Child abuse

A bar graph on types of child abuse and neglect, by U.S. Department of Health and Human Services

Child abuse, literally, is the act of intentionally harming a child, or the results of that act. Child abuse is an inherent part of the long, unfortunate saga of maltreatment and neglect of children. Such abuse and neglect has probably always been a feature of childhood for some individuals in every human society. There are some social and psychological settings in families and institutions that make maltreatment of children more likely to happen, and there are characteristics of chilodren that increase their liklihood of being abused. Child abuse also has specific legal meanings, that, like all legal meanings, are locally defined.

Experts in child abuse consider that acts of ommission, as well as acts of commission, count as maltreatment of children. Physical abuse includes not only beating or other injury, but also, for example, failure to touch or hold a child. Certainly, in older children, there is a broad range of normal when it comes to adults having physical contact with children, but in neonates, infants and toddlers, lack of physical contact from care givers has clear and objective detrimental effects on health, and a young infant who is never held, for example, is actually less likely to survive. "Psychologic maltreatment of a child by a caregiver includes spurning, exploiting/corrupting, withholding emotional responsiveness, isolating, or terrorizing." (reference for quote:Charles F. Johnson:Chapter 35 – Abuse and Neglect of Children in Behrman: Nelson Textbook of Pediatrics, 17th ed. ISBN 1416024506) Psychological and physical abuse are often both features of the maltreatment of children and not used in isolation. Sexual child abuse

Epidemiology:Incidence and demographics of child abuse

How common is child abuse? Which children are abused, and how? These questions appear straightforward but cannot be answered without qualifications and explanations. The role of children in society is not constant in the different cultures of the world and has changed considerably within modern cultures over history. For example, an arranged marriage of a 13 year old girl to an adult man against her inclination is not only illegal in the United States, but the fostering of that relationship would be considered abusive. However, that was not the case in much of North America in earlier centuries and is not the case in some other countries today.

Types of child abuse

Physical abuse

Child physical abuse, by definition, is injury inflicted upon a child due to physical aggression. In order for a violent act to be considered child abuse, the injury does not need to be intended. In this regard, a parent or guardian who inflicts more injury on his/her child than what was intended is also guilty of physically abusing a child. Child physical abuse is usually caused by a parent's inability to control his or her anger. Stress, loneliness, lack of emotional support, psychiatric disorders, and substance abuse can all be causes for child physical abuse. Common warning signs of child physical abuse may include:

• Unexplained or poorly explained bruises or injuries (i.e. "I tripped and fell.")
• Sudden behavioral changes
• Lack of trust in adults
• Low self esteem
• Extremely passive or aggressive behavior

Sexual abuse

Child sexual abuse is defined by the misuse of a child for sexual pleasure or gratification. Sexual abuse tends to be one of the most difficult forms of abuse to cope with, due to its taboo nature and society's failure to completely acknowledge the degree of the problem. Sexual abuse can include both touching and non-touching activities, and tends to be one of the most underreported forms of child abuse. Common warning signs for child sexual abuse may include:

• Torn, stained, or bloody undergarments
• Difficulty walking or sitting
• Sexual knowledge that is not age-appropriate
• Unexplained fears of a certain person or place.

Emotional abuse

Emotional abuse, which accounts for about 8% of all reported child abuse cases, is defined by the intentional destruction of a child's self-esteem. Because some children who are victims of emotional abuse may show no warning signs at all, emotional abuse tends to be very difficult to detect. Examples of emotional abuse may include:

• Rejection - a parent's inability to bond with their child. They make the child feel unwanted or unloved. In many cases, the child may become the family's scapegoat.
• Ignoring - a parent who physically cares for their child may not be there emotionally. The parent may show little affection or not acknowledge the child's existence.
• Isolation - a parent may not allow his/her child to interact with other peers. May not allow a child to go out, or may force him/her to eat in secluded areas.
• Corruption - a parent may allow children to watch cruelty to animals, watch adult material, or use drugs/alcohol.

Emotional abuse can have many adverse psychological effects such as poor self esteem, destructive behavior, increased aggression, alcohol/drug abuse, and in severe cases - suicide.

Neglect

Child neglect is the most common form of child abuse and is reported most to child protective services. By definition, child neglect is a parent's "failure to provide needed age-appropriate care." Child neglect can come in many different forms as the definition is very broad and encompasses many types of maltreatment. Such examples may include:

• Physical neglect - not providing necessary healthcare, child abandonment, or physical injury caused due to lack of supervision.
• Educational neglect - allowing a child to skip school, or not enrolling a child in school even though he/she is of legal school age.
• Emotional neglect - spousal abuse in the presence of the child, lack of psychological care, withholding affection.
• Medical neglect - not providing necessary medical care even though the parent is financially able to do so.

Types of abusers

Abusive parents or caregivers can usually be broken up into three categories, based on the underlying factors driving the abuse.

Category A (Premeditated)

Abusers who fall into this category do not abuse their children accidentally, as the inflicted injury is premeditated and is not a result of causing more harm than what was intended. Category A abusers usually suffer from psychopathic disorders but are not legally mentally ill; or in other words, they fully understand the consequences of their actions. Abusers in this category or not only chronic physical abusers, but also experts at manipulation. When confronted with suspicion of abuse, they will typically become overdramatic and make the questioning individual feel guilty for merely bringing up the possibility. They are also clever at fabricating plausible explanations for physical or emotional signs of abuse. Some reasons for an abuser's behavior may include gratification from inflicting pain or the need to dominate or have control over a child. Abusers in this category tend to have a Jekyll and Hyde personality, as their mood may dramatically change as soon as they are home alone with their child.

Category B (Impulsive)

Abusers in this category do not typically inflict non-accidental injury on their child. These abusers usually suffer from high stress, depression, lack of family support, or may have a drug or alcohol related problem. As a result, most abuse is not premeditated and instead happens in a spur of the moment. Physical abuse is usually inflicted during the parent's breaking point, at which time the parent can no longer tolerate the child's requests and will usually inflict unintentional injury. However, the main difference between this group and group A lies in the parent's ability to recognize the abuse as dangerous to his/her child. Once the parent continuously inflicts abuse even when it is apparent that the abuse is seriously damaging the child, the abuser would then fall back into the category A group.

Category C (Mild Maltreatment)

Category C consists of parents who mildly treat their children in an abusive way. In many societies, such individuals are not recognized as abusers; however by using the definition of ill treatment of a child, such individuals can technically be grouped into this category. Certain acts that may fall under the definition of ill treatment of a child may include slapping, excessively aggressive shouts, hurtful/demeaning remarks, and possibly even spanking. However, for many civilizations such as Western Europe and the United States and Canada, category C abusers are not considered to be abusive parents by general societal standards.

References

Committee on Child Abuse and Neglect , 2nd Committee on Children with Disabilities : Assessment of maltreatment of children with disabilities. Pediatrics 2001; 108:508-511

Overpeck MD, Brenner RA, Trumble AC, et al: Risk factors for infant homicide in the United States. N Engl J Med 1998; 339:1211

External links

• SAFE-Child Protection : A UK charity dedicated to educating children, parents, and teachers on the prevention of child abuse. [1]
• Third National Incidence Study of Child Abuse and Neglect (NIS-3). The NIS is the single most comprehensive source of information about the current incidence of child abuse and neglect in the United States. [2]
• American Humane Association, Children's Division, 63 Inverness Drive East, Englewood, CO 80112-5117. Email http://www.amerhumane.org