Mandatory Reporter Child Abuse Criteria

"Physical abuse" is defined as any non-accidental physical injury, or injury which is at variance with the history given of it, suffered by a child as the result of the acts or omissions of a person responsible for the care of the child.

Common indicators could include unusual or unexplained burns, bruises, or fractures. Health services personnel should be especially alert to cases of child abuse where inconsistent histories are presented. Inconsistent histories can take the form of an explanation that does not fit the degree or type of injury to the child, or where the story or explanation of the injury changes over time.

Some indicators of child abuse are not visible on the child's body. Many times there are no physical indicators of abuse. A child's behavior can change as a result of abuse. Health services personnel need to be alert to possible behavioral indicators of abuse and if they believe those to be present, they are required to make a report. Behavioral indicators include behaviors such as:

• extreme aggression
• withdrawal
• seductive behaviors
• being uncomfortable with physical contact or closeness

"Mental injury" is defined as any mental injury to a child's intellectual or psychological capacity as evidenced by an observable and substantial impairment in the child's ability to function within the child's normal range of performance and behavior as the result of the acts or omissions of a person responsible for the care of the child, if the impairment is diagnosed and confirmed by a licensed physician or qualified mental health professional as defined in Iowa Code section 622.10.

Examples of mental injury may include:

• Ignoring the child and failing to provide necessary stimulation, responsiveness, and validation of the child's worth in normal family routine. 
• Rejecting the child's value, needs, and request for adult validation and nurturance. 
• Isolating the child from the family and community; denying the child normal human contact. 
• Terrorizing the child with continual verbal assaults, creating a climate of fear, hostility, and anxiety, thus preventing the child from gaining feelings of safety and security. 
• Corrupting the child by encouraging and reinforcing destructive, antisocial behavior until the child is so impaired in socio-emotional development that interaction in normal social environments is not possible. 
• Verbally assaulting the child with constant, excessive name-calling, harsh threats, and sarcastic put downs that continually "beat down" the child's self-esteem with humiliation. 
• Over pressuring the child with subtle but consistent pressure to grow up fast and to achieve too early in the areas of academics, physical or motor skills, or social interaction, which leaves the child feeling that he or she is never quite good enough.

"Sexual abuse" is defined as the commission of a sexual offense with or to a child pursuant to Iowa Code chapter 709, Iowa Code section 726.2, or Iowa Code section 728.12, subsection 1, as a result of the acts or omissions of the person responsible for the care of the child or of a person who resides in a home with the child.

Notwithstanding Iowa Code section 702.5, the commission of a sexual offense under this paragraph includes any sexual offense referred to in this paragraph with or to a person under the age of 18 years.

There are several sub-categories of sexual abuse:

• First degree sexual abuse
• Second degree sexual abuse
• Third degree sexual abuse
• Lascivious acts with a child
• Indecent exposure
• Assault with intent to commit sexual abuse
• Indecent contact with a child
• Lascivious conduct with a minor
• Incest
• Sexual exploitation by a counselor, therapist, or school employee
• Sexual exploitation of a minor
• Sexual misconduct with juveniles
• Invasion of Privacy – Nudity

Behavioral indicators of sexual abuse could include things such as excessive knowledge of sexual matters beyond their normal developmental age or seductiveness. Physical indicators of sexual abuse could include things such as bruised or bleeding genitalia, venereal disease, or even pregnancy.

There are specific physical examination procedures used in child abuse. For instance, in the evaluation of sexual abuse, the colposcope provides for a taped copy of that examination. That copy alleviates the need then for the child to be subjected to further examinations.

Note: What most people think of as an issue of "neglect" is covered under the child abuse category of "denial of critical care." 

"Child prostitution" is defined as the acts or omissions of a person responsible for the care of a child which allow, permit, or encourage the child to engage in acts prohibited pursuant to Iowa Code section 725.1. Notwithstanding Iowa Code section 702.5, acts or omissions under this paragraph include an act or omission referred to in this paragraph with or to a person under the age of 18 years.

Note: "Prostitution" is defined a person who sells or offers for sale the person's services as a partner in a sex act, or who purchases or offers to purchase such services. 

"Presence of illegal drugs" is defined as occurring when an illegal drug is present in a child's body as a direct and foreseeable consequence of the acts or omissions of the person responsible for the care of the child.

Note: "Illegal drugs" are defined as cocaine, heroin, amphetamine, methamphetamine, other illegal drugs (including marijuana), or combinations or derivatives of illegal drugs which were not prescribed by a health practitioner.

 "Denial of critical care" is defined as the failure on the part of a person responsible for the care of a child to provide for the adequate food, shelter, clothing or other care necessary for the child's health and welfare when financially able to do so or when offered financial or other reasonable means to do so.

 A parent or guardian legitimately practicing religious beliefs who does not provide specified medical treatment for a child for that reason alone shall not be considered abusing the child. However, this does not preclude a court from ordering that medical service be provided to the child where the child's health requires it.

 Denial of critical care includes the following eight sub-categories:

• Failure to provide adequate food and nutrition to such an extent that there is danger of the child suffering injury or death.

• Failure to provide adequate shelter to such an extent that there is danger of the child suffering injury or death.

• Failure to provide adequate clothing to such an extent that there is danger of the child suffering injury or death.

• Failure to provide adequate health care to such an extent that there is danger of the child suffering serious injury or death.

• Failure to provide the mental health care necessary to adequately treat an observable and substantial impairment in the child's ability to function.

• Gross failure to meet the emotional needs of the child necessary for normal development evidenced by the presence of an observable and substantial impairment in the child's ability to function within the normal range of performance and behavior.

• Failure to provide proper supervision of a child which a reasonable and prudent person would exercise under similar facts and circumstances, to such an extent that the child was directly harmed or placed at risk of harm.

Note: This definition includes cruel and undue confinement of a child and the dangerous operation of a motor vehicle when the person responsible for the care of the child is driving recklessly or driving while intoxicated with the child in the vehicle.

The Department of Health and Human Services receives many inquiries each year regarding when a child can be left home alone safely. Iowa law does not define an age that is appropriate for a child to be left alone. Each situation is unique. Examples of questions to help determine whether there are safety concerns for the child include:

•    Does the child have any physical disabilities?
•    Could the child get out of the house in an emergency?
•    Does the child have a phone and know how to use it?
•    Does the child know how to reach the caretaker?
•    How long will the child be left home alone?
•    Is the child afraid to be left home alone?
•    Does the child know how to respond to an emergency such as fire or injury?

Failure to respond to the infant's life-threatening conditions by failing to provide treatment which in the treating physician's judgment will be most likely to be effective in improving or correcting all conditions. This subcategory or the denial of critical care abuse type is also known as withholding of medically indicated treatment. The type of treatments included are appropriate nutrition, hydration and medication. The term does not include the failure to provide treatment other than appropriate nutrition, hydration and medication to an infant when in the treating physician's medical judgment, any of the following circumstances apply:

• The infant is chronically and irreversibly comatose.
• The provision of treatment would merely prolong dying, not be effective in improving or correcting all of the infant's life-threatening conditions, or otherwise be ineffective in terms of the survival of the infant.  
• The provision of the treatment would be ineffective in terms of the survival of the infant and the treatment itself under the circumstances would be inhumane.

"Dangerous substance" occurs when the person responsible for the care of a child did any of the following:

• In the presence of a child:
  • Unlawfully used, possessed, manufactured, cultivated, or distributed a dangerous substance, or
  • Knowingly allowed use, possession, manufacture, cultivation, or distribution of a dangerous substance by another person, or
  • Possesses a product with the intent to use the product as a precursor or an intermediary to a dangerous substance.
• In a child’s home, on the premises, or in a motor vehicle located on the premises (even if a child was not present):
  • Unlawfully used, possessed, manufactured, cultivated, or distributed amphetamine, methamphetamine, or a chemical or combination of chemicals that poses a risk of causing an explosion, fire, or other danger to the life or health of persons who are in the vicinity while the chemical or combination of chemicals is used or intended to be used in the manufacturing of an illegal or controlled substance.

For the purposes of this definition, "in the presence of a child" means:

• in the physical presence of a child, or
• occurring under other circumstances in which a reasonably prudent person would know that the use, possession, manufacturing, cultivation, or distribution may be seen, smelled, ingested, or heard by a child.

For the purpose of this definition, "dangerous substance" means any of the following:

• Amphetamine, its salts, isomers, or salts of its isomers
• Methamphetamine, its salts, isomers, or salts of its isomers
• A chemical or combination of chemicals that poses a reasonable risk of causing an explosion, fire, or other danger to the life or health of people who are in the vicinity while the chemical or combination of chemicals is used or is intended to be used in any of the following:
  • The process of manufacturing an illegal or controlled substance
  • As a precursor in the manufacturing of an illegal or controlled substance
  • As an intermediary in the manufacturing of an illegal or controlled substance
• Cocaine, its salts, isomers, salts of its isomers, or derivatives
• Heroin, its salts, isomers, salts of its isomers, or derivatives
• Opium and opiate, and any salt, compound, derivative, or preparation of opium or opiate

Bestiality in the Presence of a Minor is defined as the commission of a sex act with an animal in the presence of a minor as defined in 717C.1 by a person who resides in a home with a child, as the result of the acts or omissions of a person responsible for the care of the child.

Knowingly allowing a person custody or control of, or unsupervised access to a child or minor, after knowing the person is required to register or is on the sex offender registry under chapter 692A for a violation of section 726.6.

Knowingly allowing access, exhibiting or disseminating obscene material to a child.

Any person engages in the recruitment, harboring, transportation, provision, obtaining, patronizing, or soliciting of a child for the purpose of commercial sexual activity as defined in Iowa Code section 710A.1.