Child abuse (Forensic Science)
Child abuse is a serious crime whose victims’ psychological and physical scars often last for years. Child abuse cases are typically difficult to investigate and prosecute, but the tools of modern forensic science are making important contributions in identifying and convicting offenders. Teamwork plays a special role in these investigations, which typically involve not only law-enforcement professionals but also social workers, mental health providers, physicians, and others.
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Forms of Abuse (Forensic Science)
Both sociological and legal definitions of child abuse and molestation have varied over time. “Child abuse” and “child molestation” can be subsumed under the more inclusive phrase “child maltreatment,” which encompasses neglect, child endangerment, emotional and psychological abuse, physical abuse, and sexual abuse. Perhaps the most common form of child maltreatment is neglect—the failure to provide minor children with the most basic needs of food, shelter, clothing, education, and medical care.
Legal definitions of child abuse and subtypes of abuse are codified in state statutes and vary among jurisdictions. In contrast to sociological definitions, which may be vague and open to different interpretations, legal definitions and individual statutes spell out exactly what behaviors are illegal. For example, when adults who are legally responsible for the care of children expose those children to dangerous conditions, the adults are guilty of child endangerment. Examples of endangerment range from leaving young children unattended in parked cars while running errands to leaving minors completely alone in their homes for extended periods.
Physical abuse takes many forms that are easy to define—hitting, slapping, punching, kicking, beating, striking with objects, stabbing, cutting, burning, and choking. Somewhat less obviously abusive but equally serious is the violent shaking of infants or toddlers, which...
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Criminal Investigations (Forensic Science)
The gathering and preservation of evidence in child abuse investigations can be a daunting job. police investigators must find out what has happened, how it happened, and other information in order to make arrests and bring offenders to justice. The forensic sciences provide important tools for collecting evidence in these crimes.
The first step in collecting evidence of abuse in cases that are reported is to determine when the crimes occurred and how much time has elapsed since the crimes took place. When child abuse is reported immediately after incidents occur, police can usually collect more physical evidence than in cases in which longer periods of time have elapsed.
The clothing worn by victims during times when they have been abused often provides valuable physical evidence. Hairs and traces of tears, dirt, blood, and semen found on clothing can be used as direct evidence of crimes. Investigators also comb the crime scenes, which often contain such physical evidence as bloodstains, hair samples, semen stains, and fragments of damaged clothing. All items that are collected must be carefully packaged, labeled, analyzed, and protected for use in court.
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Medical Evidence of Abuse (Forensic Science)
Most injury evidence can be documented through medical procedures. Ideally, victims of child abuse should receive physical examinations by qualified physicians as quickly as possible. Indeed, in most cases of physical abuse of children, physicians discover evidence that maltreatment has occurred in the injuries themselves. For example, spiral arm fractures provide almost conclusive evidence of abuse, as such fractures are caused by arm twisting and can occur in almost no other way.
Another almost conclusive sign of child abuse that may be detected by physicians is traumatic alopecia—the forceful pulling of hair or breaking of hair shafts by friction, traction, or other forms of physical trauma. Traumatic alopecia occurs when abusers deliberately pull the hair of their child victims. Hair pulling can cause hemorrhaging under the scalp, which has a rich supply of blood vessels. Accumulations of blood under the scalp are often important clues in differentiating between abusive and nonabusive hair loss.
Medical evaluations can discover evidence of shaken baby syndrome, which is responsible for at least half the deaths of victims of child abuse. Vigorous shaking of an infant or toddler causes a number of medical conditions that physicians can read as signs of the syndrome. These include closed-head injuries that are evidenced by altered levels of consciousness, coma, convulsions, or death; central nervous system...
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DNA Evidence (Forensic Science)
Although many proven forensic science techniques are helpful in the investigation of child abuse, perhaps nothing has helped solve more crimes in this area than DNA (deoxyribonucleic acid) testing. DNA carries coded genetic information that determines individual traits. Analyses of DNA samples can be used to identify the persons from whom the samples come. DNA testing was first used in criminal investigations during the early 1980’s and almost immediately became one of the most valuable tools available to forensic science.
Many parts of human DNA are the same in different persons; however, the parts found in nonfunctioning sequences vary greatly. The variable parts can be matched to single individuals. In criminal child abuse cases, investigators often collect samples of fluids, hairs, and tissues left behind on victims by their abusers. These samples are then compared with samples taken from suspected perpetrators. When samples are found to match, the possibilities of misidentification are remote. DNA testing requires only small amounts of sample material. Bloodstains the size of a dime and semen samples the size of a quarter are usually sufficient. Results of analyses are usually obtained within four to six weeks. DNA evidence has been used successfully in the prosecution of many perpetrators of child abuse.
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Further Reading (Forensic Science)
Barkan, Steven E. Criminology: A Sociological Understanding. 3d ed. Upper Saddle River, N.J.: Pearson Prentice Hall, 2006. Examines criminal justice issues from a sociological perspective. Includes discussion of child abuse.
Buzawa, Eve S., and Carl G. Buzawa. Domestic Violence: The Criminal Justice Response. 3d ed. Thousand Oaks, Calif.: Sage, 2003. Presents information on how law-enforcement agencies and the courts approach cases of child and spousal abuse.
Fontes, Lisa Aronson, ed. Sexual Abuse in Nine North American Cultures: Treatment and Prevention. Thousand Oaks, Calif.: Sage, 1995. Collection of essays discusses the characteristics of child sexual abuse in various cultural communities in North America.
Monteleone, James A. A Parent’s and Teacher’s Handbook on Identifying and Preventing Child Abuse. St. Louis: G. W. Medical Publishing, 1998. Provides valuable information on the signs and symptoms of child abuse for lay readers.
_______, ed. Child Abuse: Quick Reference for Healthcare Professionals, Social Services, and Law Enforcement. St. Louis: G. W. Medical Publishing, 1998. Illustrated guide is designed to help those who might come into contact with abused children in their professional capacities.
Walker, Lenore E. A., and David L. Shapiro. Introduction to Forensic Psychology: Clinical and Social Psychological Perspectives. New...
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Introduction (Psychology and Mental Health)
It is difficult to imagine anything more frightening to a child than being rejected, threatened, beaten, or molested by an adult who is supposed to be his or her primary source of nurturance and protection. Yet throughout human history, children have been abandoned, incarcerated, battered, mutilated, and even murdered by their caregivers. Although the problem of child maltreatment is an old one, both the systematic study of child abuse and the legally sanctioned mechanisms for child protection are relatively new and gained momentum in the last half of the twentieth century.
In the United States, child abuse and neglect are defined in both federal and state legislation. The federal legislation provides a foundation for states by identifying a minimum set of acts or behaviors that characterize maltreatment. This legislation also defines what acts are considered physical abuse, neglect, and sexual abuse.
The Child Abuse Prevention and Treatment Act (CAPTA) of 1974 as amended in 1996 defines child abuse and neglect as, at a minimum, any recent act or failure to act on the part of a parent or caretaker that results in death, serious physical or emotional harm, or sexual abuse or exploitation or an act or failure to act that presents an imminent risk of serious harm.
When applied by legal and mental health professionals in real-world situations, however, the definition of abuse may vary according to the developmental...
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Types of Abuse (Psychology and Mental Health)
Physical abuse is characterized by the infliction of physical injury as a result of punching, beating, kicking, biting, burning, shaking, or otherwise harming a child. The parent or caretaker may not have intended to hurt the child; rather, the injury may have resulted from overdiscipline or physical punishment. Child neglect is characterized by failure to provide for the child’s basic needs. Neglect can be physical, educational, or emotional. Physical neglect includes refusal of, or delay in, seeking health care; abandonment; expulsion from the home or refusal to allow a runaway to return home; and inadequate supervision. Educational neglect includes the allowance of chronic truancy, failure to enroll a child of mandatory school age in school, and failure to attend to a special educational need. Emotional neglect includes such actions as marked inattention to the child’s needs for affection; refusal of or failure to provide needed psychological care; spouse abuse in the child’s presence; and permission of drug or alcohol use by the child. The assessment of child neglect requires consideration of cultural values and standards of care, as well as recognition that the failure to provide the necessities of life may be related to poverty.
Sexual abuse includes fondling a child’s genitals, intercourse, incest, rape, sodomy, exhibitionism, and commercial exploitation through prostitution or the production of pornographic...
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Extent of Abuse (Psychology and Mental Health)
Estimates of the extent of child abuse in the United States have ranged from two hundred thousand to four million cases per year. The most widely accepted incidence figure comes from the National Committee for the Prevention of Child Abuse, which estimated that in 1999, 826,000 children were “severely abused,” including more than one thousand abuse-related deaths. It is important, when considering the actual magnitude of the problem of child maltreatment, to remember that the estimates given most likely underestimate the true incidence of child abuse, both because of the large number of cases that go unreported and because of the lack of agreement as to precisely which behaviors constitute “abuse” or “neglect.” In addition, abusive treatment of children is rarely limited to a single episode, and it frequently occurs within the context of other forms of family violence.
Certain forms of maltreatment seem to appear with greater regularity within certain age groups. Neglect is most often reported for infants and toddlers, with incidence declining with age. Reports of sexual abuse and emotional maltreatment are most common among older school-aged children and adolescents. Physical abuse seems to be reported equally among all age groups; however, children less than five years old and adolescents have the highest rates of actual physical injury. Victimization rates by race and ethnicity ranged from a low of 4.4...
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Consequences of Abuse (Psychology and Mental Health)
Abused children are believed to be at much greater risk of developing some form of pathology in childhood or in later life. When considered as a group and compared to nonabused youngsters, abused children exhibit a variety of psychological difficulties and behavioral problems. Yet no single emotional or behavioral reaction is consistently found in all abused children. It is important, when investigating the impact of child abuse, to view the abuse within a developmental perspective. Given a child’s different developmental needs and capabilities over the course of his or her development, one might expect that both the psychological experience and the impact of the abuse would be quite different for an infant than if the same maltreatment involved an eight-year-old child or an adolescent. One should also note that the abuse occurs within a particular psychological context, and that the experience of the abuse per se may not be the singular, most powerful predictor of the psychological difficulties found in abused children. Rather, the child’s daily exposure to other, more pervasive aspects of the psychological environment associated with an abusive family situation (for example, general environmental deprivation, impoverished parent-child interactions, or chronic family disruption and disorganization) may prove to be more psychologically damaging. Finally, it is important not to view the range of symptoms associated with...
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Signs of Abuse (Psychology and Mental Health)
In infancy, the earliest sign of abuse or neglect is an infant’s failure to thrive. These infants show growth retardation (weight loss can be so severe so as to be life-threatening) with no obvious physical explanation. To the observer, these infants appear to have “given up” on interacting with the outside world. They become passive, socially apathetic, and exhibit little smiling, vocalization, and curiosity. Other abused infants appear to be quite irritable, exhibiting frequent crying, feeding difficulties, and irregular sleep patterns. In either case, the resulting parent-child attachment bond is often inadequate and mutually unsatisfying.
Abused toddlers and preschoolers seem to lack the infectious love of life, fantasy, and play that is characteristic of that stage of development. They are typically anxious, fearful, and hypervigilant. Their emotions are blunted, lacking the range, the spontaneity, and the vivacity typical of a child that age. Abused toddlers’ and preschoolers’ ability to play, particularly their ability to engage in imaginative play, may be impaired; it is either deficient or preoccupied with themes of aggression. Abused children at this age can either be passive and overcompliant or oppositional, aggressive, and hyperactive.
School-aged children and adolescents exhibit the more recognizable signs of low self-esteem and depression in the form of a self-deprecating attitude and...
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Explanations (Psychology and Mental Health)
Child maltreatment is a complex phenomenon that does not have a simple, discrete cause, nor does it affect each victim in a predictable or consistent manner. Since “battered child syndrome” gained national attention in the early 1960’s, theories attempting to explain child maltreatment have evolved from the simplistic psychiatric model focusing on the abuser as a “bad” parent suffering from some form of mental illness to a view of child abuse as a multidetermined problem, with anyone from any walk of life a potential abuser.
Perhaps the most comprehensive and widely accepted explanation of child abuse is the ecological model. This model views abuse as the final product of a set of interacting factors, including child-mediated stressors (for example, temperamental difficulties or a mental or physical handicap), parental predispositions (for example, history of abuse as a child, emotional immaturity), and situational stresses (for example, marital conflict, insufficient social support, or financial stress) occurring within a cultural context that inadvertently supports the mistreatment of children by its acceptance of corporal punishment and tolerance for violence and its reluctance to interfere with family autonomy. Utilizing this ecological framework, one can imagine how an abusive situation can develop when, for example, an irritable, emotionally unresponsive infant is cared for by an inexperienced, socially isolated...
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Sources for Further Study (Psychology and Mental Health)
Bass, Ellen, and Laura Davis. The Courage to Heal: A Guide for Women Survivors of Child Sexual Abuse. New York: Collins Living, 2008. Using firsthand stories from women who have suffered child abuse, the authors show the deleterious effects of abuse and the emotional passages experienced by the abused as they work toward a positive future. Includes a bibliography and a list of self-help programs.
Briere, John N. Child Abuse Trauma. Newbury Park, Calif.: Sage Publications, 1992. Considers the unique and overlapping long-term effects of all major forms of child abuse. Includes information on seven types of child abuse and neglect—ranging from sexual and physical abuse to mistreatment by alcoholic or drug-addicted parents.
Cicchetti, Dante, and Vicki Carlson, eds. Child Maltreatment: Theory and Research on the Causes and Consequences of Child Abuse and Neglect. New York: Cambridge University Press, 1997. Edited chapters by leading experts in the field provide state-of-the-art evaluations of what is known about the causes and consequences of child maltreatment. Describes the history of child maltreatment and intervention strategies designed to prevent or remediate the negative consequences of abuse.
Clark, Robin E., and Judith Freeman Clark. The Encyclopedia of Child Abuse. 3d ed. New York: Facts On File, 2007. In encyclopedic form, this resource provides comprehensive...
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Child Abuse (Encyclopedia of Medicine)
Child abuse is the 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.
Prevalence of abuse
Child abuse was once viewed as a minor social problem affecting only a handful of United States children. However, in recent years it has received close attention from the media, law enforcement, and the helping professions, and with increased public and professional awareness 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, experts suggest that its true prevalence is possibly much greater than the official data indicate. In 1996, more than three million victims of alleged abuse were reported to child protective services (CPS) agencies in the United States, and the reports were substantiated in more than one million cases. Put another way, 1.5% of the country's children were confirmed victims of abuse in 1996. Parents were the abusers in 77% of the confirmed cases, other relatives in...
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Child Abuse (Encyclopedia of Psychology)
The act of harming children by neglect, physical force, violence, sexual attack, or by inflicting psychological or emotional distress.
For much of history, children were considered the property of parents. The family system was rarely, if ever, intervened upon by society. If a mother or father routinely abused their children, the abuse went unnoticed, or if noticed, merely ignored. It was largely considered a parent's prerogative to do whatever he or she wanted with their child.
Over the past several decades, however, the issue and, seemingly, the prevalence of child abuse have become widespread. Psychologists question whether the number of child abuse cases indicates increased occurrences of abuse or increased public awareness that encourages more reporting.
The first detailed account of the abuse of children was published in 1962 by Harry Hemke in an article titled "The Battered Child Syndrome," and since then there have been numerous articles and books published on this subject.
Over the years, child abuse has been categorized into four types, although many psychologists dispute the usefulness of doing so. In compiling statistics on abuse, the
The following organizations operate hotlines or provide advice for...
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Child Abuse (Encyclopedia of Children's Health)
Child abuse is the blanket term for four types of child mistreatment: physical abuse, sexual abuse, emotional abuse, and neglect.
Prevalence of abuse
Child abuse was once viewed as a minor social problem affecting only a handful of U.S. children. However, in the late 1990s and early 2000s it has received close attention from the media, law enforcement, and the helping professions, and with increased public and professional awareness has come a sharp rise in the number of reported cases. Because abuse is often hidden from view and its victims too young or fearful to speak out, however, experts suggest that its true prevalence is possibly much greater than the official data indicate. An estimated 896,000 children across the country were victims of abuse or neglect in 2002, according to national data released by the U.S. Department of Health and Human Services (HHS) in April 2004. Parents were the abusers in 77 percent of the confirmed cases, other relatives in 11 percent. Sexual abuse was more likely to be committed by males, whereas females were responsible for the majority of neglect cases. The data show that child protective service agencies received about...
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Child Abuse (West's Encyclopedia of American Law)
Physical, sexual, or emotional mistreatment or neglect of a child.
CHILD ABUSE has been defined as an act, or failure to act, on the part of a parent or caretaker that results in the death, serious physical or emotional harm, SEXUAL ABUSE, or exploitation of a child, or which places the child in an imminent risk of serious harm (42 U.S.C.A. § 5106g). Child-abuse laws raise difficult legal and political issues, pitting the right of children to be free from harm, on the one hand, against the right of families to privacy and the rights of parents to raise and discipline their children without government interference, on the other.
The mistreatment of children at the hands of parents or caretakers has a long history. For centuries, this behavior was shielded by a system of laws that gave children few, if any, rights. Under English COMMON LAW, children were treated as property owned by the parents. Parents, particularly fathers, had great latitude over the treatment and discipline of children. This outlook was carried to the American colonies and incorporated into early laws in the United States.
One of the first cases to bring national attention to child abuse arose in the early 1870s. An eight-year-old New York orphan named Mary Ellen Wilson...
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Child Abuse (Encyclopedia of Nursing & Allied Health)
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.
Prevalence of abuse
Child abuse was once viewed as a minor social problem affecting only a handful of children in the United States. 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 child abuse in the United States 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 205% of females and 105% 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. Neglectailure to satisfy a child's basic needsan 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, 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
|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 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|
|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|
|Chronic running away|
|Fear of medical help or examination|
|Aggression towards others|
|Fear of physical contacthrinking 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|
|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|
|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.|
are genuinely loving, abusive parents tend to harbor deep-rooted negative feelings toward their children.
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.
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 150% 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 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.
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.
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 inter- viewing 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.
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.
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.
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.
Child maltreatmentnother name for child abuse or neglect.
Munchausen syndrome by proxy rare form of physical abuse wherein a caretaker (most often the mother) seeks attention by making the child sick or appear to be sick.
Perpetratorny person who inflicts abuse of any form on a child, including neglect.
Krugman, Richard D. "Child Abuse & Neglect." In Pediatric Diagnosis & Treatment. Edited by William W. Hay, Jr., et al. Stamford, CT: Appleton & Lange, 1997.
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. <<a href="http://www.calib.com/nccanch">http://www.calib.com/nccanch>.
National Committee to Prevent Child Abuse. 200 S. Michigan Avenue, 17th Floor, Chicago, IL 60604. (312) 663-3520. <<a href="http://www.childabuse.org">http://www.childabuse.org>.
National Parents Anonymous. 675 W. Foothill Blvd., Suite 220, Claremont, CA 91711. (909) 621-6184. <<a href="http://www.parentsanonymous.org">http://www.parentsanonymous.org>.
Bethea, Lesa. "Primary Prevention of Child Abuse.". American Family Physician (March 15, 1999). <<a href="http://www.aafp.org/afp/990315ap/1577.html">http://www.aafp.org/afp/990315ap/1577.html>.