Requirements to Report Instances of Suspected Child Abuse or Maltreatment

Bureau of EMS Policy Statement
Policy Statement #02-01
SubjectRe: Requirements to
report instances of
suspected child abuse
or maltreatment

On November 13th, 2001 Section 413 of the Social Services Law was amended, in relation to persons and officials who are required to report cases of suspected child abuse or maltreatment. Effective February 1st, 2002 the law will require Emergency Medical Technicians to report suspected child abuse they come across while performing their jobs. The Bureau of EMS will not require EMTs to attend a specialized course for child abuse. The current EMS course curricula include sections on child abuse. However, the Bureau does reserve the right to amend the curricula in the future. Therefore, this Policy Statement and attached fact sheet are intended to be used by New York State EMTs to help them better understand their obligations as well as the signs and symptoms of possible child abuse or maltreatment.

Reporting Procedures

Section 415 of the Social Services Law states that, "Reports of suspected child abuse or maltreatment made pursuant to this title shall be made immediately by telephone or by telephone facsimile machine on a form supplied by the commissioner. Oral reports shall be followed by a report in writing within forty-eight hours after such oral report. Oral reports shall be made to the statewide central register of child abuse and maltreatment unless the appropriate local plan for the provision of child protective services provides that oral reports should be made to the local child protective service." i

Oral Reports of suspected child abuse or maltreatment shall be made by calling the NYS Child Abuse and Maltreatment Register at:


NOTE: This phone number is for mandated reporters ONLY and should NOT be provided to the general public.

Agency Policy

10 NYCRR Part 800.21(p)(11)(ii) requires all ambulance services to have and enforce a written policy regarding the reporting of child abuse. Based on the addition to §413 of Social Services Law all services should ensure that the policy developed regarding this requirement includes the mandatory reporting requirement and the process required by Social Services Law § 415. The agency policy needs to address areas such as Prehospital Care Report documentation, notifying the Emergency Room staff, calling the above 800 telephone number, and the completion of form DSS-2221-A.

Immunity From Liability

Immunity from liability for reporting cases of suspected child abuse or maltreatment is provided to those individuals required to report such cases under § 419 of the Social Services Law so long as the individual was acting in, "good faith".

Failure To Report

Section 420 Of the Social Services Law states:

1. Any person, official or institution required by this title to report a case of suspected child abuse or maltreatment who willfully fails to do so shall be guilty of a class A misdemeanor.

2. Any person, official or institution required by this title to report a case of suspected child abuse or maltreatment who knowingly and willfully fails to do so shall be civilly liable for the damages proximately caused by such failure.

Issued and Authorized by:
Edward G. Wronski, Director
Bureau of Emergency Medical Services

iReporting to Local CPS Pertains to Onondoga and Monroe Counties Only

Child Abuse and Maltreatment
Fact Sheet

This fact sheet is intended to be used by New York State EMTs as a learning tool and guide to help them better understand the signs and symptoms of possible child abuse or maltreatment. The signs and indicators listed in this document are not conclusive proof of child abuse or maltreatment. There can be other, reasonable explanations for what you observe.

Definition of Child Abuse:

An "abused child" is a child less than eighteen (18) years of age whose parent or other person legally responsible for his/her care:

  1. Inflicts or allows to be inflicted upon the child serious physical injury, or
  2. Creates or allows to be created a substantial risk of physical injury, or
  3. Commits or allows to be committed against the child a sexual offense as defined in the penal law.

Definition of Child Maltreatment:

A "maltreated child" is a child under eighteen (18) years of age who has had serious physical injury inflicted upon him/her by other than accidental means.

A "maltreated child" is also a child under eighteen (18) years of age whose physical, mental or emotional condition has been impaired or is in danger of becoming impaired as a result of the failure of his/her parent or other person legally responsible for his/her care to exercise a minimum degree of care:

  1. In supplying the child with adequate food, clothing, shelter, education, medical or surgical care, though financially able to do so or offered financial or other reasonable means to do so; or
  2. In providing the child with proper supervision or guardianship; or
  3. By unreasonable inflicting, or allowing to be inflicted, harm or substantial risk thereof, including the infliction of excessive corporal punishment; or
  4. By using a drug or drugs; or
  5. By using alcoholic beverages to the extent that he/she loses self-control of his/her actions; or
  6. By any other acts of a similarly serious nature requiring the aid of the Family Court.

Some of the physical indicators of possible child abuse:

  • Bruises in different stages of healing, welts, or bite marks on face, lips, mouth, neck, wrist, thighs, ankles, or torso, or on several area of the body such as:
  • Injuries to both eyes or both cheeks (usually only one side of the face is injured in an accident)
  • Marks that are clustered, that form regular patterns, that reflect the shape of such articles as an electrical cord, belt buckle, fork tines, or human teeth.
  • Grab marks on the arms or shoulders; and/or
  • Bizarre marks, such as permanent tattoos

  • Lacerations or abrasions to mouth, lips, gums, eyes, external genitalia, arms, legs, or torso.
  • Burns:
  • From cigars or cigarettes, especially on soles, palms, back, or buttocks.
  • From immersion in scalding water (socklike or glovelike on feet or on hands, doughnut-shaped on buttocks or genitalia)
  • That are patterned like an object, such as an iron or electric burner; burns from ropes on arms, legs, neck, or torso.

  • Any fractures:
  • Multiple or spiral, of the long bones, to skull, nose, or facial structure.
  • Other injuries, such as dislocation.

  • Head Injuries:
  • Absence of hair or hemorrhage beneath the scalp from hairpulling.
  • Subdural hematomas
  • Retinal hemorrhage or detachment, from shaking
  • Eye injuries
  • Jaw and nasal fractures
  • Tooth or frenulum injury

  • Symptoms that suggest fabricated or induced illness, sometimes known as Munchausen Syndrome by Proxy (MSP); for example, a parent might be repeatedly feeding a child quantities of laxatives sufficient to cause diarrhea, dehydration, or hospitalization, without revealing the child has been medicated.

Some of the emotional and behavioral signs of possible child abuse:

  • Apprehension when other children cry
  • Aggressiveness
  • Withdrawal
  • Fear of going home
  • Fear of parents and other adults
  • Extreme mood swings
  • Inappropriate mood
  • Habit disorder, such as nail-biting
  • Low self-esteem
  • Neuroses, such as hypochondria, obsessions
  • Refusal to remove outer garments
  • Attempted suicide

Some of the physical signs of possible child neglect:

  • Newborn with positive toxicology for drugs
  • Lags in physical development
  • Constant hunger
  • Speech disorder
  • Poor hygiene
  • Inappropriate dress for the season
  • Lack of medical care
  • Inadequate supervision

Some of the emotional and behavioral indicators of possible child neglect:

  • Chronic fatigue
  • Habit disorder, such as thumb-sucking by a ten-year-old, rocking, biting
  • Reports no caregiver at home
  • Frequent absences from school or lateness
  • Hypochondria
  • Shifts from complaint to aggressive behavior
  • Age-inappropriate behavior
  • Begging for food
  • Lags in emotional or mental development
  • Use of alcohol or drugs

Some of the signs of possible child sexual abuse:

  • Difficulty in walking and sitting
  • Pain or itching in the genital area
  • Torn, stained, or bloody underclothing
  • Bruises or bleeding of external genitalia or vaginal or anal areas
  • Bruises to the hard or soft palate
  • Sexually transmitted diseases, especially in preteens
  • Painful discharge of urine or repeated urinary infections
  • Foreign bodies in the vagina or the rectum
  • Pregnancy, especially in early adolescence

Some emotional and behavioral signs of possible child sexual abuse:

Many of the following indicators may also reflect problems unrelated to sexual abuse. Moreover, no one child will show all of these signs.

Particularly in children who are less than eight years of age look for:

Eating disorders Crying spells
Fear of sleeping alone Hyperactivity
Enuresis (bed wetting at night or daytime accidents) Change in school behavior (fear of school, drop in grades, trouble concentrating)
Separation anxiety Regular tantrums
Thumb or object sucking Excessive fear (including of men or women)
Encopresis (soiling) Nightmares or night terrors
Language regression Sadness or depression
Sexual talk Suicidal thoughts
Excessive masturbation Extreme nervousness
Sexual acting out, posturing Hypochondria

In children over eight through adolescence:

Fear of being alone Overly compliant behavior
Peer problems Suicidal thoughts or gestures
Frequent fights with family members Self-mutilation
Poor self-esteem Hyperalertness
Excessive nervousness Sexual acting out
Emotional numbness (out-of body experiences, or feelings of unreality) Avoidant, phobic behavior, including sexual topics
Substance Abuse Unwillingness to change into gym clothes
Excessive guilt or shame Violent fantasies
Mood swings Memory problems
Sexual concerns or preoccupations Fear of future abuse
Withdrawn, isolated behavior Intrusive, recurrent thoughts, or flashbacks