• Have all caregivers been trained how to prevent child abuse, how to recognize signs of child abuse and how to report suspected abuse?



• Do caregivers get regular breaks during the day, so that their own stress is manageable?



• Has the program developed prevention measures to help reduce the likelihood of abuse and neglect?



• Have all caregivers (including substitutes) had a background check? (See Background Checks section for detailed information)


Note: Child care programs with good child to adult ratios (fewer children per adult caregiver) are less likely to have situations that lead up to abuse or neglect.

• Definitions of abuse and neglect (including emotional, physical and sexual abuse):

• Child abuse - For the purposes of this document, its definition is considered to be that contained in the laws of the state in which the child care program is located or the abuse occurs. While these state definitions differ somewhat, most of them contain basic elements as follows:



• Emotional abuse - Acts that damage a child in psychological ways, but do not fall into other categories of abuse. Most states require for prosecution that psychological damage be very definite and clearly diagnosed by a psychologist or psychiatrist.



• Neglect - Neglect is divided into two categories: general neglect and severe neglect. General neglect is the failure to provide the common necessities, including food, shelter, a safe environment, education, and health care, but without resultant or likely harm to the child. Severe neglect is neglect that results or is likely to result in harm to the child.



• Physical abuse - An intentional (non-accidental) act affecting a child that produces tangible physical harm.



• Shaken baby syndrome - is the collection of signs and symptoms resulting from the violent shaking of an infant or small child.



• Sexual abuse - Any sexual act performed with a child by an adult or by another child who exerts control over the victim. Many state laws provide considerable detail about the specific acts that make up sexual abuse.


• Preventing Child Abuse and Neglect in Child Care Settings

• Access to Children, Facility and Facility Layout


• Does the program have a system to identify those persons that you authorize to pick up your child?



• Does the program have a check-in system to allow authorized persons to enter the facility?



• Does the program have a procedure on how they would handle an individual who attempts to pick up your child but does not have authorization?



• Are authorized parents/guardians able to visit the program at any time?



• Are all outside doors kept locked except for a secure entry door to prevent access from intruders?



Example: Back doors are kept locked from the outside, visitors can only enter from one entrance always visible by a program staff.

Note: Caregivers and children must be able to exit from the inside in case of fire or other emergency.


• If emergency exits lead to potentially unsafe areas for children (such as busy streets), are alarms or other signaling devices installed on these doors to alert staff in case a child attempts to leave?



• Is the physical layout (of centers) arranged so that all areas can be viewed by at least one other adult in addition to the caregiver at all times?



• Positive discipline
• Do you observe caregivers using the following discipline techniques and classroom procedures to help prevent the possibility of abuse and neglect?



• Positive guidance -


Example: "Just Walk..Thank You!" instead of "Don't Run!"


• Redirection -


Example: The caregiver distracts children who are fighting over one toy, by suggesting additional toys or materials that create an opportunity for each child to have a cooperative role. "What if Angelo were to fill the dump truck with sand and Kira were to drive it? Angelo could wait for the load at the construction site, and then you could build a new school together."


• Classroom rules, expectations and activities that are realistic for the age of the children -


Example: Long waits between activities may disrupt the group and cause the caregiver to resort to yelling. Examine cause and effect, and you'll notice that the problem of misbehaving children may be triggered in part by lack of planning on the part of adults.


• Limits, consequences and choices that children understand, and that promote self-discipline -


Example: "If you're not sleepy, you may read a book or listen to a story with headphones on your cot, but you may not get up and run around while other children are sleeping."


• Limits and consequences that are consistent and applied equally to all children -


Example of what not to see: An active child is often monitored closely, and punished frequently, while the quiet child can "get away with" the very same behavior without consequence.


• Desired behavior modeled by caregivers -


Example: Caregivers show patience, honesty, courtesy, generosity, turn taking, thoughtfulness and other good qualities with both adults and children.


• Minimal use of negative consequences -


Example: For children 3 years of age or over, programs may use "time out" only to help the child to regain control of himself or herself. The time out area must allow the caregiver to hear and see the child who is taking a short break from the group.


Note:

• Physical punishment should NEVER be allowed - Shaking, spanking, pinching and other physical contact that causes discomfort is never acceptable.



• Abusive language should NEVER be allowed - Words that frighten or belittle a child are emotionally damaging and should never be tolerated.



• Grabbing and yelling is ONLY appropriate to prevent harm -


Example: If a child is about to throw a heavy toy at another child a caregiver could shout, "Stop! Put that down!"

See also Discipline Section



• Stress Relief and Support for Caregivers


• Healthy environments for children begin with the caregivers' own physical and mental health.



• Parents should inquire about the health of their child's caregiver. Also, Center directors and family caregivers are responsible for making sure that staff members (or they themselves) are healthy and supported. Here are some key questions:



• Are procedures set up for a caregiver to "take a break" when needed?



• Is ongoing training offered and taken on topics such as: positive discipline, interpersonal relationships between adults, creating calming spaces in the classroom, helping struggling families connect to resources, healthy lifestyles for the caregiver?



• Are caregivers paid for time they spend taking evening and weekend classes?



• Do the caregivers seem to be happy and enjoying their work, like their fellow caregivers (in a center) and their surroundings?



• Do caregivers who are caring for a child with extra challenges have convenient access to support groups, mentors, on-site consultants, therapists and other resources like respite care?


• Background Checks - See Background Checks section for detailed information.



• Recognizing abuse or neglect

• Are caregivers regularly trained on recognizing the following signs and symptoms of abuse and neglect? Also parents need to be familiar with the following signs:



Type of Abuse	Physical Signs	Behavioral Signals
Physical Abuse	Bruises or welts in various stages of healing or other visible injuries that appear on a child recurrently and cannot be explained by developmentally expected behavior.	Explanation for a physical injury that is inconsistent with the injury, or the child's developmental age.
	Unexplained or multiple broken bones, especially a broken rib, severe skull fracture or other major head injury.	Persistent or repetitive physical and health complaints of unclear cause.
		The parent/caregiver reports that a significant injury was self-inflicted or the child reports being injured by a parent or other caregiver.
	Burns or injuries in the shape of an object used to cause the injury such as bite marks, hand prints, cigar or cigarette burns, belt buckle markings. Burns from immersion in scalding water or other hot liquids.	The parent/caregivers have delayed seeking appropriate medical care.
	Unexplained or repetitive dental injuries.
	Failure to grow at the expected rate in a child who seems hungry and eager to eat when offered food.
Sexual Abuse	Pain, bruises or bleeding around the genitalia. Stained or bloody underclothing.	Bizarre, too sophisticated, or unusual sexual knowledge or behavior for the child's age such as asking others to do sex acts, putting mouth on sex parts, trying to have intercourse.
	Difficulty walking or sitting.	Child reports sexual abuse by a parent, older child or adult.
	Unusual or unexplained discharge from the vagina or urine openings.
Emotional Abuse	Delayed physical, emotional or intellectual development that is not otherwise explicable.	Impaired sense of self-worth, depression, withdrawal.
	Habits such as rocking, sucking on fingers in excess of expectation for developmental stage.	Extremes of behavior, such as overly aggressive or passive, apathetic, empty facial appearance, decreased social interaction with others, phobias, generalized fearfulness, fear of parent.
Neglect	Constant hunger, begging for food or hoarding food. Fatigue or listlessness. Poor hygiene such as dirty hair, skin and clothes. Inappropriate dress.	Lack of supervision for long periods of time, inappropriate to the child's age or developmental stage.
	Malnutrition or failure to thrive not explained by physical illness.
	Delayed seeking of professional attention for physical or dental problems.
	Impairment of parent or caregiver due to substance abuse, physical or mental illness.
Any Type of Abuse	Substance abuse. Unexplained absences from the child care program.	Over and under compliance of the child. Lack of selectivity in friendly approach to adults. Developmental regression, such as a previously toilet-trained child reverting to incontinence. Sleep and appetite disturbances. Depression. Self-destructive behavior. Excessive/inappropriate fears.


Source: Adapted from Caring for Our Children, 2nd Ed. - Appendix K


• Signs and symptoms of Shaken Baby Syndrome

Moderate Brain Injury:

• Tired, sleepy / decreased muscle tone


• Extreme irritability


• Decreased appetite, poor feeding or vomiting for no apparent reason


• Grab-type bruises on arms or chest


• No smiling or limited talking


• Poor sucking or swallowing


• Rigidity or posturing



Extensive Brain Injury:

• Difficulty breathing


• Seizures


• Head or forehead appears larger than usual or soft-spot on head appears to be bulging


• Inability to suck or swallow


• Inability to lift head


• Inability of eyes to focus or track movement or unequal size of pupils

Source: National Center on Shaken Baby Syndrome http://www.dontshake.org/sbs.php?topNavID=3&subNavID=22


• Reporting Abuse or Neglect

If you suspect child abuse or neglect is occurring in your child's child care program, please call your state Child Abuse Hotline. To find out your state's hotline number, go to:

Child Abuse Reporting Telephone Numbers by State
http://www.childwelfare.gov/pubs/reslist/rl_dsp.cfm?rs_id=5&rate_chno=11-11172

See also Complaints Section for tips on communicating concerns with your caregiver.


• Do caregivers know how to report suspected child abuse and neglect to appropriate state agencies?



NOTE: Child care providers (caregivers) are "mandated reporters" of child abuse - that is, they are required by law to report suspected cases of physical, sexual and emotional abuse, and neglect.
For individual state specifics, see the following documents compiled by the Child Welfare Information Gateway:



• Child Abuse Reporting Telephone Numbers by State

http://www.childwelfare.gov/pubs/reslist/rl_dsp.cfm?rs_id=5&rate_chno=11-11172


• Mandatory Reporters of Child Abuse and Neglect: Summary of State Laws (2005) (note: this may take some time to load if you don't have broadband Internet service)

http://www.childwelfare.gov/systemwide/laws_policies/statutes/mandaall.pdf


• Do child care centers have a policy that caregivers who report suspected abuse and/or neglect are protected?



• If they have acted in good faith, they should not be disciplined - suspended, laid off, fired or put on probation.



• Caregivers should receive training (before they begin work) on what to look for, how to document and how to report suspected abuse or neglect.


• Family caregivers should cover abuse and neglect in their contracts or policy guides, and share this with parents during pre-enrollment orientations.

How to help your caregiver with this topic

• NEVER give permission to a caregiver (nor ask a caregiver) to use corporal punishment (spanking, etc.) with your child.



• If your child with brown skin has a common bluish-gray birthmark called "Mongolian Spots", let your caregiver know about it. Sometimes these birthmarks are mistaken for child abuse. To view a mongolian spot , click here - http://www.fwcc.org/mongolianspot.htm.



• Drop off and pick up your child at the times you negotiated. Budget enough commuting time, so that you can get "stuck in traffic" and still be on time. Always call if you are delayed.



• Make sure your caregiver has an up-to-date list of people that are authorized to pick up your child and that the caregiver has your current phone numbers (work, home, cell) in case an unauthorized person shows up.



• NEVER pick up your child while you are under the influence of alcohol or drugs; this places you, your child, and your caregiver in a "no win" situation that could have devastating consequences.



• Child care is a highly stressful job. Treat your caregiver like you would like to be treated in a time of great stress. Encouragement, kindness, consideration, and thoughtfulness go a long way.



• Questions and concerns related to your child's care and development should be discussed openly and regularly - before small irritations become big issues!



• Watch for signs of stress in your caregiver: irritability, negativity, frequent illness. Make sure your caregiver is taking breaks - holidays and vacations and little rest periods every day.



• Remember your caregiver's birthday and other important dates. Everyone likes to be remembered on special days - a special card or note of appreciation is always uplifting!

Additional Resources

Research


Child care providers make up only 0.7 % of the offenders of child maltreatment; compared to 78.5% of the offenders are parents.

Source: Child Maltreatment 2004: Reports from the States to the National Child Abuse and Neglect Data Systems - National statistics on child abuse and neglect (2006)
http://www.acf.hhs.gov/programs/cb/pubs/cm04/figures_6.htm

13 Indicators of Quality Child Care: Research Update: Child Abuse Indicator
http://aspe.hhs.gov/hsp/ccquality-ind02/#Child

Resources


10 Things You Should Expect from Your Child Care Provider
http://www.dontshake.org/sbs.php?topNavID=3&subNavID=29&navID=148

10 Things Your Child Care Provider Should Expect from You
http://www.dontshake.org/sbs.php?topNavID=3&subNavID=29&subnav_1=128&subnav_2=136&subnav_3=146&navID=149

American Academy of Pediatrics Child Abuse/Shaken Baby Syndrome Resources
http://www.aap.org/healthtopics/childabuse.cfm

Child Abuse Prevention - California Childcare Health Program
English - http://www.ucsfchildcarehealth.org/pdfs/healthandsafety/childaben081803.pdf
Spanish - http://www.ucsfchildcarehealth.org/pdfs/healthandsafety/childabsp081803.pdf

Child Protection: Facts and figures - Child Welfare League of America
http://www.cwla.org/programs/childprotection/childprotectionfaq.htm

Recognizing Child Abuse and Neglect: Signs and Symptoms - Child Welfare Information Gateway
English - http://www.childwelfare.gov/pubs/factsheets/signs.pdf
Spanish - http://www.childwelfare.gov/pubs/factsheets/sp_signs.pdf

Organizations


American Professional Society on the Abuse of Children (APSAC)
PO BOX 30669
Charleston, SC 29417
1-877-402-7722
http://www.apsac.org

Center for Research on Child Wellbeing
Wallace Hall
Princeton University
Princeton, NJ 08544
http://crcw.princeton.edu/index.asp

Child Welfare Information Gateway
Children's Bureau/ACYF
1250 Maryland Avenue, SW, Eighth Floor
Washington, DC 20024
1-800-394-3366
http://www.childwelfare.gov/index.cfm

Childhelp
800-422-4453
http://www.childhelp.org/

National Center for Shaken Baby Syndrome
2955 Harrison Blvd #102
Ogden, UT 84403
888-273-0071
http://dontshake.com/

National Respite Locator Service
1- 800-677-1116
For parents, caregivers, and professionals caring for children and adults with disabilities, terminal illnesses, or those at risk of abuse or neglect

Prevent Child Abuse America
200 S. Michigan Avenue
17th Floor
Chicago, IL 60604-2404
312-663-3520
http://www.preventchildabuse.org/



Based on Caring for Our Children: National Health and Safety Performance Standards: Guidelines for Out-of-Home Child Care Programs, 2nd Edition, 2002, (American Academy of Pediatrics, American Public Health Association, and National Resource Center for Health and Safety in Child Care)

STANDARD 1.008 REFERENCES AND BACKGROUND CHECKS
STANDARD 2.039 DISCIPLINE MEASURES
STANDARD 2.046 PARENT VISITS
STANDARD 3.053 REPORTING SUSPECTED CHILD ABUSE, NEGLECT, EXPLOITATION
STANDARD 3.054 CONSULTANTS ON CHILD ABUSE AND NEGLECT
STANDARD 3.055 IMMUNITY OF REPORTERS OF CHILD ABUSE FROM SANCTION
STANDARD 3.056 INSTRUCTION AND FORMS FOR STAFF TO RECOGNIZE AND REPORT CHILD ABUSE
STANDARD 3.057 CARE FOR CHILDREN WHO HAVE BEEN ABUSED
STANDARD 3.058 DEALING WITH CAREGIVER STRESS
STANDARD 3.059 FACILITY LAYOUT TO REDUCE RISK OF ABUSE
STANDARD 5.023 LOCKS
STANDARD 5.025 ACCESS TO EXITS
STANDARD 8.028 AUTHORIZED PERSONS TO PICK UP CHILD
STANDARD 8.029 POLICY ON ACTIONS TO BE FOLLOWED WHEN NO AUTHORIZED PERSON ARRIVES TO PICK UP CHILD
STANDARD 8.030 DOCUMENTATION OF DROP OFF AND PICK UP OF CHILD
RECOMMENDATION 9.003 CRIMINAL RECORD AND CHILD ABUSE CHECKS
APPENDIX K - CLUES TO CHILD ABUSE AND NEGLECT
APPENDIX L - RISK FACTORS FOR ABUSE AND/OR NEGLECT
GLOSSARY