information is needed about the circumstances and the child's sexual partner, who might have been another minor about the same age, an older minor, or an adult. The sexual contact may have been assaultive or may otherwise qualify as "sexual conduct harmful to a child." Reasonable suspicions of this nature must be reported and may be investigated, depending on circumstances.

Specific behavioral indicators of sexual abuse

Children who have been sexually abused may be identified by their frequent expressions (verbal references, pictures, pretend games) of sexual activity between adults and children or by knowledge about sexual relations beyond what is probable for their age. They may masturbate inappropriately or compulsively. Their behavior may be sexually suggestive, inappropriate, or promiscuous; or, conversely, they may show infantile behavior or extreme fear of being alone with adults of a particular sex. A very strong indication that a child has been abused is that child's sexual victimization of other children.

Symptoms of emotional injury

More generalized psychological impacts of sexual abuse include withdrawal, depression, sleeping and eating disorders, self-mutilation, phobias, and psychosomatic symptoms such as stomachaches and headaches. The child may develop school problems such as frequent absence or a sudden drop in grades. The child may exhibit either poor hygiene or excessive bathing. Older children may abuse alcohol or drugs, run away, or adopt other self-destructive behaviors including suicide threats or attempts. Any or all of these behaviors can arise from causes other than sexual abuse; however, in context, any one of them could be taken as a warning that some form of harmful sexual conduct has occurred or is still occurring.

D. What is Neglect?

A child's parent, guardian, or conservator is responsible for either directly providing safe and adequate food, clothing, shelter, protection, medical care, and supervision for the child, or arranging to have someone else provide these needs. Neglect, as defined by the Family Code, Chapter 261 on child abuse and neglect, is the failure to meet this responsibility. Neglect, like other forms of abuse, must involve "observable and material impairment" or "substantial risk" to the child, in order for the civil statute to apply. In addition, the Penal Code provides criminal sanctions against anyone who knowingly abandons or endangers a child.

Failing to arrange for the care of a child

The caregiver must arrange for necessary care and supervision during any period of time when the caregiver is absent and does not intend to return. Neglect includes placing the child in or failing to remove a child from a situation where the child is exposed to "substantial risk" of harm. Neglect also includes placing a child in or failing to remove a child from a situation requiring judgment beyond the child's years or capabilities. Here again, to qualify as neglect, the acts or omissions must result in harm or substantial risk of harm to the child.

How long can a child be left unattended?

The law provides few guidelines as to how long a child may be left unattended. The law does specify that a caregiver cannot leave a child under age five unattended in a car for more than five minutes, unless a person aged 14 or older is watching over the child. However, there is no set length of time a "latchkey" child of school age may be left unattended. The child's maturity, the proximity of helpful adults, and a number of other circumstances must be taken into account. As always, the ultimate guideline for determining whether a child is being left unattended too long is whether the child suffers actual harm, or is at substantial risk of being harmed, due to lack of supervision.

Failing to provide a child with food, clothing, or shelter

Failure to provide the child with food, clothing, or shelter necessary to sustain the life or health of the child may be considered neglect as long as the failure is not primarily caused by financial need.

Caregivers who are impoverished are not neglectful unless the child is harmed or substantially at risk of harm and relief services have been offered and refused. Lack of heating or plumbing in the home does not mean that the children in the home are neglected. On the other hand, failure to prepare meals, spoiled food in the refrigerator or cupboards, and severe infestations of insects and rodents are possible indicators of neglect. However, the totality of circumstances must be taken into account. Neglect generally involves conditions that are extreme, persistent, and substantially damaging to the child.

Failing to seek, obtain, or follow through with medical care

A parent, guardian, or conservator who fails to seek, obtain, or follow through with medical care for a child may be guilty of neglect. The need for medical care must entail a substantial risk of death, disfigurement, injury, or impairment. Caregivers who refuse medical care for religious reasons are not considered to be neglectful, but may still need to be reported. In extreme cases the court may order treatment for the child over the parents' wishes. Caregivers who cannot afford medical treatment are also not considered to be neglectful unless they have been informed of and have refused free or affordable treatment. Some parents who commit physical and sexual abuse are guilty of medical neglect because of their wish to keep the abuse secret.

Failure to permit the child to return home

The law requires the person responsible for a child to permit the child to return home, or else to arrange for the necessary care for the child, after the child has been absent from the home. The fact that the child has run away or been in residential placement does not in any way diminish the responsibility of the parent, guardian, or conservator to care for the child, either by taking the child back into the home or by making other arrangements.

Indicators of neglect

Physical signs of neglect include obvious malnourishment, lack of personal cleanliness, torn and/or dirty clothes, insufficient clothing for warmth and protection, or need for glasses, dental care, or other medical attention. Behavioral indicators of neglect include stealing, hoarding, or begging for food and frequent absence or tardiness at school. A child that is always hungry, tired, and listless may be neglected. For the situation to indicate neglect under the law, the child's condition must not result solely from the caregiver's lack of financial resources (unless aid has been offered and refused), and the child's condition must be severe, chronic, and threatening to the child's health. The child may say that no one cares for him or her, or may describe being alone, caring for younger children, or doing dangerous things (a very young child bathing an infant, for example, or being allowed or instructed to use power tools).

E. Who are the Child Abusers?

Child abuse can occur in any social, cultural, or economic class. Women are somewhat more likely to be the abuser than men; women are more likely to be caregivers. Most often when a child is injured, the perpetrator is someone known to the child. Most often it is the child's parent, guardian, or conservator; some other household or family member; or another person with regular access to the child. This is true of both physical and sexual abuse; strangers account for only about one in five harmful acts toward children.

Abusive parents may have been abused themselves as children. They may have very limited parenting skills, believing strongly in and relying almost solely upon corporal punishment for discipline. These are likely to be parents who experience great frustration in their efforts to make their children behave as they wish. Parents with a tendency to abuse their children are even more likely to do so under the stress that accompanies divorce, unemployment, or other family crises.

A special child

In some families, one child will be singled out for abuse. The parents may describe the child as being bad or a liar, or even "evil," a "witch," or a "monster." This child often has a special disadvantage such as attention deficit disorder, hyperactivity, deformity, or handicap; the child may have been unplanned or unwanted; or the child may simply be considered disappointing by the parent or caregiver for some reason. Other children in the family may escape mistreatment. If the targeted child is removed from the family, another child may be selected for abuse instead.

Parents who hide a child's injuries

Parents who abuse their children may show little concern for their children's injuries, and will often go to great lengths to protect themselves (or their abusive spouses) from blame. Abusive families may become isolated to prevent the chance of anyone's observing the abuse. They may move frequently, disappearing whenever anyone shows concern or suspicion. The child's injuries may go untreated as long as possible, and when medical attention is unavoidable, the abusive parent usually will avoid going to a doctor who has attended the child for injuries in the past. The parent's account of how the child was injured is likely to be inconsistent or improbable. Depending on the child's injuries, abuse may be suspected when a parent takes a child to a hospital that is unnecessarily far from home, bypassing closer, equally well-equipped medical facilities.

Child molesters

The child molester is sexually attracted to children (usually children of a certain age) and assaults them to obtain sexual gratification. While anyone of any age, race, or gender can be a child molester, this person is typically an adult heterosexual male. Most often, molestation is not a "stranger" assault, and may not involve force. Many child molesters relate quite well to children and seek out professions, jobs, or volunteer positions that give them access to children. They often make or collect child pornography.

Their methods of seduction may include bribes and the use of pornography depicting sex between adults and children the age of the intended victim. The relationship with the child may develop over a period of weeks or months, becoming increasingly coercive and invasive. Child molesters repeatedly offend and may molest or attempt to molest literally hundreds of children before being caught. The victims, while frequently befriended by the child molester, are generally not related by blood or marriage.

Spouse abusers, violent families

In many families where spousal abuse occurs, the children are also abused. In most such families, it is the male partner who is violent toward other family members. In 2003, according to the Texas Department of Safety, 78 percent of all family violence offenders were male. Even if they are not abused, the children in these families are harmed by witnessing the violent assaults on their mothers. In addition, they may be injured during an incident of parental violence or traumatized by fear. They may blame themselves for not preventing the violence, or think that they have caused it. They may be neglected.

Studies have shown that adjustment difficulties evident in children who witness spousal violence are similar to problems found in children who are abused. Any intervention involving spousal violence should include attention to the needs of any children in the family. Legislation passed in 1995 requires TDFPS to direct its employees to document indications of domestic violence and to make available information about community services for adult victims of domestic violence. New laws also provide that when a child has a protective parent remaining in the home, the child should not be removed from the home; rather, TDFPS should seek a protective order against the abuser.

Abused children who become abusers

Some abusers are themselves children. Children can become aggressive toward other children for a number of reasons. They may be copying adults who are role models for them (parents, for example). Or they simply may not have learned how to play with smaller children. When an older child victimizes younger children or animals, the older child has frequently been abused, too. If the children are anywhere near the same age and size, the incident, however one-sided, is unlikely to qualify as abuse or assault, but this depends on the context. If the aggression is severe or sexual in nature, it may be regarded as abusive and/or assaultive. It may, in fact, be a turning point for the older child; that child may be at the point of discovering that he prefers to play the role of the more powerful aggressor in a scene that is all too familiar to him.

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