child abuse

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Child abuse

 

Definition


Child abuse, sometimes called child maltreatment, describes four types of child mistreatment: physical abuse, sexual abuse, psychological 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, caregivers such as teachers or babysitters, acquaintances (including other children), and (in very rare instances) strangers.

Description

Prevalence of abuse


Child abuse was once viewed as a minor social problem affecting only a handful of American children. However, in the late twentieth century, issues of child welfare came under closer scrutiny by the media, law enforcement, and the helping professions. This increase in public and professional awareness led to a sharp rise in the number of reported cases of child abuse. Today child abuse is recognized as a problem that occurs among households or all racial, ethnic, and income levels, although the incidence of reported cases is higher in low-income households where adult caregivers experience greater financial stress and social difficulties, have less education and less understanding of child development, and may have less access to social services. In addition, children of parents who are substance abusers are more likely to experience abuse than children living in households where there is no substance abuse. Many child abusers were themselves abused as children.
According to the United States Department of Health and Human Services Administration for Children and Families, in 2006 in the United States Child Protective Services (CPS) investigated almost reports of child abuse of almost 3.6 million children. Of these, approximately 905,000 children, or about 12 children per 1,000 population, were documented victims of child maltreatment. Nearly three-quarters of these children were victims of repeated maltreatment. In addition, 1,530 child fatalities resulted from child abuse. Of these, about three-quarters of the children were under age four, with the largest number of deaths occurring in infants under one year old. Nearly 83% of abused children were abused by a parent or a parent acting with another individual. Child abuse almost always occurs in private, and because abuse often is hidden from view and its victims may be too young or too frightened to speak out, experts suggest that its true prevalence is probably greater than the official data indicate.

Physical abuse


Physical abuse is the nonaccidental infliction of physical injury to a child. The abuser is usually a family member or other caregiver, and is more likely to be male The injuries can be inflicted by punching, kicking, biting, burning, beating, or use of a weapon such as a baseball bat or knife. Physical abuse can result in bruises, burns, poisoning, broken bones, and internal hemorrhages. A rare form of physical abuse is Munchausen syndrome by proxy, in which a caregiver (most often the mother) seeks attention by intentionally making the child sick or appear to be sick.

Sexual abuse


Sexual abuse is any activity with a child occurring before the age of legal consent that is for the sexual gratification of an adult or a significantly older or dominant child. Sexual behaviors can include touching breasts, genitals, and buttocks while the victim is either dressed or undressed. Sexual abuse behavior also includes exhibitionism, cunnilingus, fellatio, or penetration of the vagina or anus with sexual organs or objects. Pornographic photography also is a form of sexual abuse of children. The U.S. Department of Justice estimates that one in six victims of a sexual assault are under age 12. Despite publicity surrounding cases where a child is assaulted by a stranger, almost all sexual abuse against children is perpetrated by a family member (e.g. father, stepfather, aunt, uncle, sibling, cousin) or family intimate (e.g., live-in lover or friend of the parent).
Rape is the most violent form of sexual abuse. Rape is the perpetration of an act of sexual intercourse when:
  • will is overcome by force or fear (from threats, use of weapons, or use of drugs).

  • mental impairment renders the victim incapable of rational judgment.

  • if the victim is below the legal age established for consent.

According the U.S. Department of Justice, 54% of all rapes are of women under age 18.
Child Abuse: Signs And SymptomsAlthough 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 clingy 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 becoming withdrawn Inability to concentrate Lack of trust or fear someone they know well, such as not wanting to be alone with a babysitter or specific family member Starting to wet bed again, day or night/nightmares Become worried about clothing being removed Suddenly starting to draw sexually explicit pictures Trying to be "ultra-good" or perfect; overreacting to criticismPhysical 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 contactedPsychological Abuse Physical, mental, and psychological developmental lags Sudden speech disorders Continual self-depreciation (e.g.,I'm stupid, ugly, worthless) Overreaction to mistakes Extreme fear of any new situation Inappropriate response to pain (e.g., I deserve this) Neurotic behavior (e.g., rocking, hair twisting, self-mutilation) Extremes of passivity or aggressionNeglect Constant hunger Poor personal hygiene No social relationships Constant tiredness Poor state of clothing Compulsive scavenging Emaciation Untreated medical problems Destructive tendenciesA 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.

Psychological abuse


Psychological abuse encompasses rejection, ignoring, criticizing, belittling, humiliating, threatening the child with violence, or otherwise terrorizing the child, all of which have the effect of eroding the child's self-esteem and sense of security. It also can include isolating the child from friends or other family members or destroying the child's property. Psychological abuse often accompanies other types of abuse. It is difficult to prove and is rarely reported.

Neglect


Neglect is the failure to satisfy a child's basic needs. It can assume many forms. Physical neglect is the failure (beyond the constraints imposed by poverty) to provide adequate food, clothing, shelter, or supervision. Psychological neglect is the failure to satisfy a child's normal psychological needs and/or behavior that damages a child's normal psychological development (e.g., permitting drug abuse in the home, having the child witness domestic violence). Failing to see that a child receives proper schooling and medical care also are considered neglect. Most of the cases reported to CPS involve neglect.

Causes and symptoms

Physical abuse


The usual physical abuse scenario involves a parent who loses control and lashes out at a child. The trigger may be normal child behavior such as crying or dirtying a diaper. Often caregivers who are abusers have little understanding of child development and have unrealistically high expectations of what young children are capable of doing for themselves and poor anger management skills. The child abuser is often a regular user of drugs or alcohol.
Unexplained or suspicious bruises or burns on the skin are typical signs of physical abuse. Skull and other bone fractures are often seen in young abused children. Head injuries are the leading cause of death in abused children. Children less than one year old are particularly vulnerable to brain injury from shaking. This is called battered child syndrome or shaken baby syndrome. Physical abuse also causes a wide variety of negative behavioral changes in children.

Sexual abuse


Factors that may contribute to the sexual abuse of children include alcohol or drug abuse, poor impulse control, and a belief that the 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 that the child has been sexually abused. Anxiety, poor academic performance, and suicidal conduct are some of the behavioral signs of sexual abuse, but these behaviors also are found in children experiencing other kinds of stress. Excessive masturbation and unusually sexually precocious behaviors are often indicative of sexual abuse.

Psychological abuse


Psychological abuse can happen in many settings including at home, at school, and on sports teams. Some of the possible symptoms include loss of self-esteem, sleep disturbances, headaches or stomach aches, school avoidance, and anxiety. Psychological abuse is difficult to pinpoint, as the child may believe that the behavior is normal and something all children experience.

Neglect


Neglect may occur because the parent/guardian experiences strong negative feelings toward the child or because the parent/guardian lacks the ability or strength to adequately provide for the child's needs because he or she is handicapped by drug abuse, alcoholism, mental retardation, clinical depression, schizophrenia, or some other mental health problem.
Neglected children often do not receive adequate nourishment or psychological and mental stimulation. As a result, their physical, social, psychological, and mental development is hindered. They may, for instance, be underweight, develop language skills less quickly than other children, and seem psychologically 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 often are a group effort involving medical personnel, social workers, police officers, 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 is capable of being interviewed). Trained investigators must ensure, however, that their questioning does not further traumatize the child an also that their style of questioning does not prompt the child to give the answers the child thinks the questioner wants rather than accurate answers. A physical examination for signs of abuse or neglect is necessary and may include x rays, blood tests, and other procedures.

Treatment


Notification of 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 a group home or 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. This process involves evaluating not only the child's needs but also the needs of the family's (e.g., drug abuse counseling, parental skills training, anger management training). The authorities also must determine whether other children living in the same household also have been abused. On investigation, signs of physical abuse are discovered in about 20% of other children living in the abused child's household.

Prognosis


Child abuse can have lifelong consequences. Research shows that abused children and adolescents are more likely to do poorly in school, experience depression, extreme anger, antisocial personality traits and other psychiatric problems. They also are more likely to become promiscuous, abuse drugs and alcohol, run away, and attempt suicide. As adults they often have trouble establishing intimate relationships. Long-term therapy by a professional trained in working with abused children and adults offers the best chance of overcoming childhood abuse.

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. Psychological abuse prevention has been promoted through the media.
When children reach age three, parents should begin teaching them about "bad touches" and about confiding in a suitable 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 caregivers. Anyone who suspects abuse should report those suspicions to the police or his or her local CPS agency. Prevent Child Abuse America (listed in references) 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, Parents Anonymous, sponsors local self-help groups throughout the United States, Canada, and Europe.

For Your Information

Resources


American Help Hotlines

  • Childhelp National Child Abuse Hotline 1-800-4-A-CHILD. TDD for the Deaf 1-800-2-A-Child. Help for children who are being abused or adults who are concerned that a child they know is being abused or neglected.

  • Rape, Abuse and Incest National Network (RAINN) Online hotline http://www.rainn.org/get-help/national-sexual-assault-online-hotline or telephone: 1-800-656-HOPE. Online counseling and referral to local rape crisis centers using anonymous instant messaging or telephone counseling and referrals to local crisis center.

Websites

  • "Child Abuse." MedlinePlus, National Institutes of Health. December 4, 2008 [cited December 17, 2008]. http://www.nlm.nih.gov/medlineplus/childabuse.html.

  • "Child Welfare Information Gateway." United States Department of Health and Human Services. December 1, 2008 [cited December 17, 2008]. http://www.childwelfare.gov.

Organizations

  • Prevent Child Abuse America. 500 North Michigan Avenue, Suite 200, Chicago, IL 60611-3703. Telephone: 1-800-CHILDREN or (312) 663-3520. Fax: (312) 939-8962 email: mailbox@preventchildabuse.org Web site: http://www.preventchildabuse.org

  • Parents Anonymous. 675 W. Foothill Blvd., Suite 220, Claremont, CA 91711-3475. Telephone: (909) 621-6184. Fax: (909) 625-6304. Web site: http://www.parentsanonymous.org

Child sexual abuse
Negligence
Physical abuse
Child abuse
Abused children
Psychological child abuse

abuse

 [ah-būs´]
misuse, maltreatment, or excessive use.
child abuse see child abuse.
domestic abuse abuse of a person by another person with whom the victim is living, has lived, or with whom a significant relationship exists. The abuse may take the form of verbal abuse, sexual abuse, physical battering, or psychological (emotional) unavailability. Abuse is a learned behavior and has an escalating cycle; abusive behavior cuts across all racial, ethnic, educational, and socioeconomic boundaries.
drug abuse see drug abuse.
elder abuse maltreatment of an older adult, ranging from passive neglect of needs to overt mental, physical, or sexual assault.
physical abuse any act resulting in a nonaccidental physical injury, including not only intentional assault but also the results of unreasonable punishment.
psychoactive substance abuse substance abuse.
sexual abuse any act of a sexual nature performed in a criminal manner, as with a child or with a nonconsenting adult, including rape, incest, oral copulation, and penetration of genital or anal opening with a foreign object. The term also includes lewd or lascivious acts with a child; any sexual act that could be expected to trouble or offend another person when done by someone motivated by sexual interest; acts related to sexual exploitation, such as those related to pornography, prostitution involving minors, or coercion of minors to perform obscene acts.
substance abuse a substance use disorder characterized by the use of a mood or behavior-altering substance in a maladaptive pattern resulting in significant impairment or distress, such as failure to fulfill social or occupational obligations or recurrent use in situations in which it is physically dangerous to do so or which end in legal problems, but without fulfilling the criteria for substance dependence. Specific disorders are named for their etiology, such as alcohol abuse and anabolic steroid abuse. DSM-IV includes specific abuse disorders for alcohol, amphetamines or similar substances, cannabis, cocaine, hallucinogens, inhalants, opioids, PCP or similar substances, and sedatives, hypnotics, or anxiolytics. See also drug abuse.

child

 [chīld]
the human young, from infancy to puberty.
child abuse the nonaccidental use of physical force or the nonaccidental act of omission by a parent or other custodian responsible for the care of a child. Child abuse encompasses malnutrition and other kinds of neglect through ignorance as well as deliberate withholding from the child of the necessary and basic physical care, including the medical and dental care necessary for the child to grow up without threat to his or her physical and emotional survival. Examples of physical abuse range from burns and exposure to extreme cold to beating, poisoning, strangulation, and withholding of food and water. Members of the health care team should be alert for signs of child abuse and aware of the proper procedure for reporting suspected cases to local authorities.

Abusive parents come from all socioeconomic groups. Many have themselves been abused as children. They typically lack parenting skills and do not understand the normal developmental stages through which children progress and demand performance from their children that is clearly beyond a child's capability. Some engage in role reversal, looking to the child for protection and loving response, while at the same time denying the child satisfaction of his or her own needs. The majority of identified abusive parents are believed to want professional help in changing their behavior.
abused child/adult in the omaha system, a client problem in the psychosocial domain, defined as a child or adult subjected to nonaccidental physical or emotional injury.
autistic child a child suffering from autistic disorder.
exceptional child a child with special learning needs; he or she may have learning disabilities, be handicapped, or be gifted.
neglected child/adult in the omaha system, a client problem in the psychosocial domain, defined as a child or adult deprived of minimally accepted standards of food, shelter, clothing, and care.

child a·buse

the psychological, emotional, and sexual abuse of a child, typically by a parent, stepparent, or parent surrogate. See: domestic violence.

child abuse

the physical, sexual, or emotional maltreatment of a child. Child abuse predominantly affects children less than 3 years of age and is the result of multiple and complex factors involving both the parents and the child, compounded by various stressful environmental circumstances, such as inadequate physical and emotional support within the family and any major life change or crisis, especially those crises arising from marital strife. Parents at high risk for abuse are characterized as having unsatisfied needs, difficulty in forming adequate interpersonal relationships, unrealistic expectations of the child, and a lack of nurturing experience, often involving neglect or abuse in their own childhoods. Predisposing factors among children include the temperament, personality, and activity level of the child; order of birth in the family; sensitivity to parental needs; and requirement for special physical or emotional care resulting from illness, premature birth, or congenital or genetic abnormalities. Identification of abused children or potential child abusers is a major concern for all health care workers. Obvious physical marks on a child's body, such as burns, welts, or bruises, and signs of emotional distress, including symptoms of failure to thrive, are common indications of some degree of neglect or abuse. Often, radiograph films to detect healed or new fractures of the extremities or diagnostic tests to identify sexual molestation are necessary. If abuse is suspected, the health care worker is required to make the necessary report. Special counseling services or support groups, such as Parents Anonymous, help families in which a child is abused. The nurse can play a significant role in preventing abuse by promoting a positive parent-child relationship, especially in the neonatal period, by teaching parents proper child care and disciplinary techniques, by explaining normal child development and behavior so that parents can formulate realistic guidelines for discipline, and by identifying parents at risk for child abuse. Compare child neglect.
observations Abuse may reveal itself through physical, sexual, and/or emotional manifestations. Physical signs include unexplained bruising on soft tissue areas, such as the face, back, neck, buttocks, upper arms, thighs, ankles, and back of legs; multiple bruises at different stages of healing; burns; bites; cuts; unexplained head or abdominal injuries; multiple fractures; or x-ray evidence of multiple old fractures. The child may exhibit a fear of being hit or hurt. The child may be wearing long-sleeve shirts or similar clothing to hide injuries. Patterns of sexual abuse are evidenced as torn, stained, or bloody underclothing; bruising, redness, swelling, or bleeding of the genitalia, vagina, or rectum; statements that it hurts to walk or sit; and complaints of pain or itching in the genital area. The child may play out abuse with dolls or playmates. Emotional abuse may be exhibited in the child as inappropriate behavior or developmental delays in speech or social interactions. This may be accompanied by facial tics, rocking motions, and odd reactions to persons in authority. Emotional abuse is often seen in combination with other forms of abuse or neglect. Patterns of neglect are evidenced through a lack of care and attention. The child may have to provide care for him or herself that is inappropriate for his or her age or developmental level. The child may be unresponsive or withdrawn, or may not respond to the caregiver's coaxing. Nonorganic failure to thrive or malnutrition should be considered when a healthy baby appears to have lost weight or physical tone, especially when the infant is 25% below the expected growth curve. Diagnosis is typically made by social service, health care, and legal experts after history, investigation, and physical examination. A physical exam is conducted to show injuries or evidence of past injuries and general state of health and hygiene (height or weight parameters that are less than expected, malnourishment, and unkempt appearance). Information, drawing, or play behaviors from child that include evidence of abuse are also diagnostic tools, as are observation of child-parent interactions (eye contact, touching, verbal interaction, and/or parental concern). Severe injury, disability, developmental delay, mental impairment, and death are all complications of chronic and/or severe physical abuse. Abuse victims have an increased likelihood of becoming abusers.
interventions Initial interventions are geared toward stabilizing injuries and preventing further abuse. If serious signs are obvious, the situation should be reported to the appropriate local sources for immediate investigation. If the child is perceived to be in immediate danger, child protection should be sought through the local child protection agency. If the signs are vague or inconsistent, observations need to be documented and reported to appropriate local sources for investigation. Long-term interventions include monitoring, therapy, and support for child and abuser(s).
nursing considerations Nurses serve as a front-line resource for the detection and prevention of child abuse. This includes the identification of high-risk dependent child relationships, such as lack of prenatal care; previous history of child abuse or neglect; prior removal of other children from the home; parents with a history of substance abuse, depression, or other psychiatric illness; parents with a history of domestic violence; parents who were themselves abused as children; lack of adequate support networks or resources; and infants or children with high care demands. The nurse needs to do a thorough assessment for signs of abuse or neglect, monitor parent-child interactions, and report any suspicions through appropriate channels. The nurse is also instrumental in the institution of actions, such as parenting classes, home visits, early intervention, support groups for parents, and counseling to prevent or halt abuse. Social agency referrals should be made for financial assistance, food, clothing, and shelter needs. Education centers on teaching about realistic expectations for child behavior at various stages of development, and about appropriate forms of discipline and on providing information on available community resources, such as Parents Anonymous or Parents United International.
Paediatrics A tragedy that claims 2,000–5,000 lives/year and causes countless injuries in the USA; it is often first recognised by characteristic radiologic findings
Social medicine Behaviour by a parent or guardian that causes significant negative emotional or physical consequences in a child
Types Physical abuse, emotional abuse, sexual abuse, neglect

child abuse

Battered child syndrome, trauma 'X' Public health A tragedy that claims 2000-5000 lives/yr and causes countless injuries in the US; CA is often first recognized by characteristic radiologic findings–eg metaphyseal fragmentation, incomplete 'bucket handles', old fractures, sub-periosteal hematomas–with epiphyseal dislocations, metaphyseal cupping, shortening of long bone shafts, and a ball-and-socket configuration, pelvic fractures, fractures of posterior ribs, spine, and sternum, a post-mortem radiologic survey may be required to convict the caretaker/parent of manslaughter Social medicine Behavior by a parent or guardian that causes significant negative emotional or physical consequences in a child Types Physical abuse, emotional abuse, sexual abuse, neglect. See Batttered child, Child maltreatment, Domestic violence, Emotional abuse, Neglect, Physical abuse, Sexual abuse, Shaken-baby syndrome.

child a·buse

(chīld ă-byūs')
The physical, emotional, or sexual maltreatment of a child.
See: domestic violence

child abuse

Active assault or physical or emotional neglect of a child. Characteristic injuries include finger-shaped bruises, bruises at different stages, mouth injuries especially tearing of the fold of membrane behind the centre of the upper lip and small bruises or burns on the face. Unexplained fractures or X ray evidence of old, untreated fractures are common, as are injuries which are out of proportion to the claimed cause.

child a·buse

(chīld ă-byūs')
Psychological, emotional, and sexual abuse of a child, typically by a parent, stepparent, or parent surrogate.
See: domestic violence