Texas Do not delay; children's lives depend on child-abuse reporting by Willis-Knighton Health System It's hard to imagine someone intentionally hurting a child, yet nearly a million children are abused every year just in the United States alone. And these are only the reported incidents of child abuse — many more cases are unreported and undetected, often because children are afraid to tell somebody who can help. Most of the time, kids know their abusers and the abuse occurs in the home. This makes it difficult for kids to speak up. They may feel trapped by the affection they feel for their abusers or fearful of the power the abusers have over them — so they stay silent. That's why it's especially important to be able to recognize the signs of child abuse.

Child abuse happens when a parent or other adult causes serious physical or emotional harm to a child.

In the United States, the laws defining what constitutes child abuse vary from state to state, but generally speaking, child abuse can take forms including physical abuse, sexual abuse, neglect and abandonment and emotional or psychological abuse.

PHYSICAL ABUSE

When people think of child abuse, their first thought probably is of physical abuse such as striking, kicking or shaking a child. Physical abuse also can include holding a child under water, tying up a child, intentionally burning a child or scalding a child with hot water, throwing an object at a child or using an object to beat a child and starving a child or failing to provide a child with food.

Abusive head trauma, or shaken baby syndrome, is a specific form of physical abuse. It's the leading cause of death in child-abuse cases in the U.S. Most incidents last just a few seconds, but that's enough time to cause brain damage or even kill a baby.

SEXUAL ABUSE

Sexual abuse happens when a child is raped or forced to commit a sexual act. But it's also any sort of sexual contact with a child or any behavior that is meant to sexually arouse the abuser. So, in addition to having sex with a child, fondling a child's genitals or making a child touch someone else's genitals, sexual abuse also includes making a child pose or perform for pornographic pictures or videos, telling a child dirty jokes or stories and showing a child pornographic material.

Sexual abuse also includes forcing a child to undress and “flashing” a child or showing them one's genitals.

NEGLECT

Neglect is any action — or inaction — on the part of a caregiver that causes a child physical or emotional harm. For example, withholding food, warmth in cold weather or proper housing is considered neglectful. Basically, anything that interferes with a child's growth and development constitutes neglect. This also includes failing to provide medical care when a child is injured or sick, locking a child in a closet or room and placing a child in a dangerous situation that could lead to physical injury or death.

Abandonment is a type of neglect. This occurs when a child is left alone for extended periods of time or suffers serious harm because no one was looking after him or her.

EMOTIONAL ABUSE

Emotional abuse or psychological abuse is a pattern of behavior that has negative effects on a child's emotional development and sense of self worth. Ignoring a child or withholding love, support or guidance is considered emotional abuse. So is threatening, terrorizing, belittling or constantly criticizing a child.

SUBSTANCE ABUSE

The use of alcohol, tobacco or illicit drugs can hinder a caregiver's judgment and put a child in danger, leading to things like neglect or physical abuse. But in some states, substance abuse also is considered a form of child abuse on its own.

Examples of child abuse due to a substance abuse problem in the house include allowing a child to drink alcohol or take illegal drugs; manufacturing, ingesting or distributing illegal drugs in the presence of a child; and exposing a fetus to illegal drugs or other substances while pregnant.

PROFILE OF AN ABUSER

It would be simpler if all child abusers followed a pattern and were easy to recognize. The truth is that child abusers come from all walks of life. They can be parents, other family members, teachers, coaches and family friends. Virtually anyone who has access to a child is in a position to mistreat the child. Fortunately, the vast majority of people don't.

SIGNS OF ABUSE

It's sometimes difficult to tell the difference between the ordinary scrapes and scratches of childhood and a physical sign of child abuse. Multiple bruises or those that keep coming back, black eyes and broken bones are certainly red flags, but other signs — like a child's emotional health — are also telling.

Kids who are abused might be sad or angry, perhaps contemplating suicide or becoming bullies and having problems managing their anger and other emotions.

They might have trouble with relationships and trust, act out and engage in risky behavior, abuse drugs or alcohol or be sexually promiscuous.

IF YOU SUSPECT ABUSE

Once you suspect child abuse, you need to act to protect the child from further possible harm. It doesn't matter if you're wrong; it's better to be wrong than sorry.

It is your responsibility to contact your local child protective services agency, police, hospital or emergency hotline. If necessary, you may remain anonymous. The child's safety is the immediate issue; you could save his or her life by removing the child from a dangerous situation as soon as possible.

Pediatricians recommend that children who are suspected abuse victims be brought to a hospital, where the initial diagnosis can be made and treatment can be given. Psychological help also is strongly recommended. Without it, children who have been abused may suffer emotional problems or repeat the pattern of abuse with their own kids.

BREAK THE SILENCE

While not all suspicions and accusations of child abuse turn out to be true, all deserve serious attention and immediate action. Child abuse can rob kids of the joy of growing up and affect them negatively for years to come.

But abuse doesn't have to ruin a child's life, as long as it's stopped and dealt with. So take any accusations of abuse seriously until you know for sure whether or not they're true.

If you suspect child abuse or neglect, please make a report by calling the Child Protective Services hotline 24 hours a day, 7 days a week at 800-252-5400 or by calling local law enforcement.

The Children's Advocacy Center, Parent's Anonymous and CASA have teamed up for a candlelight vigil for Child Abuse Prevention Month, honoring all who have been affected by child abuse and domestic violence. Candles will be lit at 8 p.m. Thursday at the Children's Park in Tyler.

The Parenting Puzzle is provided by the Children's Advocacy Center of Smith County Inc. For more information, call 903-533-1880 or visit www.cacsmithcounty.org