Child Abuse: What Is It?

     I am often asked, "what IS the definition of child abuse?"  Such a taboo topic for so many people in the world today. "I mind my business and stay out of others" is often said by at least one person when the issue arises. But what about the child? Does he or she have a say in how they are raised? Can anyone be strong enough to meddle in the affairs of others for the sake of the child? Is it OK to 'look the other way' because that child wasn't born of you?

     We should first be aware of the public knowledge of child abuse. The first formal descriptions of inflicted injuries as such only appeared in the medical literature in 1946 and the phenomenon was not considered a significant problem until the 1960s.  However, our four-legged creatures had protection laws even in the times before Christ. You can read Triptolemus BCE-476 for more information. For the next 14 years, child abuse was seen, but remained unresolved. It wasn't until 1974,when Congress enacted the Child Abuse Prevention and Treatment Act (P.L. 93-247), establishing the legal framework for current federal efforts which focus on data collection and technical assistance to states.
    
    Statistics show that one out of every 10 ER visits treated were the result of abuse. But what is abuse? There several different forms of abuse.
The most prevalent forms are:

1. Physical   
2. Sexual
3. Child Neglect and Abandonment
4. Educational Neglect
5. Psychological Abuse
6. Munchausen Syndrome by Proxy

     The first is common in identifying abuse. The physical characteristics of abuse include but are not limited to Skin brusing and burns, bites, hair loss, bones, brain injuries, intra-abdominal injuries, and mouth injuries. 

     The second is harder to identify. On part of the victim because they may be scared or may have been threatened that harm would come to them if they told. On the otherhand, they may be told that it is ok to do those things, but not aware they were being lied to. On part of the perpetrator because they can perform certain things on the child that can not be detected through testing.  It has been estimated that as many as one in four girls and one in ten boys will be victims of sexual abuse by the time they become adults. The most common ways to determine if sexual abuse has occurred is:

1. The child discloses a history of sexual abuse
2. The child presents with nonspecific behavioral or medical symptoms which are the underlying manifestation of sexual abuse
3. The child has unexplained injury or medical findings consistent with those that would be received from sexual abuse.

     Child Neglect and Abandonment is another broad area. The basic definition of child neglect is when a child suffers from not having his or her basic needs met, regardless of the circumstances leading to the inadequacy of care. In 1996, the total of physical, emotional and educational neglect alone was 879,002 or 13.1 out of 1,000 children. That was 15 years ago. Can you begin to fathom the numbers today?

     Several underlying causes contribute to the totality of neglect. Social factors are the number one cause of neglect. Another is maternal/paternal factors. Parents who fall into the category often lack basic problem solving skills and social competence. They may be young or inexperienced, and ignorant of the nutritional, developmental and safety needs of their children.
Types of neglect include but are not limited to:

1. Failure to thrive
2. Inadequate supervision
3. Abandonment/Expulsion
4. Custody issues
5. Other physical neglect
6. Refusal of health care
7. Delay in health care
8. Educational neglect

     Of those listed, abandonment is the most extreme act of neglect. all child neglect reflects a degree of emotional abandonment, but occasionally physical abandonment also occurs.

     Neglect and Abuse are often lumped together as child maltreatment and suggesting that the risk factors, dynamics and outcomes are similar. Child abuse gotten more publicity than neglect in recent years, prompting an outcry of 'neglect of neglect'.

     Educational neglect is simply put, the neglect to provide education for your child, the means of obtaining said education or depriving them from education.

     Psychological abuse is one of the lesser common forms, but abuse nevertheless. It is a repeated pattern of caregiver behavior or extreme incidents that convey to children they are worthless, flawed, unloved, endangered or of value only in meeting another's needs.
Other identifying factors of psychological abuse include but are not limited to:

1. Ignoring or degrading a child or failing to provide necessary stimulation, responsiveness and validation.
2. Rejecting the child's value, needs and requests for nurture.
3. Isolation
4. Terrorizing or threatening the child with physical harm
5. Corrupting or exploiting the child
6. Verbally assaulting the child
7. Overpressuring the child
8. Overexposing children to domestic and community violence

     The final category is Munchausen Syndrome by Proxy also known as Factitious Disorder by Proxy (FDP). MSBP, is a very serious and potentially fatal form of child abuse. It is a situation in which a caregiver  intentionally falsifies or exaggerates a medical history, or induces symptoms in a child in order to assume the sick role indirectly and health professionals participate, albeit unwillingly, in harming the child. The most common way of detecting MSBP is to recognize the child is not responding to treatment in the way that the condition usually does, has unusual features and has few objective findings. The caregiver who raises most concern is the ever-present mother with medical knowledge who is interested in having more tests and more treatment for her child rather than appearing concerned that her child's condition remains undiagnosed. This particular form of abuse is discovered once the medical professionals see the presentation of illness. Afterward, they evaluate, and report their findings if any, to the authorities. The mortality rate of MSBP has been totalled at 9%.

     Child neglect, the failure to meet a child's basic needs, is a complex problem that is more prevalent than the better publicized problem of child abuse. Its long-term impact on physical and cognitive development can be severe. Social factors, such as poverty and lack of social supports, and parental disabilities, such as depression and substance abuse, play important roles in may cases of child neglect. Interventions must be individualized and long-term to be successful in creating a more nurturing environment for neglected children.

     In conclusion, if you see something that doesn't look right, suspect something isn't right or feel in your heart of hearts that a child is suffering beyond the factors, don't hesitate to contact the authorities. It may be your report that speaks for the child. It may be your report that saves a childs life.

     The National Child Abuse Hotline is 1-800-4-A-Child (1-800-422-4453)
    
*Information and statistics from "Recognition of Child Abuse for the Mandated Reporter: Third Edition" by Angelo P. Giardino, M.D., Ph.D. and Eileen R. Giardino, Ph.D., R.N., C.R.N.P.