Child abuse

Child abuse

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Child abuse is the physical, sexual, emotional mistreatment, or neglect of a child. In the United States, the Centers for Disease Control and Prevention
Centers for Disease Control and Prevention
The Centers for Disease Control and Prevention are a United States federal agency under the Department of Health and Human Services headquartered in Druid Hills, unincorporated DeKalb County, Georgia, in Greater Atlanta...

 (CDC) and the Department of Children And Families (DCF) define child maltreatment as any act or series of acts of commission or omission by a parent or other caregiver that results in harm, potential for harm, or threat of harm to a child. Child abuse can occur in a child's home, or in the organizations, schools or communities the child interacts with. There are four major categories of child abuse: neglect
Neglect
Neglect is a passive form of abuse in which a perpetrator is responsible to provide care for a victim who is unable to care for himself or herself, but fails to provide adequate care....

, physical abuse
Physical abuse
Physical abuse is abuse involving contact intended to cause feelings of intimidation, injury, or other physical suffering or bodily harm.-Forms of physical abuse:*Striking*Punching*Belting*Pushing, pulling*Slapping*Whipping*Striking with an object...

, psychological/emotional abuse
Psychological abuse
Psychological abuse, also referred to as emotional abuse or mental abuse, is a form of abuse characterized by a person subjecting or exposing another to behavior that may result in psychological trauma, including anxiety, chronic depression, or post-traumatic stress disorder...

, and child sexual abuse
Child sexual abuse
Child sexual abuse is a form of child abuse in which an adult or older adolescent uses a child for sexual stimulation. Forms of child sexual abuse include asking or pressuring a child to engage in sexual activities , indecent exposure with intent to gratify their own sexual desires or to...

.

Different jurisdictions have developed their own definitions of what constitutes child abuse for the purposes of removing a child from his/her family and/or prosecuting a criminal charge. According to the Journal of Child Abuse and Neglect, child abuse is "any recent act or failure to act on the part of a parent or caretaker which results in death, serious physical or emotional harm, sexual abuse or exploitation, an act or failure to act which presents an imminent risk of serious harm". A person who feels the need to abuse or neglect a child may be described as a "pedopath".

Types


Child abuse can take several forms: The four main types are physical, sexual, psychological, and neglect.

Neglect



Child neglect is where the responsible adult does not provide adequately for various needs, including physical (not providing adequate food, clothing, or hygiene), emotional (not providing nurturing or affection), educational (not providing an adequate education), or medical (not medicating the child or taking him or her to the doctor). There are many effects of child neglect, such as children not being able to interact with other children around them.The continuous refusal of a child's basic needs is considered chronic neglect.

Physical abuse


Physical abuse is physical aggression directed at a child by an adult. It can involve punching, striking, kicking, shoving, slapping, burning, bruising, pulling ears or hair, stabbing, choking, belting
Belting (beating)
Belting is the use of belts made of strong materials as a whip-like instrument for corporal punishment . It is most often associated with educational institutions where it has been used as disciplinary measure but it has also been applied domestically by parents...

 or shaking a child. Shaking a child can cause shaken baby syndrome
Shaken baby syndrome
Shaken baby syndrome is a triad of medical symptoms: subdural hematoma, retinal hemorrhage, and brain swelling from which doctors, consistent with current medical understanding, infer child abuse caused by intentional shaking...

, which can lead to intracranial pressure
Intracranial pressure
Intracranial pressure is the pressure inside the skull and thus in the brain tissue and cerebrospinal fluid . The body has various mechanisms by which it keeps the ICP stable, with CSF pressures varying by about 1 mmHg in normal adults through shifts in production and absorption of CSF...

, swelling of the brain, diffuse axonal injury
Diffuse axonal injury
Diffuse axonal injury is one of the most common and devastating types of traumatic brain injury, meaning that damage occurs over a more widespread area than in focal brain injury. DAI, which refers to extensive lesions in white matter tracts, is one of the major causes of unconsciousness and...

, and oxygen deprivation
Asphyxia
Asphyxia or asphyxiation is a condition of severely deficient supply of oxygen to the body that arises from being unable to breathe normally. An example of asphyxia is choking. Asphyxia causes generalized hypoxia, which primarily affects the tissues and organs...

; which leads to patterns such as failure to thrive, vomiting, lethargy, seizures, bulging or tense fontanels, altered breathing, and dilated pupils. The transmission of toxins to a child through its mother (such as with fetal alcohol syndrome
Fetal alcohol syndrome
Fetal alcohol syndrome is a pattern of mental and physical defects that can develop in a fetus in association with high levels of alcohol consumption during pregnancy. Current research also implicates other lifestyle choices made by the prospective mother...

) can also be considered physical abuse in some jurisdictions.

Most nations with child-abuse laws consider the infliction of physical injuries or actions that place the child in obvious risk of serious injury or death to be illegal. Beyond this, there is considerable variation. The distinction between child discipline
Child discipline
Child discipline is the set of rules, rewards and punishments administered to teach self control, increase desirable behaviors and decrease undesirable behaviors in children. In its most general sense, discipline refers to systematic instruction given to a disciple. To discipline thus means to...

 and abuse is often poorly defined. Cultural norms about what constitutes abuse vary widely: among professionals as well as the wider public, people do not agree on what behaviors constitute abuse.

Some human-service professionals claim that cultural norms that sanction physical punishment are one of the causes of child abuse, and have undertaken campaigns to redefine such norms.

Child sexual abuse


Child sexual abuse (CSA) is a form of child abuse in which an adult or older adolescent abuses a child for sexual stimulation. Forms of CSA include asking or pressuring a child to engage in sexual activities (regardless of the outcome), indecent exposure
Indecent exposure
Indecent exposure is the deliberate exposure in public or in view of the general public by a person of a portion or portions of his or her body, in circumstances where the exposure is contrary to local moral or other standards of appropriate behavior. Indecent exposure laws vary in different...

 of the genitals to a child, displaying pornography
Pornography
Pornography or porn is the explicit portrayal of sexual subject matter for the purposes of sexual arousal and erotic satisfaction.Pornography may use any of a variety of media, ranging from books, magazines, postcards, photos, sculpture, drawing, painting, animation, sound recording, film, video,...

 to a child, actual sexual contact
Human sexual behavior
Human sexual activities or human sexual practices or human sexual behavior refers to the manner in which humans experience and express their sexuality. People engage in a variety of sexual acts from time to time, and for a wide variety of reasons...

 against a child, physical contact with the child's genitals, viewing of the child's genitalia without physical contact, or using a child to produce child pornography
Child pornography
Child pornography refers to images or films and, in some cases, writings depicting sexually explicit activities involving a child...

. Selling the sexual services
Procuring (prostitution)
Procuring or pandering is the facilitation or provision of a prostitute in the arrangement of a sex act with a customer. Examples of procuring include:*trafficking a prostitute into a country for the purpose of soliciting sex...

 of children may be viewed and treated as child abuse with services offered to the child rather than simple incarceration.

Effects of child sexual abuse include guilt
Guilt
Guilt is the state of being responsible for the commission of an offense. It is also a cognitive or an emotional experience that occurs when a person realizes or believes—accurately or not—that he or she has violated a moral standard, and bears significant responsibility for that...

 and self-blame, flashbacks, nightmare
Nightmare
A nightmare is an unpleasant dream that can cause a strong negative emotional response from the mind, typically fear or horror, but also despair, anxiety and great sadness. The dream may contain situations of danger, discomfort, psychological or physical terror...

s, insomnia
Insomnia
Insomnia is most often defined by an individual's report of sleeping difficulties. While the term is sometimes used in sleep literature to describe a disorder demonstrated by polysomnographic evidence of disturbed sleep, insomnia is often defined as a positive response to either of two questions:...

, fear of things associated with the abuse (including objects, smells, places, doctor's visits, etc.), self-esteem
Self-esteem
Self-esteem is a term in psychology to reflect a person's overall evaluation or appraisal of his or her own worth. Self-esteem encompasses beliefs and emotions such as triumph, despair, pride and shame: some would distinguish how 'the self-concept is what we think about the self; self-esteem, the...

 issues, sexual dysfunction
Sexual dysfunction
Sexual dysfunction or sexual malfunction refers to a difficulty experienced by an individual or a couple during any stage of a normal sexual activity, including desire, arousal or orgasm....

, chronic pain
Chronic pain
Chronic pain has several different meanings in medicine. Traditionally, the distinction between acute and chronic pain has relied upon an arbitrary interval of time from onset; the two most commonly used markers being 3 months and 6 months since the initiation of pain, though some theorists and...

, addiction
Substance dependence
The section about substance dependence in the Diagnostic and Statistical Manual of Mental Disorders does not use the word addiction at all. It explains:...

, self-injury, suicidal ideation
Suicidal ideation
Suicidal ideation is a common medical term for thoughts about suicide, which may be as detailed as a formulated plan, without the suicidal act itself. Although most people who undergo suicidal ideation do not commit suicide, some go on to make suicide attempts...

, somatic complaints, depression
Clinical depression
Major depressive disorder is a mental disorder characterized by an all-encompassing low mood accompanied by low self-esteem, and by loss of interest or pleasure in normally enjoyable activities...

, post-traumatic stress disorder
Post-traumatic stress disorder
Posttraumaticstress disorder is a severe anxiety disorder that can develop after exposure to any event that results in psychological trauma. This event may involve the threat of death to oneself or to someone else, or to one's own or someone else's physical, sexual, or psychological integrity,...

, anxiety
Anxiety
Anxiety is a psychological and physiological state characterized by somatic, emotional, cognitive, and behavioral components. The root meaning of the word anxiety is 'to vex or trouble'; in either presence or absence of psychological stress, anxiety can create feelings of fear, worry, uneasiness,...

, other mental illnesses (including borderline personality disorder
Borderline personality disorder
Borderline personality disorder is a personality disorder described as a prolonged disturbance of personality function in a person , characterized by depth and variability of moods.The disorder typically involves unusual levels of instability in mood; black and white thinking, or splitting; the...

 and dissociative identity disorder
Dissociative identity disorder
Dissociative identity disorder is a psychiatric diagnosis and describes a condition in which a person displays multiple distinct identities , each with its own pattern of perceiving and interacting with the environment....

, propensity to re-victimization in adulthood, bulimia nervosa
Bulimia nervosa
Bulimia nervosa is an eating disorder characterized by binge eating and purging or consuming a large amount of food in a short amount of time, followed by an attempt to rid oneself of the food consumed, usually by purging and/or by laxative, diuretics or excessive exercise. Bulimia nervosa is...

, physical injury to the child, among other problems.
Approximately 15% to 25% of women and 5% to 15% of men were sexually abused when they were children. Most sexual abuse offenders are acquainted with their victims; approximately 30% are relatives of the child, most often brothers, fathers, mothers, uncles or cousins; around 60% are other acquaintances such as friends of the family, babysitters, or neighbours; strangers are the offenders in approximately 10% of child sexual abuse cases.

Psychological/emotional abuse



Out of all the possible forms of abuse, emotional abuse is the hardest to define. It could include name-calling, ridicule, degradation, destruction of personal belongings, torture
Torture
Torture is the act of inflicting severe pain as a means of punishment, revenge, forcing information or a confession, or simply as an act of cruelty. Throughout history, torture has often been used as a method of political re-education, interrogation, punishment, and coercion...

 or destruction of a pet, excessive criticism
Criticism
Criticism is the judgement of the merits and faults of the work or actions of an individual or group by another . To criticize does not necessarily imply to find fault, but the word is often taken to mean the simple expression of an objection against prejudice, or a disapproval.Another meaning of...

, inappropriate or excessive demands, withholding communication, and routine labeling or humiliation
Humiliation
Humiliation is the abasement of pride, which creates mortification or leads to a state of being humbled or reduced to lowliness or submission. It can be brought about through bullying, intimidation, physical or mental mistreatment or trickery, or by embarrassment if a person is revealed to have...

.

Victims of emotional abuse may react by distancing themselves from the abuser, internalizing the abusive words, or fighting back by insult
Insult
An insult is an expression, statement which is considered degrading and offensive. Insults may be intentional or accidental...

ing the abuser. Emotional abuse can result in abnormal or disrupted attachment development
Attachment theory
Attachment theory describes the dynamics of long-term relationships between humans. Its most important tenet is that an infant needs to develop a relationship with at least one primary caregiver for social and emotional development to occur normally. Attachment theory is an interdisciplinary study...

, a tendency for victims to blame themselves (self-blame) for the abuse, learned helplessness
Learned helplessness
Learned helplessness, as a technical term in animal psychology and related human psychology, means a condition of a human person or an animal in which it has learned to behave helplessly, even when the opportunity is restored for it to help itself by avoiding an unpleasant or harmful circumstance...

, and overly passive behavior.

Prevalence


According to the (American) National Committee to Prevent Child Abuse, in 1997 neglect represented 54% of confirmed cases of child abuse, physical abuse 22%, sexual abuse 8%, emotional maltreatment 4%, and other forms of maltreatment 12%.

A UNICEF report on child wellbeing stated that the United States and the United Kingdom ranked lowest among industrial nations with respect to the wellbeing of children. It also found that child neglect and child abuse were far more common in single-parent families than in families where both parents are present.

In the USA, neglect is defined as the failure to meet the basic needs of children including housing, clothing, food and access to medical care. Researchers found over 91,000 cases of neglect in one year (from October 2005 to 30 September 2006) using information from a database of cases verified by protective services agencies.

Neglect could also take the form of financial abuse by not buying the child adequate materials for survival.

The U.S. Department of Health and Human Services reports that for each year between 2000 and 2005, "female parents acting alone" were most likely to be perpetrators of child abuse.

Fatalities


A child abuse fatality: when a child’s death is the result of abuse or neglect, or when abuse and/or neglect are contributing factors to a child’s death. In the United States, 1,730 children died in 2008 due to factors related to abuse; this is a rate of 2.33 per 100,000 U.S. children. Child abuse fatalities are widely recognized as being under-counted; it is estimated that between 60-85% of child fatalities due to maltreatment are not recorded as such on death certificates. Younger children are at a much higher risk for being killed, as are African Americans. Girls and boys, however, are killed at similar rates. Caregivers, and specifically mothers, are more likely to be the perpetrators of a child abuse fatality, than anyone else, including strangers, relatives, and non-relative caregivers [source needed]. Family situations which place children at risk include moving, unemployment, having non-family members living in the household. A number of policies and programs have been put into place to try to better understand and to prevent child abuse fatalities, including: safe-haven laws, child fatality review teams, training for investigators, shaken baby syndrome
Shaken baby syndrome
Shaken baby syndrome is a triad of medical symptoms: subdural hematoma, retinal hemorrhage, and brain swelling from which doctors, consistent with current medical understanding, infer child abuse caused by intentional shaking...

 prevention programs, and child abuse death laws which mandate harsher sentencing for taking the life of a child.

History


Also known as Tardieu's Syndrome in homage to the French medical doctor Auguste Ambroise Tardieu
Auguste Ambroise Tardieu
Auguste Ambroise Tardieu was a French medical doctor and the pre-eminent forensic medical scientist of the mid-19th century.Tardieu's specialties were forensic medicine and toxicology...


Causes


Child abuse is a complex phenomenon with multiple causes. Understanding the causes of abuse is crucial to addressing the problem of child abuse. Parents who physically abuse their spouses are more likely than others to physically abuse their children. However, it is impossible to know whether marital strife is a cause of child abuse, or if both the marital strife and the abuse are caused by tendencies in the abuser.

Children resulting from unintended pregnancies are more likely to be abused or neglected. In addition, unintended pregnancies are more likely than intended pregnancies to be associated with abusive relationships, and there is an increased risk of physical violence during pregnancy. They also result in poorer maternal mental health, and lower mother-child relationship quality.

Substance abuse
Substance abuse
A substance-related disorder is an umbrella term used to describe several different conditions associated with several different substances .A substance related disorder is a condition in which an individual uses or abuses a...

 can be a major contributing factor to child abuse. One U.S. study found that parents with documented substance abuse, most commonly alcohol
Alcohol
In chemistry, an alcohol is an organic compound in which the hydroxy functional group is bound to a carbon atom. In particular, this carbon center should be saturated, having single bonds to three other atoms....

, cocaine
Cocaine
Cocaine is a crystalline tropane alkaloid that is obtained from the leaves of the coca plant. The name comes from "coca" in addition to the alkaloid suffix -ine, forming cocaine. It is a stimulant of the central nervous system, an appetite suppressant, and a topical anesthetic...

, and heroin, were much more likely to mistreat their children, and were also much more likely to reject court-ordered services and treatments. Another study found that over two thirds of cases of child maltreatment involved parents with substance abuse problems. This study specifically found relationships between alcohol and physical abuse, and between cocaine and sexual abuse.

Unemployment
Unemployment
Unemployment , as defined by the International Labour Organization, occurs when people are without jobs and they have actively sought work within the past four weeks...

 and financial difficulties are associated with increased rates of child abuse. In 2009 CBS News reported that child abuse in the United States had increased during the economic recession. It gave the example of a father who had never been the primary care-taker of the children. Now that the father was in that role, the children began to come in with injuries.

Studies have found that not biologically related parents (like stepparents) are up to a hundred times more likely to kill a child than biological parents. An evolutionary psychology
Evolutionary psychology
Evolutionary psychology is an approach in the social and natural sciences that examines psychological traits such as memory, perception, and language from a modern evolutionary perspective. It seeks to identify which human psychological traits are evolved adaptations, that is, the functional...

  explanation for this is that using resources in order to take care of another person's biological child is likely not a good strategy for increasing reproductive success
Reproductive success
Reproductive success is defined as the passing of genes onto the next generation in a way that they too can pass those genes on. In practice, this is often a tally of the number of offspring produced by an individual. A more correct definition, which incorporates inclusive fitness, is the...

. See also Infanticide (zoology)
Infanticide (zoology)
In animals, infanticide involves the killing of young offspring by a mature animal of its own species, and is studied in zoology, specifically in the field of ethology. Ovicide is the analogous destruction of eggs. Although human infanticide has been widely studied, the practice has been observed...

. More generally, stepchildren have a much higher risk of being abused which is sometimes referred to as the Cinderella effect
Cinderella Effect
The Cinderella effect is a term used by psychologists to describe the high incidence of stepchildren being physically abused, emotionally abused, sexually abused, neglected, murdered, or otherwise mistreated at the hands of their stepparents at significantly higher rates than at the hands of their...

.

Effects


There are strong associations between exposure to child abuse in all its forms and higher rates of many chronic conditions. The strongest evidence comes from the Adverse Childhood Experiences (ACE's) series of studies which show correlations between exposure to abuse or neglect and higher rates in adulthood of chronic conditions, high-risk health behaviors and shortened lifespan. A recent publication, Hidden Costs in Health Care: The Economic Impact of Violence and Abuse, makes the case that such exposure represents a serious and costly public-health issue that should be addressed by the healthcare system. Child abuse is a major life stressor that has consequences involving the mental health of an adult but, the majority of studies examining the negative consequences of abuse have been focused on adolescences and young adults. It has been identified that childhood sexual abuse is a risk factor for the development of substance-related problems during adolescence and adulthood.
The early experiences of child abuse can trigger the development of an internalizing disorder, such as anxiety and depression. For example, adults with a history of some form of child abuse, whether sexual abuse, physical abuse, or neglect, have more chances of developing depression then an adult who has never been abused.
Child abuse can also cause problems with the neurodevelopment of a child. Research shows that abused children often develop deficits with language, deregulation of mood, behaviour and also social/emotional disturbances. These risks are elevated when child abuse is combined with traumatic events and/or fetal alcohol exposure.

Psychological effects


Children with a history of neglect or physical abuse are at risk of developing psychiatric problems, or a disorganized attachment style
Attachment in children
Newborn humans infants cannot survive without a caregiver to provide food and protection, and will not thrive without other types of support as well. While infants have relatively few inborn behaviors—such as crying, rooting, and sucking—they also come with many behavioral systems ready to be...

. Disorganized attachment is associated with a number of developmental problems, including dissociative symptoms, as well as anxiety, depressive, and acting out
Acting out
Acting out is a psychological term from the parlance of defense mechanisms and self-control, meaning to perform an action in contrast to bearing and managing the impulse to perform it. The acting done is usually anti-social and may take the form of acting on the impulses of an addiction Acting out...

 symptoms. A study by Dante Cicchetti found that 80% of abused and maltreated infants exhibited symptoms of disorganized attachment
Attachment theory
Attachment theory describes the dynamics of long-term relationships between humans. Its most important tenet is that an infant needs to develop a relationship with at least one primary caregiver for social and emotional development to occur normally. Attachment theory is an interdisciplinary study...

. When some of these children become parents, especially if they suffer from posttraumatic stress disorder (PTSD), dissociative symptoms, and other sequelae of child abuse, they may encounter difficulty when faced with their infant and young children's needs and normative distress, which may in turn lead to adverse consequences for their child's social-emotional development. Despite these potential difficulties, psychosocial intervention can be effective, at least in some cases, in changing the ways maltreated parents think about their young children.

Victims of childhood abuse, it is claimed, also suffer from different types of physical health problems later in life. Some reportedly suffer from some type of chronic head, abdominal, pelvic, or muscular pain with no identifiable reason. Even though the majority of childhood abuse victims know or believe that their abuse is, or can be, the cause of different health problems in their adult life, for the great majority their abuse was not directly associated with those problems, indicating that sufferers were most likely diagnosed with other possible causes for their health problems, instead of their childhood abuse.

The effects of child abuse vary, depending on the type of abuse. A 2006 study found that childhood emotional and sexual abuse were strongly related to adult depressive symptoms, while exposure to verbal abuse
Verbal abuse
Verbal abuse is best described as a negative defining statement told to you or about you; or by withholding any response thus defining the target as non-existant...

 and witnessing of domestic violence
Domestic violence
Domestic violence, also known as domestic abuse, spousal abuse, battering, family violence, and intimate partner violence , is broadly defined as a pattern of abusive behaviors by one or both partners in an intimate relationship such as marriage, dating, family, or cohabitation...

 had a moderately strong association, and physical abuse a moderate one. For depression, experiencing more than two kinds of abuse exerted synergetically stronger symptoms. Sexual abuse was particularly deleterious in its intrafamilial form, for symptoms of depression, anxiety
Anxiety
Anxiety is a psychological and physiological state characterized by somatic, emotional, cognitive, and behavioral components. The root meaning of the word anxiety is 'to vex or trouble'; in either presence or absence of psychological stress, anxiety can create feelings of fear, worry, uneasiness,...

, dissociation
Dissociation
Dissociation is an altered state of consciousness characterized by partial or complete disruption of the normal integration of a person’s normal conscious or psychological functioning. Dissociation is most commonly experienced as a subjective perception of one's consciousness being detached from...

, and limbic irritability. Childhood verbal abuse had a stronger association with anger-hostility than any other type of abuse studied, and was second only to emotional abuse in its relationship with dissociative symptoms. More generally, in the case of 23 of the 27 illnesses listed in the questionnaire of a French INSEE
INSEE
INSEE is the French National Institute for Statistics and Economic Studies. It collects and publishes information on the French economy and society, carrying out the periodic national census. Located in Paris, it is the French branch of Eurostat, European Statistical System...

 survey, some statistically significant correlations were found between repeated illness and family traumas encountered by the child before the age of 18 years. According to Georges Menahem
Georges Menahem
Georges Menahem is a French sociologist and economist whose work employs methods drawn from economics, sociology and statistics...

, the French sociologist who found out these correlations by studying health inequalities, these relationships show that inequalities in illness and suffering are not only social. Health inequality also has its origins in the family
Family
In human context, a family is a group of people affiliated by consanguinity, affinity, or co-residence. In most societies it is the principal institution for the socialization of children...

, where it is associated with the degrees of lasting affective problems (lack of affection, parental discord, the prolonged absence of a parent, or a serious illness affecting either the mother or father) that individuals report having experienced in childhood.

Physical effects



Children who are physically abused are likely to receive bone fractures, particularly rib fractures, and may have a higher risk of developing cancer.
Children who experience child abuse & neglect are 59% more likely to be arrested as juveniles, 28% more likely to be arrested as adults, and 30% more likely to commit violent crime.

The immediate physical effects of abuse or neglect can be relatively minor (bruises or cuts) or severe (broken bones, hemorrhage, or even death). In some cases the physical effects are temporary; however, the pain and suffering they cause a child should not be discounted. Meanwhile, the long-term impact of child abuse and neglect on physical health is just beginning to be explored. The long-term effects can be:

Shaken baby syndrome
Shaken baby syndrome
Shaken baby syndrome is a triad of medical symptoms: subdural hematoma, retinal hemorrhage, and brain swelling from which doctors, consistent with current medical understanding, infer child abuse caused by intentional shaking...

. Shaking a baby is a common form of child abuse that often results in permanent neurological damage (80% of cases) or death (30% of cases). Damage results from intracranial hypertension (increased pressure in the skull) after bleeding in the brain, damage to the spinal cord and neck, and rib or bone fractures (Institute of Neurological Disorders and Stroke, 2007).

Impaired brain development. Child abuse and neglect have been shown, in some cases, to cause important regions of the brain to fail to form or grow properly, resulting in impaired development (De Bellis & Thomas, 2003). These alterations in brain maturation have long-term consequences for cognitive, language, and academic abilities (Watts-English, Fortson, Gibler, Hooper, & De Bellis, 2006). NSCAW found more than three-quarters of foster children between 1 and 2 years of age to be at medium to high risk for problems with brain development, as opposed to less than half of children in a control sample (ACF/OPRE, 2004a).

Poor physical health. Several studies have shown a relationship between various forms of household dysfunction (including childhood abuse) and poor health (Flaherty et al., 2006; Felitti, 2002). Adults who experienced abuse or neglect during childhood are more likely to suffer from physical ailments such as allergies, arthritis, asthma, bronchitis, high blood pressure, and ulcers (Springer, Sheridan, Kuo, & Carnes, 2007).

On the other hand, there are some children who are raised in child abuse, but who manage to do unexpectedly well later in life regarding the preconditions. Such children have been termed , as inspired from the way that dandelions seem to prosper irrespective of soil, sun, drought, or rain. Such children (or currently grown-ups) are of high interest in finding factors that mitigate the effects of child abuse.

Prevention


Unintended conception increases the risk of subsequent child abuse, and large family size increases the risk of child neglect. Thus a comprehensive study for the National Academy of Sciences concluded that affordable contraceptive
Birth control
Birth control is an umbrella term for several techniques and methods used to prevent fertilization or to interrupt pregnancy at various stages. Birth control techniques and methods include contraception , contragestion and abortion...

 services should form the basis for child abuse prevention. "The starting point for effective child abuse programming is pregnancy planning
Family planning
Family planning is the planning of when to have children, and the use of birth control and other techniques to implement such plans. Other techniques commonly used include sexuality education, prevention and management of sexually transmitted infections, pre-conception counseling and...

," according to an analysis for US Surgeon General C. Everett Koop
C. Everett Koop
Charles Everett Koop, MD is an American pediatric surgeon and public health administrator. He was a vice admiral in the Public Health Service Commissioned Corps, and served as thirteenth Surgeon General of the United States under President Ronald Reagan from 1982 to 1989.-Early years:Koop was born...

.

April has been designated Child Abuse Prevention Month in the United States since 1983. U.S. President Barack Obama
Barack Obama
Barack Hussein Obama II is the 44th and current President of the United States. He is the first African American to hold the office. Obama previously served as a United States Senator from Illinois, from January 2005 until he resigned following his victory in the 2008 presidential election.Born in...

 continued that tradition by declaring April 2009 Child Abuse Prevention Month. One way the Federal government of the United States
Federal government of the United States
The federal government of the United States is the national government of the constitutional republic of fifty states that is the United States of America. The federal government comprises three distinct branches of government: a legislative, an executive and a judiciary. These branches and...

 provides funding for child-abuse prevention is through Community-Based Grants for the Prevention of Child Abuse and Neglect (CBCAP).

Resources for child-protection services are sometimes limited. According to Hosin (2007), "a considerable number of traumatized abused children do not gain access to protective child-protection strategies." Briere (1992) argues that only when "lower-level violence" of children ceases to be culturally tolerated will there be changes in the victimization and police protection of children.

Treatment


A number of treatments are available to victims of child abuse. Trauma-focused cognitive behavioral therapy, first developed to treat sexually abused children, is now used for victims of any kind of trauma. It targets trauma-related symptoms in children including post-traumatic stress disorder
Post-traumatic stress disorder
Posttraumaticstress disorder is a severe anxiety disorder that can develop after exposure to any event that results in psychological trauma. This event may involve the threat of death to oneself or to someone else, or to one's own or someone else's physical, sexual, or psychological integrity,...

 (PTSD), clinical depression and anxiety
Anxiety
Anxiety is a psychological and physiological state characterized by somatic, emotional, cognitive, and behavioral components. The root meaning of the word anxiety is 'to vex or trouble'; in either presence or absence of psychological stress, anxiety can create feelings of fear, worry, uneasiness,...

. It also includes a component for non-offending parents. Several studies have found that sexually abused children undergoing TF-CBT improved more than children undergoing certain other therapies. Data on the effects of TF-CBT for children who experienced only non-sexual abuse was not available as of 2006.

Abuse-focused cognitive behavioral therapy was designed for children who have experienced physical abuse. It targets externalizing behaviors and strengthens prosocial behaviors. Offending parents are included in the treatment, to improve parenting skills/practices. It is supported by one randomized study.

Child-parent psychotherapy was designed to improve the child-parent relationship following the experience of domestic violence. It targets trauma-related symptoms in infants, toddlers, and preschoolers, including PTSD, aggression, defiance, and anxiety. It is supported by two studies of one sample.

Other forms of treatment include group therapy, play therapy, and art therapy. Each of these types of treatment can be used to better assist the client, depending on the form of abuse they have experienced. Play therapy and art therapy are ways to get children more comfortable with therapy by working on something that they enjoy (coloring, drawing, painting, etc.). The design of a child's artwork can be a symbolic representation of what they are feeling, relationships with friends or family, and more. Being able to discuss and analyze a child's artwork can allow a professional to get a better insight of the child.

Ethics


One of the most challenging ethical dilemmas arising from child abuse relates to the parental rights of abusive parents or caretakers with regard to their children, particularly in medical settings. In the United States, the 2008 New Hampshire case of Andrew Bedner
Andrew Bedner
Andrew Bedner is an American man at the center of a bioethical controversy regarding the rights of parents to make medical decisions for children they have allegedly abused....

 drew attention to this legal and moral conundrum. Bedner, accused of severely injuring his infant daughter, sued for the right to determine whether or not she remain on life support; keeping her alive, which would have prevented a murder charge, created a motive for Bedner to act that conflicted with the apparent interests of his child. Bioethicists Jacob M. Appel
Jacob M. Appel
Jacob M. Appel is an American author, bioethicist and social critic. He is best known for his short stories, his work as a playwright, and his writing in the fields of reproductive ethics, organ donation, neuroethics and euthanasia....

 and Thaddeus Mason Pope
Thaddeus Mason Pope
Thaddeus Mason Pope is an American bioethcist and law professor at Widener University. Pope is a leading authority of medical futility and the author of numerous articles on articles on law and medicine, including: more than nearly twenty law review and bar journal articles and over 25...

 recently argued, in separate articles, that such cases justify the replacement of the accused parent with an alternative decision-maker.

Child abuse also poses ethical concerns related to confidentiality
Confidentiality
Confidentiality is an ethical principle associated with several professions . In ethics, and in law and alternative forms of legal resolution such as mediation, some types of communication between a person and one of these professionals are "privileged" and may not be discussed or divulged to...

, as victims may be physically or psychologically unable to report abuse to authorities. Accordingly, many jurisdictions and professional bodies have made exceptions to standard requirements for confidentiality and legal privileges
Privilege (evidence)
An evidentiary privilege is a rule of evidence that allows the holder of the privilege to refuse to provide evidence about a certain subject or to bar such evidence from being disclosed or used in a judicial or other proceeding....

 in instances of child abuse. Medical professionals, including doctors, therapists, and other mental health workers typically owe a duty of confidentiality to their patients and clients, either by law and/or the standards of professional ethics
Professional ethics
Professional ethics encompass the personal and corporate standards of behaviour expected of professionals.- Professional ethics :Professional people and those working in acknowledged professions exercise specialist knowledge and skill...

, and cannot disclose personal information without the consent
Consent
Consent refers to the provision of approval or agreement, particularly and especially after thoughtful consideration.- Types of consent :*Implied consent is a controversial form of consent which is not expressly granted by a person, but rather inferred from a person's actions and the facts and...

 of the individual concerned. This duty conflicts with an ethical obligation to protect children from preventable harm. Accordingly, confidentiality is often waived when these professionals have a good faith suspicion that child abuse or neglect has occurred or is likely to occur and make a report to local child protection authorities. This exception allows professionals to breach confidentiality and make a report even when the child or his/her parent or guardian has specifically instructed to the contrary. Child abuse is also a common exception to Physician–patient privilege: a medical professional may be called upon to testify in court as to otherwise privileged evidence about suspected child abuse despite the wishes of the child and his/her family.

Organizations


There are organizations at national, state, and county levels in the United States that provide community leadership in preventing child abuse and neglect. The National Alliance of Children's Trust Funds and Prevent Child Abuse America are two national organizations with member organizations at the state level.

Many investigations into child abuse are handled on the local level by Child Advocacy Centers. Started over 25 years ago at what is now known as the National Children's Advocacy Center in Huntsville, Alabama by District Attorney Robert "Bud" Cramer these multi-disciplinary teams have met to coordinate their efforts so that cases of child abuse can be investigated quickly and efficiently, ultimately reducing trauma to the child and garnering better convictions. These Child Advocacy Centers (known as CACs) have standards set by the National Children's Alliance.

Other organizations focus on specific prevention strategies. The National Center on Shaken Baby Syndrome focuses its efforts on the specific issue of preventing child abuse that is manifested as shaken baby syndrome
Shaken baby syndrome
Shaken baby syndrome is a triad of medical symptoms: subdural hematoma, retinal hemorrhage, and brain swelling from which doctors, consistent with current medical understanding, infer child abuse caused by intentional shaking...

. Mandated reporter
Mandated reporter
In many U.S. states and Australia, mandated reporters are professionals who, in the ordinary course of their work and because they have regular contact with children, disabled persons, senior citizens, or other identified vulnerable populations, are required to report whenever financial, physical,...

 training is a program used to prevent ongoing child abuse.

See also



External links