Child abuse

August 3, 2011

Child abuse or maltreatment occurs in many settings and places around the world. There are various kinds of abuse, and many times a child is the victim of more than one type of maltreatment. The spectrum of maltreatment includes physical abuse, emotional abuse, neglect, and sexual abuse. Issues of child labor and exploitation, lack of appropriate health care, food, shelter, and adequate sanitation pose big threats to the safety of children throughout the world. Any of these can have long-lasting negative psychological effects on a child.

The actual number of maltreated children in the world is unknown because many cases are never reported, and most countries do not have or do not enforce laws against child abuse. Estimates in the united States show that in the year 2000 there were 5 million children referred for investigation of potential abuse; 879,000 children were found to be victims of abuse. The rate of abuse was 12.2 per 1,000 children. (Reasons for not finding abuse were: no evidence of abuse or risk, or insufficient information available.) Sixty-three percent of these were neglect, 19% physical abuse, 10% sexual abuse, and 8% psychological abuse. About 1,200 children died in the year 2000 due to abuse. Forty-four percent of abuse victims were less than 1 year old, and 85% were less than age 6. Perpetrators of abuse are usually the parents or caretakers of a child.

Child abuse or maltreatment can occur in many different forms. Physical abuse is defined as an intentional act that causes harm to the body. Emotional abuse is verbal or behavioral actions that can impede a child’s psychological development. Behavioral actions such as rejection, isolation, criticism, or terrorizing a child are examples of emotional abuse. Neglect is defined as failure to provide appropriate needs to a child, and this may include omission of physical or emotional needs. For example, physical needs include food, clothing, and shelter, and emotional needs include appropriate nurturing for healthy development. Sexual abuse is when an adult uses a child for his or her own sexual gratification. One of the negative effects of the Internet is exploitation of children via pornographic photos now available throughout the world.

Child maltreatment occurs in most cultures and societies. Internationally, there are some types of abuse or neglect that are related to poverty, disease, war, or global economics. Street children found throughout the world may or may not be homeless, but poverty and home abuse are primary reasons for their taking to the streets to find money and food. AIDS and other diseases have left many children homeless. War has also killed many parents, leaving children homeless or in unstable family situations. In some societies, certain disciplinary procedures or rites of passage procedures (such as circumcision) are not regarded as maltreatment. Yet these procedures may induce significant psychological distress. In Kenya, for example, many boys would be hospitalized for hysterical paralysis shortly before they reached puberty and were required to undergo ritual circumcision. (Due to the global distribution of resources, millions of children live in poverty, are homeless, and are desperate for food, water, shelter, and warmth. Millions have no access to health care or education.)

In 1989, the United Nations adopted the Convention on the Rights of the Child (CRC), which grants children rights relating to their civil, political, economic, and cultural lives. Although many countries passed laws regarding these rights, children continue to suffer violations of these rights. They continue to be the victims of child labor, neglect, sexual exploitation, physical and emotional abuse, and are subject to the effects of armed conflict and the lack of access to education, health care, safe water, and sanitation facilities.

Diagnosing or identifying abuse can be difficult. (It can be difficult to document maltreatment in many cases.) Legal definitions may vary from state to state. In the United States, professionals such as physicians, nurses, or teachers are mandated by law to report to the police or child protection services if they suspect a child is being maltreated. Certainly, abuse can sometimes be obvious, but mistakes have been made about what appears obvious. For example, parents have been accused of abuse when their children developed “black eyes” related to an eye tumor or after they had used “coining” as a treatment for fever. In many circumstances, it is hard to know if a child is being maltreated or is at risk for abuse. If someone suspects a child is being abused, those accusations should be taken seriously. Definitions may vary, but there are some guidelines available to help identify the various forms of abuse. Physical abuse should be suspected in a child with an injury or repeated injuries that cannot be explained or when an injury is not likely to have occurred as explained by the caretaker. Emotional abuse should be suspected if a parent is repeatedly verbally attacking a child, or ignoring or rejecting the child. Neglect can be identified by noting inadequate clothing, poor hygiene, or nutritional deprivation. Other clues to potential abuse include a child who is acting out, who runs away from home, who attempts to hurt or kill him/herself, or who reports that he/she is being abused. As these children grow, they may develop psychological problems, such as depression, anger, and eating disorders. Substance abuse, criminal behavior, and suicide are increased in abused children. Behaviors such as these may also lead one to suspect that a child has been maltreated.

There are a number of theories about what factors place a child at risk for abuse. Parents who abuse their children have been reported from most ethnic, geographic, religious, educational, occupational, and socioeconomic groups. Poverty is a significant risk factor for abuse in children. This may be due to several factors, such as increased stress due to unemployment, overcrowding, lack of food, and other necessities. Other factors that contribute to the occurrence of child abuse in poverty-stricken families include limited social support, higher incidence of violence in their community, teenage and single parenthood, and substance abuse. Mentally retarded or handicapped children are at increased risk for abuse. Many abusive parents have experienced abuse as children.

Trying to identify risk factors for abuse is an important means for prevention, and is a focus of research today. Some studies are looking at parental attributions as characteristics of risk for child-abusive parenting. Some studies are looking at characteristics of children that may predispose to maltreatment. Parental attitude toward a child may be more significant than actual characteristics of the child.

Treatment for a child who is being or has been abused may require many modalities. In the United States, it is mandatory to report to the Child Protective Services any child suspected of being a victim of abuse. Assessment of and treatment for physical injuries must be addressed immediately. A caseworker is then involved to help decide how to protect the child. First, it is important to place a child in a safe environment. This sometimes involves removing parental rights. The usual goal is to keep a child with a parent or eventually return a child to his/her home if at all possible. This can be a very difficult decision if there is the potential for further abuse in the home. Many times a child is returned to a home where abuse continues, if the risks were not fully identified. Other times the child may be placed by the court with relatives or in a foster home. If a child is to return to his/her home, it is important that the parent perpetrator receive psychotherapy and that social services continue observation of the child for months or years after the return.

A child is traumatized by abuse, as well as by removal from his/her parent. Counseling is very important to an abused child. This may involve talking or play therapy, directed at helping a child cope with fears and anxieties. Some children feel responsible if a parent has been jailed and this issue must be addressed in therapy. Most hospitals have teams trained in managing child abuse. Members of these teams are on call to assist these children in the emergency room or hospital. As children of abuse grow to adulthood, the management of their “posttraumatic” psychological effects of abuse is ongoing.

Prevention of child abuse is also multifaceted. Identifying at-risk families is a major goal. Parenting classes may help inexperienced mothers learn appropriate behavior and nonviolent discipline techniques. Stress management skills for parents are helpful in reducing stress and anger in difficult life situations. Support groups, and support from family, friends, or others in the community can help. Members of the groups should be encouraged to ask for respite if they feel likely to abuse their children. Keeping weapons out of the home will also help. In many states, there are laws to inform communities when pedophiles are released from prison. Increased community awareness about the location of potential abusers is likely to increase safety of the children in that community.

SEE ALSO: Domestic violence, Sexual abuse

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