Chapter 3: Health Promotion and Protection
3.4 Health Protection in Child Care
3.4.4 Child Abuse and Neglect
220.127.116.11: Care for Children Who Have Experienced Abuse/Neglect
Caregivers/teachers should have access to specialized training and expert advice when caring for children with behavioral challenges related to abuse or neglect.
All children who have experienced abuse or neglect have had their physical and emotional boundaries violated. With this violation often comes a breach of the child’s sense of security and trust. Children who have experienced abuse and neglect may come to believe that the world is not a safe place and that adults are not trustworthy. These children may have more emotional needs and may require more individual staff time and attention than children who have not experienced maltreatment.
Children who have experienced abuse or neglect may display varying levels of developmental delay, physical symptoms, or behavioral concerns such as avoidant or anxious behavior, fearfulness, sadness/depression, or impulsive, oppositional, aggressive, and sexualized behavior (1).
These problems may persist long after the maltreatment occurred and may have significant psychiatric and medical consequences into adulthood. In particular, children who have experienced abuse or neglect or have been exposed to violence, including domestic violence, often have excessive responses to environmental stress. Caregivers/teachers are better equipped in responding to a child’s behavior when provided with training and information about the dynamics of abuse, mental health consultation to explore trauma-informed strategies to support and keep the child safe, and data on long-term outcomes of child maltreatment (2). Child care staff may need to work closely with the child’s primary health care provider, therapist, social worker, and parents/guardians to formulate a more personalized behavior management plan.
Centers serving children with a history of maltreatment-related behavior problems may require staff trained in trauma-informed practices and/or assistance from a child care mental health consultant. Care may be facilitated by having an intentional, written behavioral care plan. Resources on caring for a child who has experienced abuse or neglect are available from the following agencies:
- American Academy of Pediatrics. Managing Chronic Health Needs in Child Care and Schools: A Quick Reference Guide. Donoghue EA, Kraft CA, eds. 2nd ed. Itasca, IL: American Academy of Pediatrics; 2019
- Child Welfare Information Gateway. Trauma-informed practice. https://www.childwelfare.gov/topics/responding/trauma. Accessed June 26, 2018
- National Children’s Advocacy Center (www.nationalcac.org)
- Office of Juvenile Justice and Delinquency Prevention, Safe Start. Trauma-informed care for children exposed to violence: tips for teachers. https://www.justice.gov/sites/default/files/defendingchildhood/legacy/2011/09/19/tips-teachers.pdf. Accessed June 26, 2018
- Office of Head Start, Early Childhood Learning & Knowledge Center. Infant and early childhood mental health consultation and your program. https://eclkc.ohs.acf.hhs.gov/mental-health/article/infant-early-childhood-mental-health-consultation-your-program. Updated June 11, 2018. Accessed June 26, 2018
TYPE OF FACILITYCenter, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS18.104.22.168 Child Care Health Consultants
Center for Early Childhood Mental Health Consultation, Georgetown University Center for Child and Human Development. Trauma signs and symptoms. https://www.ecmhc.org/tutorials/trauma/mod3_1.html. Accessed June 26, 2018
Van Toledo A, Seymour F. Caregiver needs following disclosure of child sexual abuse. J Child Sex Abus. 2016;25(4):403–414. http://www.tandfonline.com/doi/full/10.1080/10538712.2016.1156206. Accessed June 26, 2018
Content in the STANDARD was modified on 08/28/2018