CHILD ABUSE. TYPES OF CHILD ABUSE

Child abuse involves the physical, emotional, or sexual mistreatment or neglect of a child. National studies show that one in 20 American children are physically abused each year. The physical and psychological effects of abuse can be extensive and severe. Abuse can impair brain development and intellect, delay development of skills such as walking and speaking, and cause physical disabilities and other long-term health problems. The psychological damages of abuse outlast the actual episodes of mistreatment. Some abused children develop posttraumatic stress disorder, leading to symptoms such as nightmares and irritability. Low self-esteem and unstable emotions can be the lifelong legacy of abuse. Adults who were abused as children are more likely to need help for depression, anxiety, substance abuse and eating disorders. They are also more apt to exhibit aggressive behavior and to become abusers themselves.

Types of Child Abuse

As dependent members of society, children are especially vulnerable. Any action taken by an adult that impedes a child's normal healthful development constitutes abuse. Injury to the child can result from physical assault, mental cruelty and deprivation.

Physical Abuse
This type of abuse concerns committing violence against a child. Burns, bruises, broken bones and other physical injuries are included. Abuse is a leading cause of serious head injury in babies. Among the most frequent types of child abuse injuries are burns. Cigarette burns and scalding, in which part of a child's body has been immersed in overly hot water, are common types of burns. Immersion burns leave a characteristic water level mark. Often physical abuse by a caregiver follows his or her unsuccessful attempts to calm a colicky baby or discipline an unruly child. In frustration, the caretaker mistakenly uses inappropriate and unnecessary force. Teaching caretakers how to prevent their anger from turning into physical violence may decrease the frequency of child abuse.

Emotional Abuse
Constant bombardment of a child with negative words or behavior can leave deep emotional scars. Criticizing, blaming, isolating, rejecting and terrorizing a child all are examples of emotional abuse. Withdrawing affection or exposing a child to a violent or sexually inappropriate environment also constitutes emotional abuse. Low self-esteem and feelings of worthlessness that often last well into adulthood typify the outcomes of such abuse. Although emotional abuse can be as harmful as physical abuse, it is much harder to detect. Emotionally deprived or abused children are often withdrawn and listless, and developmentally they may lag behind other children the same age.

Sexual Abuse
The involvement of children and adolescents in sexual activities that they do not fully comprehend or for which they are unable to give informed consent is abuse. Activities that violate the social taboos of proper family roles are included. The least reported and most underdiagnosed type of abuse, sexual abuse, may include vaginal, oral or anal intercourse; inappropriate touching of a child's breasts or genitalia; an adult exposing his or her genitalia to a child; and involving a child in any activity that gives the abuser sexual gratification. Most sexual abusers are male. Commonly, a family member or close family friend is the sexual abuser.

Neglect
Negligence in caring for a child can take several forms. Physical neglect means depriving a child of basic needs such as food, shelter and clothing. Emotional neglect includes failing to provide love, support, supervision and approval necessary for healthy development. Medical neglect consists of withholding necessary medical care. Educational neglect means causing the child to be chronically absent from school. For example, a child may be forced to stay home from school to baby-sit smaller children. Neglected children are often physically smaller than their peers and may lack the nurturing necessary to develop normally.

Warning Signs

Physical symptoms of abuse may include unexplained burns, bruises or broken bones. In infants and children, abuse or neglect is often shown by a failure to thrive, a condition in which the child does not grow at the expected rate for his or her age and sex. Emotionally abused children can appear unhappy and withdrawn. A child who has been sexually abused may have recurrent infections and be overly explicit in play or conversation. There is reason to suspect abuse if the explanation a parent or caregiver gives for an injury seems inconsistent with the injury or if different caregivers' accounts contradict each other. An inappropriate parental reaction to an injury — either overly concerned or not concerned enough — may be a sign that a child has been abused. Sometimes the child and abuser alike try to hide the abuse. Especially in sexual abuse, children are often confused and ashamed. They may blame themselves, rather than the abuser, and try to conceal the fact that they have been mistreated. Sometimes, children are threatened, intimidated or bribed into silence by their abusers. They may fear that no one will believe them or not want to get a close family member into trouble. Parents, too, can be in denial or not aware of the symptoms of abuse.

To intervene in child abuse it is important to know how to recognize its less obvious signs. Certain physical and emotional factors may indicate an abusive situation. Unexplained injuries are physical signs of abuse. Puzzling injuries include those on parts of the body that usually do not get injured (the stomach, buttocks, back, face or backs of hands) and those that were made with an object (cigarette, belt, electric cord, iron or hand) that leaves a recognizable mark. Sexual abuse may cause physical discharges, sores, injuries in the genital area, and recurrent urinary tract infections.

Psychosocial problems can be emotional indicators of abuse. A child who fears parents or other adults or one who is reluctant to talk about home life or to invite friends over may have been abused. Also a child who shows regressive behavior, such as bed-wetting and soiling, clinging, or thumb-sucking, or one who exhibits inappropriate sexual explicitness may have been abused. Abuse may trigger extreme passivity or aggressiveness or sudden, unexplained changes in behavior. Self-destructive behavior, such as substance abuse, multiple sexual encounters, suicide attempts, crime, running away from home, or poor academic performance, can indicate a problem. Depression, chronic sadness, frequent crying, low self-esteem, feelings of worthlessness, recurrent nightmares, and neglected appearance are also possible signs.

Diagnosis and Treatment

A child who has been abused needs treatment and protection as soon as possible. Early detection and treatment increase the likelihood of a full recovery. Whenever a child may be at risk, it is important to inform a doctor, social services agency or police department. Parents who suspect their children have been abused should seek help immediately. Seeing the pediatrician or family physician is the first step. Treatment will depend on the type of abuse. The doctor can evaluate the child's condition and treat any physical problems. He or she may also refer the child to a child psychiatrist, child psychologist, clinical social worker, or rape victim advocate. Most abused children benefit from psychological counseling, especially those who have been abused by a parent or other close relative.

Doctors are required by law to report every suspected case of abuse to legal authorities, such as the state child protection agency. Once a case is reported, the agency must investigate it. For his or her own safety, a child is sometimes removed from the home while an investigation takes place. Hospital admission may be required to allow the opportunity for an in-depth medical and social evaluation. Troubled families are then given professional support and guidance. When possible, families are kept together.

Risk Factors and Prevention

Abuse can occur in a family of any socioeconomic background, race, ethnicity or religion. At the greatest risk are children under age 5 and those who require special care and attention. These include premature infants; babies who cry and fuss a lot; and children who have chronic diseases or disorders, physical or mental disabilities, or behavior problems.

Abusers usually are the child's caregivers: parents and close relatives, stepparents or foster parents, parents' friends, or baby-sitters. Many adults who are abusers were abused when they were children. A violent environment increases the risk of abuse. Abuse occurs in families of all backgrounds but is more common in families that live in poverty. Other risk factors include substance abuse, marital problems, the lack of a strong home support system, limited education, caregiver's youth, unplanned parenthood (singles or couples), and physical or mental illness in the family. Anything that undermines a caregiver's self-control — such as alcohol dependence or drug addiction — increases the risk of abuse. Parents or other caregivers who are under stress are more apt to engage in impulsive or aggressive behavior.

Caregivers who practice techniques to prevent their anger from turning into violence when under stress may be less likely to abuse. Parents who fear harming their own child should seek help immediately from a doctor, therapist, friend or member of the clergy. Adults who were abused themselves as children may benefit from counseling. To prevent abuse outside the home, parents should thoroughly investigate the references of childcare facilities. Conversations with other parents are helpful in this regard, as are unannounced visits. When they are old enough to understand (about age 3), children should be taught that it is unacceptable for anyone other than a physician to touch private parts of their bodies.