Physical Abuse is physical injury that results in substantial harm to the child, or the genuine threat of substantial harm from physical injury to the child. The physical injury (ranging from minor bruises to severe fractures or death) can result from punching, beating, shaking, kicking, biting, throwing, stabbing, hitting, burning, choking, or otherwise harming a child. Such injury is considered abuse regardless of whether the caretaker intended to hurt the child.

Suspect Physical Abuse When You See:

• Frequent injuries such as bruises, cuts, black eyes, or burns without adequate explanations
• Frequent complaints of pain without obvious injury
• Burns or bruises in unusual patterns that may indicate the use of an instrument or human bite; cigarette burns on any part of the body
• Lack of reaction to pain
• Extreme fear of going home or seeing parents
• Injuries that appear after a child has not been seen for several days
• Unreasonable clothing that may hide injuries to arms or legs

Neglect is failure to provide for a child’s basic needs necessary to sustain the life or health of the child, excluding failure caused primarily by financial inability unless relief services have been offered and refused.

Suspect Neglect When You See:

• Obvious malnourishment
• Consistent concern for lack of personal hygiene that poses a health risk
• Stealing or begging for food
• Child unattended for long periods
• Unaddressed need for dental care or other medical attention

Sexual Abuse includes fondling a child’s genitals, penetration, incest, rape, sodomy, indecent exposure, and exploitation through prostitution or producing pornographic materials.

Suspect Sexual Abuse When You See:

• Physical signs of sexually transmitted diseases
• Evidence of injury to the genital area
• Pregnancy in a young girl
• Difficulty in sitting or walking
• Extreme fear of being alone with adults of a certain sex
• Sexual comments, behaviors, or play beyond what is considered age-appropriate behavior
• Knowledge of sexual relations beyond what is expected for a child’s age
• Sexual victimization of other children

Emotional Abuse is mental or emotional injury that results in an observable and material impairment in a child’s growth, development, or psychological functioning. It includes extreme forms of punishment such as confining a child in a dark closet, habitual scapegoating, belittling, and rejecting treatment for a child.

Suspect Emotional Abuse When You See:

• Over-compliance or low self-esteem caused by scapegoating or verbal abuse by caregivers
• Severe depression, anxiety, or aggression
• Lagging in physical, emotional, and intellectual development
• Caregiver who belittles the child, withholds love, and seems unconcerned about the child’s problems
• Significant changes to behavior, such as withdrawal or over-aggression
• Significant changes to weight, such as substantial weight gain or weight loss.

Training on Recognizing, Reporting, and Preventing Child Abuse is provided by the Texas Health and Human Services Commission (HHSC) and the Texas Department of State Health Services (DSHS) (1.25 CE).