Child Abuse

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Child Abuse

Definition

Child abuse is a blanket term for four types of child mistreatment: physical abuse, sexual abuse, emotional abuse, and neglect. In many cases children are the victims of more than one type of abuse. The abusers can be parents or other family members, caretakers such as teachers and babysitters, acquaintances (including other children), and (in rare instances) strangers.

Description

Prevalence of abuse

Child abuse was once viewed as a minor social problem affecting only a handful of U.S. children. In recent years, however, it has received close attention from the media, law enforcement, and the helping professions, and with this has come a sharp rise in the number of reported cases. But because abuse is often hidden from view and its victims too young or fearful to speak out, some experts suggest that its true prevalence may be much greater than the official data indicate. In 1999, Child Protective Service (CPS) agencies investigated 3 million reports that involved the maltreatment of approximately 4 million children.

The CPS ranks neglect as the most common form of child maltreatment, comprising an estimated 54% of investigations in 1997. Physical abuse accounted for 24%; sexual abuse, 13%; emotional maltreatment, 6%; and medical neglect, 2%. Many children suffer more than one type of maltreatment.

Although experts are quick to point out that abuse occurs among all social, ethnic, and income groups, reported cases usually involve poor families with little education. Young mothers, single-parent families, and parental alcohol or drug abuse are also common in reported cases. According to recent statistics, more than 90% of abusing parents have neither psychotic nor criminal personalities. Rather, they tend to be lonely, unhappy, angry, young, single parents who do not plan their pregnancies. About 10%, or perhaps as many as 40%, of abusive parents were themselves physically abused as children, but most abused children do not grow up to be abusive parents.

Additional factors that contribute to child abuse include lack of parenting skills, unrealistic expectations about children's behavior and capabilities, social isolation, and frequent family crises. Child abuse is a symptom that parents are having difficulty coping with their situation.

In 1999, the majority of child abusers (75%) were parents, and another 10% were other relatives of the victim. About 13% of all perpetrators were classified as noncaretakers or unknown. People who were in other caretaking relationships to the victim (e.g., child care providers, foster parents and facility staff) accounted for only 2% of perpetrators. In many states, perpetrators of child maltreatment by definition must be in a caretaking role.

Types of abuse

PHYSICAL ABUSE. Physical abuse is the nonaccidental infliction of physical injury to a child. The abuser is usually a family member or other caretaker, and is more likely to be male. In 1996, 24% of the confirmed cases of U.S. child abuse involved physical abuse. A rare form of physical abuse is Munchausen syndrome by proxy, in which a caretaker (most often the mother) seeks attention by making the child sick or appear to be sick.

SEXUAL ABUSE. Child sexual abuse is defined as any activity with a child under the age of legal consent that is for the sexual gratification of an adult or a significantly older child. It includes, among other things, sexual touching and penetration, persuading a child to expose his or her sexual organs, and allowing a child to view pornography. In most cases the child is related to or knows the abuser, and about one in five abusers are themselves underage. Sexual abuse was present in 12% of the confirmed 1996 abuse cases. An estimated 20-25% of females and 10-15% of males report that they were sexually abused by age 18.

EMOTIONAL ABUSE. Emotional abuse, according to Richard D. Krugman, director of the Kempe Center in Denver, "has been defined as the rejection, ignoring, criticizing, isolation, or terrorizing of children, all of which have the effect of eroding their self-esteem." Emotional abuse usually expresses itself in verbal attacks involving rejection, scapegoating, belittlement, and so forth. Because it often accompanies other types of abuse and is difficult to prove, it is rarely reported.

NEGLECT. Neglect—failure to satisfy a child's basic needs—can assume many forms. Physical neglect is the failure (beyond the constraints imposed by poverty) to provide adequate food, clothing, shelter, or supervision for a child. Emotional neglect is the failure to satisfy a child's normal emotional needs, or behavior that damages a child's normal emotional and psychological development (such as permitting drug abuse in the home). Failing to see that a child receives proper schooling or medical care is also considered neglect. Neglect was found in 52% of 1996 abuse cases.

Causes and symptoms

Physical abuse

Physical abuse, which can be triggered be such normal child behavior as crying or dirtying a diaper, often occurs when a parent loses control and lashes out at a child. Unlike nonabusive parents, who may become angry at or upset with their children from time to time but are genuinely loving, abusive parents tend to harbor deep-rooted negative feelings toward their children.

Child abuse: signs and symptoms

Although these signs do not necessarily indicate that a child has been abused, they may help adults recognize that something is wrong. The possibility of abuse should be investigated if a child shows a number of these symptoms, or any of them to a marked degree:

Sexual abuse

Being overly affectionate or knowledgeable in a sexual way inappropriate to the child's age

Medical problems such as chronic itching, pain in the genitals, venereal diseases

Other extreme reactions, such as depression, self-mutilation, suicide attempts, running away, overdoses, anorexia

Personality changes such as becoming insecure or clinging

Regressing to younger behavior patterns such as thumb sucking or bringing out discarded cuddly toys

Sudden loss of appetite or compulsive eating

Being isolated or withdrawn

Inability to concentrate

Lack of trust or fear of someone they know well, such as not wanting to be alone with a babysitter

Starting to wet again, day or night/nightmares

Become worried about clothing being removed

Suddenly drawing sexually explicit pictures

Trying to be "ultra-good" or perfect; overreacting to criticism

Physical abuse

Unexplained recurrent injuries or burns

Improbable excuses or refusal to explain injuries

Wearing clothes to cover injuries, even in hot weather

Refusal to undress for gym

Bald patches

Chronic running away

Fear of medical help or examination

Self-destructive tendencies

Aggression towards others

Fear of physical contact—shrinking back if touched

Admitting that they are punished, but the punishment is excessive (such as a child being beaten every night to "make him/her study")

Fear of suspected abuser being contacted

Emotional abuse

Physical, mental, and emotional development lags

Sudden speech disorders

Continual self-depreciation ("I'm stupid, ugly, worthless, etc.")

Overreaction to mistakes

Extreme fear of any new situation

Inappropriate response to pain ("I deserve this")

Neurotic behavior (rocking, hair twisting, self-mutilation)

Extremes of passivity or aggression

Neglect

Constant hunger Poor personal hygiene No social relationships

Constant tiredness Poor state of clothing Compulsive scavenging

Emaciation Untreated medical problems Destructive tendencies

A child may be subjected to a combination of different kinds of abuse. It is also possible that a child may show no outward signs and hide what is happening from everyone.

source: Kidscape, http://www.kidscape.org.uk/professionals/childabuse.shtml. Reprinted by permission.

Unexplained or suspicious bruises or other marks on the skin, such as burns, are common signs of physical abuse. Skull and other bone fractures are often seen in young children, and in fact, head injuries are the leading cause of death from abuse. Children less than a year old are particularly vulnerable to injury from shaking. This is called shaken baby syndrome or shaken impact syndrome. Not surprisingly, physical abuse also causes a wide variety of behavioral changes in children.

Sexual abuse

According to psychological experts, the two prerequisites for this form of maltreatment include sexual arousal to children and the willingness to act on this arousal. Factors that may contribute to this willingness include alcohol or drug abuse, poor impulse control, and the mistaken belief that such sexual behaviors are acceptable and not harmful to the child. The chances of abuse are higher if the child is developmentally handicapped or vulnerable in some other way.

Genital or anal injuries or abnormalities (including the presence of sexually transmitted diseases) can be signs of sexual abuse, but often there is no physical evidence. In fact, physical examinations of children in cases of suspected sexual abuse supply grounds for further suspicion only 15-20% of the time. Anxiety, poor academic performance, and suicidal tendencies are some behavioral signs of sexual abuse, but these are also found in children suffering other kinds of stress. Excessive masturbation and other unusually sexualized kinds of behavior are more closely associated with sexual abuse itself.

Emotional abuse

Emotional abuse can happen in many settings: at home, at school, on sports teams, and so on. Some of the possible symptoms include loss of self-esteem, sleep disturbances, head- or stomachaches, school avoidance, and running away from home.

Neglect

Many cases of neglect occur because the parent experiences strong negative feelings toward the child. At other times, the parent may truly care about the child, but lacks the ability or strength to provide for the child's needs adequately because they are handicapped by depression, drug abuse, mental retardation, or some other problem.

Neglected children often do not receive adequate nourishment or emotional and mental stimulation. As a result, their physical, social, emotional, and mental development is hindered. They may, for instance, be underweight, develop language skills less quickly than other children, and seem emotionally needy.

Diagnosis

Doctors and many other professionals who work with children are required by law to report suspected abuse to their state's CPS agency. Abuse investigations are often a group effort involving medical personnel, social workers, police officers, teachers, and others. Some hospitals and communities maintain child-protection teams that respond to cases of possible abuse. Careful questioning of the parents is crucial, as is interviewing the child (if he or she can speak). The investigators must ensure, however, that their questioning does not further traumatize the child. A physical examination for signs of abuse or neglect is, of course, always necessary, and may include x rays, blood tests, and other procedures.

Treatment

Notifying the appropriate authorities, treatment of the child's injuries, and protecting the child from further harm are the immediate priorities in abuse cases. If the child does not require hospital treatment, protection often involves placing him or her with relatives or in foster care. Once the immediate concerns are dealt with, it becomes essential to determine how the child's long-term medical, psychological, educational, and other needs can best be met, a process that involves evaluating not only the child's needs but also the family's (such as drug abuse counseling or parental skills training). If the child has brothers or sisters, the authorities must determine whether they have been abused as well. On investigation, signs of physical abuse are discovered in about 20% of the brothers and sisters of abused children.

Prognosis

Child abuse can have lifelong and devastating consequences. Research has shown that abused children and adolescents are more likely, for instance, to do poorly in school, suffer emotional problems, develop an antisocial personality, become promiscuous, abuse drugs and alcohol, and attempt suicide. As adults they may have trouble establishing intimate relationships. Whether professional treatment is able to moderate the long-term psychological effects of abuse is a question that remains unanswered.

Health care team roles

Nursing staff and allied health professionals can assist in the treatment of child abuse by being aware of physical symptoms and emotional reactions caused by abuse or neglect. During the diagnosis and treatment phase, nursing staff and allied health professionals can help patients and perpetrators by providing appropriate educational materials, and referrals to community and individual supportive programs.

Prevention

Government efforts to prevent abuse include home-visitor programs aimed at high-risk families, and school-based efforts to teach children how to respond to attempted sexual abuse.

When children reach age three, parents should begin teaching them about "bad touches" and about confiding in a trusted adult if they are touched or treated in a way that makes them uneasy. Parents also need to exercise caution in hiring babysitters and other caretakers. Anyone who suspects abuse should immediately report those suspicions to the police or his or her local CPS agency, which will usually be listed in the blue pages of the telephone book under Rehabilitative Services or Child and Family Services, or in the yellow pages. Round-the-clock crisis counseling for children and adults is offered by the Childhelp USA/IOF Foresters National Child Abuse Hotline. The National Committee to Prevent Child Abuse is an excellent source of information on the many support groups and other organizations that help abused and at-risk children and their families. One of these organizations, National Parents Anonymous, sponsors 2,100 self-help groups throughout the United States, Canada, and Europe. Telephone numbers for its local groups are listed in the white pages of the telephone book under Parents Anonymous or can be obtained by calling the national headquarters.

KEY TERMS

Child maltreatment— Another name for child abuse or neglect.

Munchausen syndrome by proxy— A rare form of physical abuse wherein a caretaker (most often the mother) seeks attention by making the child sick or appear to be sick.

Perpetrator— Any person who inflicts abuse of any form on a child, including neglect.

Resources

BOOKS

Krugman, Richard D. "Child Abuse & Neglect." In Pediatric Diagnosis & Treatment. Edited by William W. Hay, Jr., et al. Stamford, CT: Appleton & Lange, 1997.

ORGANIZATIONS

Childhelp USA/IOF Foresters National Child Abuse Hotline. (800) 422-4453.

National Clearinghouse on Child Abuse and Neglect Information. PO Box 1182, Washington, DC 20013-1182. (800) 394-3366. ?http://www.calib.com/nccanch?.

National Committee to Prevent Child Abuse. 200 S. Michigan Avenue, 17th Floor, Chicago, IL 60604. (312) 663-3520. ?http://www.childabuse.org?.

National Parents Anonymous. 675 W. Foothill Blvd., Suite 220, Claremont, CA 91711. (909) 621-6184. ?http://www.parentsanonymous.org?.