The images are horrific.

A little boy with deep ligature marks around his ankles and wrists. A baby with hand prints on her face where someone has slapped the child with great force.

Little bodies covered in burns, bruises and cuts.

A child’s arm that is broken so badly he will have problems with it for the rest of his life.

That’s assuming he gets to grow up.

These are all real children who have suffered at the hands of others. These are victims of child abuse and neglect.

Dr. Javier Tapia, staff pediatrician for LV Stabler Hospital and the new team physician for the Greenville High School Football Team, shared information on the ongoing problem of child abuse with members and guests of the Greenville Lions Club Monday.

&uot;Of the approximately 3 million cases reported annually in our country, 34 percent are screened further…a total of 29 percent are totally substantiated. That averages out to 13 out of 1,000 kids,&uot; Tapia said.

Statistics show child abuse and neglect is least prevalent in Asian/Pacific Islander households, then steadily escalates in white, Hispanic and Native American households, with the highest incidence in black households.

It is the youngest victims, children under the age of three, who are the most vulnerable, the doctor said.

In 2002, The National Child Abuse and Neglect Data System (NCANDS) stated children younger than one year old accounted for 41 percent of fatalities, while children younger than four years accounted for 76 percent of fatalities.

&uot;Head injury trauma is the most common cause of mortality. Whatever the injury, it is crucial to get a detailed history of events,&uot; Tapia said.

Other common ways children are injured or killed are through intentional burns, aspiration problems, bruising, Shaken Baby/Impact Syndrome and ingestion of harmful substances through their mother’s breast milk (i.e., crack cocaine).

&uot;Shaken Baby/Impact Syndrome happens when a small child is shaken so hard it causes internal injury – bleeding in the brain, fractures and retinal hemorrhages. The child can’t stop crying and the parent or caregiver loses his temper and shakes the child to try to make her stop,&uot; Tapia explained.

In children under 18 months, 80 percent of skeletal injuries are due to abuse, and 25 percent of fractures in children under three.

Who are the most likely victims of child abuse? &uot;Children who are younger than three, children from a low socioeconomic system, those who are handicapped, premature, and those who have other injuries where there is no credible history present,&uot; Tapia said.

There is always suspicion if a child keeps showing up with injuries and the caregiver’s explanation is vague, the doctor said.

Some 15 to 25 percent of children who are exposed to abuse and neglect will die prematurely; 80 to 90 percent will grow up with some type of disability due to the trauma they underwent.

Indicators a child has been abused include patterns on their body reflecting belt buckle shapes and other instruments used to strike them, human bite marks, ligature marks from rope or wire, finger and hand impressions left from a hard slap and bruising patterns from a child being shaken or yanked around.

&uot;Stocking-glove burns, where a child has had their hands and/or feet immersed in hot water, are additional indicators a child has been intentionally hurt,&uot; Tapia said.

There are situations, the doctor said, that appear to be possible cases of child abuse, but are actually due to some condition or a legitimate accident.

&uot;Certain folk medicine practices, such as cupping and spooning, are used to supposedly pull the illness out of the body. They can leave patterns that appear to be some form of abuse,&uot; Tapia said.

Certain confusing skin conditions, such as Mongolian spots, which gives the skin a purplish, bruised appearance, impetigo, drug reactions, contact dermatitis and hemophilia are a few of the causes for cases mistaken for child abuse.

&uot;It is very important to thoroughly explore the history of the child’s injuries to determine what is going on,&uot; Tapia said.

For more information on signs of child abuse and neglect, go to www.aap.org, www.childabuse.org or contact or visit Safe Harbor Children’s Advocacy Center at 107 Caldwell St. in Greenville, 382-8584.