Medical Corner: Recognizing child abuse Published April 16, 2009 By Capt. Christy Cruz and Connie Tucker-Smith Family Advocacy VANCE AIR FORCE BASE, Okla. -- April marks National Child Abuse Prevention Month and learning the symptoms of child abuse is the initial step in helping its victims. Although child abuse is divided into four types - physical abuse, neglect, sexual abuse and emotional maltreatment - it is typically a combination of all four. A physically abused child also experiences emotional maltreatment. A sexually abused child can be neglected as well. Child protection advocates use the well-known saying, "One child abused or neglected is one too many." Still, not everyone knows the symptoms of child abuse. As a result, Prevent Child Abuse America, a non-profit organization, has built awareness and provided education programs. It provides some signs for both the child and the parent that may signal the presence of child abuse. Parents can ask themselves: Does their child show sudden changes in behavior or school performance, and does he come to school early, stay late or not want to come home? Is he overly compliant, an overachiever, too responsible or does he lack adult supervision? Are learning problems an issue that cannot be linked to any specific physical or psychological cause, and does he seem distracted or distant at odd times? Do sudden mood swings like rage, fear, insecurity or withdrawal occur, or does he have a sudden change in eating habits? Is he always watchful, as though preparing for something bad to happen, or does he develop new or unusual fears of certain people or places? Are there medical problems that have not been addressed or brought to the parents' attention? All of these signs can point to child abuse. However, parents show different symptoms if they are responsible for the abuse. Do the parents demand perfection or a level of physical or academic performance the child cannot achieve, or do they show little concern for the child? Are secrets and silences encouraged in children, and do they minimize hurtful or harmful behaviors when confronted? Do they deny the existence of their child's problems in school or at home or even blame them, and do they ask teachers to use harsh discipline if the child misbehaves? Are they looking primarily to the child for care, attention, and satisfaction of emotional needs, or do they see the child as entirely bad, worthless or burdensome? Is there insistent hugging or tickling of a child even when the child does not want this physical attention, and do they ignore or miss social cues about others' personal or sexual limits and boundaries? Is the parent known to make poor decisions while misusing drugs or alcohol? Of course, all of these signs do not necessarily mean that child abuse is present. Any of them can be found at one time or another. However, when these signs appear repeatedly or in combination with each other, then an outsider has a good reason to look closer at the situation. That second look may reveal further signs of neglect or abuse that is either physical, sexual, or emotional in nature.