child abuse (redirected from Dependency and neglect)

Child Abuse 

Definition

Child abuse is the blanket term to describe 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 United States children. However, it has begun to closer attention from the media, law enforcement, and the helping professions. With increased public and professional awareness has come a sharp rise in the number of reported cases. But because abuse often is 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 11%. Sexual abuse was more likely to be committed by males, whereas females were responsible for the majority of neglect cases. More than 1,000 United States children died from abuse in 1996. A 2004 report said that nearly 17% of adult women and 8% of adult men had been abused as children. The United Nations Children's Fund (UNICEF) reported in early 2004 that nearly 3,500 children younger than age 15 die every year from physical abuse and neglect in the 27 richest nations in the world.

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 also are common in reported cases. Charles F. Johnson remarks, "More than 90% of abusing parents have neither psychotic nor criminal personalities. Rather they tend to be lonely, unhappy, angry, young, and single parents who do not plan their pregnancies, have little or no knowledge of child development, and have unrealistic expectations for child behavior." 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.

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 United States 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. Charles F. Johnson defines child sexual abuse as "any activity with a child, before 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.

The 1990s and early 2000s were rocked by reports of sexual abuse of children committed by Catholic priests. Most of the abuse appeared to have occurred during the 1970s and a prominent report released early in 2004 stated that as many as 10,667 children were sexually abused by more than 4,300 priests. Increases also have been seen in recent years in child pornography cases, where children are the subjects of pornography, particularly on the Internet.

EMOTIONAL ABUSE. Emotional abuse, according to Richard D. Krugman, "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, and accounted for only 6% of the confirmed 1996 cases.

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. 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. In 1996 neglect was the finding in 52% of the confirmed abuse cases.

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. 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.

Unexplained or suspicious bruises or other marks on the skin are typical signs of physical abuse, as are burns. Skull and other bone fractures are often seen in young abused children, and in fact, head injuries are the leading cause of death from abuse. Children less than one 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

John M. Leventhal observes, "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 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 for a doctor to find. 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 conduct are some of the behavioral signs of sexual abuse, but 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, headaches or stomach aches, 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 lack the ability or strength to adequately provide for the child's needs because he or she is 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 Child Protective Services (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). 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

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 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 for 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 consequences. Research shows 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 often 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.

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. Emotional 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 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 local 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.

Resources

Periodicals

Jellinek, Michael S. "Making the Call: Identifying Child Sexual Abuse." Pediatric News March 2004: 26.

Plante, Thomas G. "Another Aftershock: What Have We Learned from the John Jay Report?" America March 22, 2004: 10.

"UNICEF Report on Child Abuse in Developed Nations." Public Health Reports March-April 2004: 220-224.

Organizations

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

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

National Committee to Prevent Child Abuse. 200 S. Michigan Ave., 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.

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abuse (ah-būs´) misuse, maltreatment, or excessive use.

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child abuse  see battered-child syndrome.

drug abuse  substance a.

physical abuse  any act resulting in a nonaccidental physical injury.

psychoactive substance abuse  substance a.

sexual abuse  assault or other crime of a sexual nature, which need not be physical. Acts of a sexual nature are considered abuse if performed with minors or nonconsenting adults.

substance abuse  use of a substance that modifies mood or behavior in a manner characterized by a maladaptive pattern of use. See also substance dependence, under dependence.

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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.

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abuse,

n the improper use of program benefits, resources, and/or services by either dental professionals, institutions, or patients.

abuse, child,

n See child abuse.

abuse, drug,

n the misuse of legal or illegal substances with the intent to alter the user's feelings, behavior, or perception.

abuse, elder,

n the behavior or treatment toward an elderly person, by another person in a position of care, that has the purpose or effect of harming the elderly person's well-being. Such harm may include economic, physical, sexual, or mental abuse.

abuse, nitrous oxide,

n the deliberate inhalation of nitrous oxide to produce mood-altering effects. A type of substance abuse.

abuse, polysubstance,

n the physical dependence on at least three substances that have been classified as habit forming, but without any one of the substances having greater importance or influence than the others. The concept does not include caffeine or nicotine.

abuse, sexual,

n sexual acts performed with children or with nonconsenting adults in a criminal manner.

abuse, substance,

n the misuse of legal or illegal substances with the intent to alter some aspect of the user's experience. May include medications, illicit drugs, legal substances with potential mood-altering effects (such as alcohol or tobacco), or substances whose primary use may not be for human consumption (such as inhalants).

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child,

n 1. a person of either gender between the time of birth and adolescence, or puberty.
2. in the law of negligence and in laws for the protection of children, a term used as the opposite of
adult (generally under the age of puberty) without reference to parentage and distinction of gender.

child abuse,

n the physical, sexual, or emotional maltreatment of a person under 18 years of age. Child abuse occurs predominantly with children under 3 years of age. Symptoms include bruises and contusions, medical record of repeated trauma, radiographic evidence of fractures, emotional distress, and failure to thrive.

child neglect,

n a form of child abuse in which proper care is denied or withheld.

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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.