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What Do We Do If We Suspect Child Abuse or Neglect?
Our Role as LLL Leaders

Kathy Koch
Great Mills MD USA
From: LEAVEN, Vol. 39 No. 5, October-November 2003, pp. 99-100.

While most of us cannot imagine hurting a child-our own or another mother's precious baby-unfortunately there are times when we may need to take action to protect children from harm or abuse.

The National Clearinghouse on Child Abuse and Neglect reports that in 2001 there were an estimated 903,000 children who were abused or neglected in the United States. Almost 60 percent of those children were age zero to three years. An estimated 1,300 children died as a result of the abuse and 85 percent of the deaths were in children under the age of six years (41 percent were children under the age of one year). The vast majority (81 percent) were abused by one or both parents. The National Society for the Prevention of Cruelty to Children (www.nspcc.org.uk) in Great Britain reports that one child dies per week at the hands of an adult.

The United States Federal Child Abuse Prevention and Treatment Act (CAPTA) (1974, as amended) defines child abuse and neglect as, at a minimum, "any recent act or failure to act on the part of a parent or caretaker which results in death, serious physical or emotional harm, sexual abuse or exploitation; or an act or failure to act which presents an imminent risk of serious harm." This definition includes the withholding of medically indicated treatment as specified by a physician's reasonable medical judgment (except in certain cases of terminally ill children).

In the United States, each individual state is responsible for providing its own definitions of child abuse and neglect specific to that state's civil and criminal codes. The National Clearinghouse on Child Abuse and Neglect describes four categories of maltreatment: physical abuse, child neglect, sexual abuse, and emotional abuse. As each country or US State is responsible for its own specific definitions, these are merely general definitions.

Physical abuse is defined as the infliction of physical injury as a result of punching, kicking, biting, burning, shaking, or otherwise harming a child, whether intentional or resulting from discipline or punishment.

Child neglect is considered to be the failure to provide for a child's basic needs. Neglect can be physical (e.g., refusal of health care, abandonment), emotional (e.g., ignoring child's need for attention, spousal abuse in child's presence), or educational (allowing chronic truancy, failure to attend to a special educational need).

Sexual abuse includes fondling, rape, incest, intercourse, exploitation through pornography or prostitution, and other activities.

Emotional abuse is defined as omissions by parents or caretakers that have caused, or could cause, serious behavioral, cognitive, emotional, or mental disorders. This could include extreme forms of punishments, verbal abuse, chronic scapegoating, or humiliation (the latter are more difficult to prove as harmful).

As LLL Leaders, we are often in contact with mothers experiencing stress, exhaustion, and/or postpartum depression. As many of our contacts are by phone, we cannot easily ascertain if abuse is taking place. Even with in-person contacts it is hard to judge if what we might be seeing really is abuse or neglect. We may hear the mother tell us things that are of concern (for example, she is afraid of hurting her baby, or that she is so angry she "just shook him to stop his crying") or we might actually hear what we may feel is physical abuse (slaps) or verbal abuse (name calling, screaming). We might see a baby who looks thin and listless, or a mother showing obvious disinterest in her crying baby. It is hard to know exactly where our responsibilities for reporting this possible abuse or neglect lie.

All US states have guidelines regarding who is mandated by law to report suspected child abuse or neglect to the authorities. In most cases, health care providers, educators, law enforcement officers, and mental health professionals are mandated reporters, or those who are required to report suspected abuse or neglect when they have reason to believe that abuse is occurring. Note that this is not factual knowledge or observation of abuse but merely "good faith" suspicions of abuse. It is not the mandated reporter's job to determine the presence or extent of the abuse or neglect. That is the job of the local agency responsible for investigations of abuse or neglect.

Although all states have guidelines for determining mandated reporters, 18 US states designate all citizens as mandated reporters. As of this writing, these states are Delaware, Florida, Idaho, Indiana, Kentucky, Maryland, Mississippi, Nebraska, New Hampshire, New Jersey, New Mexico, North Carolina, Oklahoma, Rhode Island, Tennessee, Texas, Utah, and Wyoming. Residents of these states are mandated reporters regardless of their possible additional roles that would make them mandated in other states. Specific and current guidelines for each state may be found on the Internet at www.calib.com/nccanch/statutes/manda.cfm/

Under CAPTA, all US states must provide immunity from prosecution under state and local laws for mandated reporters and others making good faith reports of suspected abuse or neglect. Specific immunity laws for all states are available at: www.calib.com/nccanch/statutes/stats02/immun.cfm#de/

Failure to report suspected abuse may result in civil or criminal liability. Thirty-four states classify failure to report suspected abuse or neglect as a misdemeanor. State imposed penalties for failure to report suspected abuse or neglect range from monetary fines to imprisonment. Specific state statutes for failure to report may be found at: www.calib.com/nccanch/ statutes/statutes/tblPenalty_search.cfm/

If you, as an LLL Leader, are in the position where you feel you might need to report a mother or father for suspected abuse or neglect, please call a Professional Liaison (PL) Leader first. They are available to help talk you through the situation and gather and document your concerns before you call Child Protective Services. This is not something you need to do alone. In fact, it is very important that your concerns be documented with your Area support people. If you have concerns relating to possible neglect due to a feeding issue with a baby-strict scheduling or failure to thrive, for example, your PL Leader, along with her PL support staff, can help you decide if the situation merits a call to your local government agency or if you should attempt to contact the baby's health care provider to alert him or her of your concerns. Of course, if you feel, at any time, that a baby's life is in imminent danger, a call to the appropriate authorities is paramount.

In all cases, reports can be made anonymously, although if you choose to identify yourself, your identity will not be disclosed to the family.

It is important to remember that, as an LLL Leader, you may encounter parents who have different parenting philosophies than you do. Although we as LLL Leaders are expected to uphold the beliefs of "loving guidance" and gentle discipline, other families may not parent the same way. Many factors, including religious and cultural beliefs, influence parenting behaviors. While we may feel personally that a parent's behavior is inappropriate, it is important that we remain objective when evaluating whether a mother's (or father's) behavior is possibly abusive.

As with all helping calls, it is essential that you use your Leader's Log to document all contacts with the family and your Area support team (PL Leaders, DA, etc.). Your PL Leader may, in turn, contact her support team and will document those contacts in her PL log.

Much of the legal information on mandated reporters and consequences for not reporting as well as statistics for this article was obtained from:

The National Clearinghouse on Child Abuse and Neglect
330 C Street, SW
Washington DC 20447 USA
Phone: 800-FYI-3366
http://nccanch.acf.hhs.gov

For more information on child abuse prevention agencies, go to www.vachss.com/help_text/child_abuse.html#resources

Additional Resources

Canadian Society for the Prevention of Cruelty to Children
356 First Street
Box 700
Midland Ontario L4R 4P4
Canada
Phone: (705) 526-5647
www.empathicparenting.org

Child Welfare League of America
440 First Street NW, Suite 310
Washington, DC 20001-2085 USA
Phone: (202) 638-2952
www.cwla.org

Kinderarztliche Beratungsstelle
Misshandlung

www.kindesmisshandlung.de (German-language page)
www.childabuse.de

National Association for Prevention of Child Abuse and Neglect (NAPCAN)
Australia Office
Suite 32, 8-24 Kippax Street
Surry Hills, NSW 2010
Phone: (61) 02 9211 0224
www.napcan.org.au

South African Society for the Prevention of Child Abuse and Neglect
Postnet Suite 141
Private Bag X7
Parkview 2122, South Africa
Phone: 011 481 5145
www.saspcan.org.za


Author's Note: The majority of this information is applicable only to residents of the United States. Space constraints limit providing information on the laws of every country. Professional Liaison Leaders in LLL Affiliates will have information specific to their country or jurisdiction. As always, this information is not to be construed as legal advice. Please refer to referenced documents for specific information for your state.

Kathy Koch, MEd, IBCLC, has been an LLL Leader since 1992. Kathy lives in Great Mills, Maryland, USA with her husband, Paul, and their three children, Andrew (12), Abby (10), and Molly (8). She currently serves as Area Professional Liaison for LLL of Maryland/Delaware/District of Columbia and is a primary school teacher, working with children with special needs.

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