HOUSTON – In the first four months of this year, nine children have died at Texas Children's Hospital as a result of child abuse.

Earlier this week, Jamail Wagner was charged with punching and stomping on his girlfriend's 4-year-old son. Police said he did it because the boy was kicking the back of the car seat.

Last month, Shawn Mayreis was charged in connection with the death of his 2-month-old daughter Azariah. She died four days after being taken to Texas Children's Hospital with a fractured skull and broken ribs.

Maria Kruppa, of Freeport, faces life in prison if she's convicted of beating and shaking her 6-month-old son. Investigators said she told them it was because he cried too much.

"We can never make these kids okay again," said John Bickel, the Community Outreach Coordinator for Texas Children's Child Abuse Pediatrics (CAP) team.

The team is one of the largest hospital-based prevention programs in the country.

Bickel said that when stories like these make headlines, often it wasn't the first instance of abuse.

"Well, we thought something was happening. We thought something was going on but we weren't sure and we didn't want to cause problems in the family," said Bickel. "Well, usually I hear that and I hear that after the child's either died or something terrible's happened to the child."

Last year, 231 children died in Texas as a result of child abuse.

For April's Child Abuse Awareness month, 2,500 blue ribbons were tied outside Texas Children's, each one honoring children needing medical attention for suspected abuse and neglect.

While cases are down slightly, experts said the ones they see are disturbingly severe.

"The majority of kids who are killed or very seriously injured are from about a few weeks old to about 6-months," said Bickel.

That's why the CAP team is reaching out to educate the community, including school staff, pediatricians, and caregivers, to help prevent abuse.

"If you have a suspicion that a child is being abused, then it's your duty to report it," said Bickel.

What to look for

Bickel said bruises that aren't your typical childhood cuts and scrapes are one thing to look for.

"If you see kids with bruises on the back, bruises on their ribs, torso, cheeks, ears. Places like that," said Bickel.

Other signs of possible physical abuse include:

• Unexplained burns, bites, broken bones, or black eyes.
• Frightened of the parents and protests when it's time to go home.
• Shrinks at the approach of adults.

The parent or caregiver might:

• Offer conflicting, unconvincing, or no explanation for the child's injury.
• Describe the child as "evil" or in another negative way.
• Have a history of abuse as a child.

Thecia Jenkins is the Advocacy and Education Director of the Bridge over Troubled Waters Crisis Center, partnered with Texas Children's to educate its caregivers and staff.

"It's really hard because sometimes all you can do is make that report and so you may not know what the follow up was but at the same time, it's very encouraging because when you walk with them in that situation, you know that child realizes, 'I don't have to live in that situation,'" said Jenkins.

"You don't want to be the cause of breaking up a family," said Leslie Jeter, a child care worker.

Jeter said she can relate to the apprehension some have in making a report, but has simple advice.

"Always trust your gut. Always," she said.

To report suspected child abuse, call the Texas Department of Family and Protective Services at 1-800-252-5400