Child Abuse

Child Abuse Introduction

Child abuse is defined as a variety of harmful behaviors directed against children. It can take many forms. Child abuse in general is a psychological problem or perversion of the abuser. The abuser is referred to as the perpetrator of abuse.

  • Child abuse includes the following conditions:
    • Child sexual abuse
    • Pedophilia
    • Physical abuse
    • Child neglect
    • Emotional neglect and abuse
    • Failure to thrive
    • Munchausen by proxy syndrome

The descriptions of child abuse in the next section are intended for people who have questions about abuse, what it is, and how it may present itself. Although some cases of child abuse are obvious, many are not. Early recognition of child abuse tendencies and intervention at the point of recognition is the only way to avoid the liability of criminal prosecution.

These descriptions may help you identify abuse in its various forms. You will also find information about what you can do if you observe child abuse or if you are a parent dealing with problems that are straining your capacity to cope with the parenting experience.

If you think you are acting in an abusive way or are having a difficult time with your children or yourself as a parent, you may have identified a tendency to be abusive. These tendencies can include the following:

  • Excessive and loud verbal confrontation
  • Excessive corporal punishment
  • Sexual feelings or excessive feelings of anger about children

Tendencies can be treated more effectively than the frank abusive behavior that can evolve from a tendency. You will want to seek help early to avoid the tendency evolving into an act of abuse.

If you observe child abuse in others, you are obligated to report the abuse to the police or medical authorities.

Child Sexual Abuse and Pedophilia

Child sexual abuse includes any activity that uses a child to create sexual gratification either in you or in others. Although the touching of children as a sign of affection and for hygiene is considered normal and necessary, there is a way to distinguish normal touching from child sexual abuse. The key is the intention by the perpetrator to be sexually aroused by the activity or the intention to create sexual arousal in others. The intent to use children in any way to create sexual arousal is illegal. This is criminal behavior that is aggressively prosecuted and severely punished by our legal system.

Child sexual abuse can include a wide variety of activities. Some are obvious acts of sexual abuse and others must be evaluated to determine if they are designed to create sexual gratification.

  • Activities can include any conventional adult sexual activity with a child. Also included are acts such as touching the child's genitals or fondling with the intention of arousing sexual feelings.
  • Child sexual abuse includes prolonged kissing, cuddling, French kissing, and excessive touching. Looking at children either with or without clothes with the intent to be sexually aroused is also included.
  • Photographing, videotaping, or filming of children with the intent to create sexual stimulation is a form of child abuse as well.
  • Other forms of child sexual abuse include exposure of a child to erotic material in the form of live behavior (excessive nudity), photographs, film, or video. The collection of any photographs or images of children taken by others in suggestive poses is illegal. The collection of any excessive number of photographs of naked children in any pose may draw the attention of law enforcement.
  • Any efforts to seduce a minor into a sexual relationship, whether the act is accomplished or not, is considered a form of child sexual abuse and can result in severe legal consequences. Inappropriate intimacy with children is also regarded as child sexual abuse.
  • Most cases of child sexual abuse are ultimately discovered. Once discovered, the perpetrator faces legal prosecution. Broad and flexible laws have been crafted and are aimed at preventing child sexual abuse. These laws give law enforcement personnel and prosecutors great latitude to classify and prosecute cases of perceived child sexual abuse behavior.
  • Acceptable displays of affection or inadvertent incidents that result in exposure of a child to a sexual act or sexual material (for example, a child walking into a closed bedroom while the parents are having sex or finding an adult magazine) are not considered criminal.
  • To identify the physical signs of child sexual abuse, parents should know the normal appearance of the genitalia of their child so that they can identify if any changes occur. If a child complains about problems with his or her genitals, take the child to the family doctor for examination. Children in day care, children cared for by others, or children who spend time alone with other people may be at risk of sexual abuse.
  • Changes in behavior, including discipline problems, fecal soiling, bed wetting, insomnia, nightmares, depression, or other changes in the way a child normally acts can be signs of sexual abuse. Parents should discuss the possible reasons for such changes in behaviors with professionals who are in a position to properly evaluate the behavioral changes and explore the possibility of child sexual abuse.

Pedophilia is a form of child sexual abuse. It is a condition which is defined as an adult who has sexual interest in children.

  • Someone with an erotic interest in children may collect material that showcases a child in sexual poses. The person may seek interaction with children with the intention of satisfying an erotic or sexual desire or actively seek a sexual relationship with a child. These nonsexual forms of interaction, even if well intentioned, can be construed as sexual. Adults who seek actual physical sexual relations with children are the most extreme and deviant of the pedophiles.
  • Using children to create erotic materials or for erotic acts with other adults is another form of child sexual abuse. In this form, the intention is to arouse others and may or may not be used to arouse the abuser as well. The law does not distinguish one from the other. Both are severely prosecuted.
  • Pedophilia, although a mental disorder, if not resisted, repressed, and treated, will result in the most severe legal consequences. The law does not tolerate pedophilia. It is imperative that any person who feels sexually attracted to children to immediately seek help from a qualified therapist. People who use children to create sexual arousal for others are already involved in serious criminal activity. Report any suspicions to authorities immediately.

Physical Abuse, Child Neglect, and Emotional Neglect

Physical abuse of children is defined as excessive intentional physical injury to a child or excessive corporal punishment of a child. Torture, beatings, and assault of children are obvious forms of physical abuse.

  • Corporal punishment by parents is subject to evaluation and interpretation. In general, corporal punishment should be avoided, though spanking with a hand and other forms of mild physical punishment that do not leave any marks are still considered within the realm of parental discretion.
  • Punishment that leads to marks that last for more than a few minutes can be interpreted as abuse, regardless of intention. The use of any objects to strike a child (other than with your open hand) is wrong. That includes belts, paddles, sticks, or any other object. A family tradition of beatings or the fact that the parent was subjected to physical abuse is not an acceptable excuse for injury to a child.
  • Excessive physical discipline is harmful and dangerous to children. Small children can be killed by relatively minor acts of physical violence (for example, shaking, dropping, or throwing the child against hard surfaces). Any severe beating with an object, forceful shaking, submersion in hot water, intentional burning, and other forms of intentional infliction of pain are inappropriate and criminal behaviors.
  • Any person who has been reared in an environment of violence may be more likely to inflict violence on others. People who recognize their tendencies to get angry, out of control, or violent should seek help. They can learn anger-management and child-rearing techniques, and try to suppress their violent tendencies through conscious and diligent effort at all times.
  • Seeing others inflict physical abuse on children should prompt immediate action by the observer. People who are physically violent generally demonstrate violence again -- at escalating levels. Early intervention is the best strategy to avoid lifelong consequences.

Child neglect in any form, when it concerns a child's welfare, is generally considered to be criminal behavior. Child neglect is considered as a possible diagnosis for children who are poorly cared for, not fed properly, improperly clothed, denied basic safety or necessities, denied proper medical care, or treated with indifference to a degree that appears to cause or put the child at risk for damage or suffering.

  • Parents, caregivers, and guardians of children must seek help from medical and social services in situations in which children have less-than-adequate care. Children can develop long-term medical, emotional, and developmental problems from such neglect.
  • Failure to continue to get help for a child who is not doing well or who is improperly cared for may be interpreted as another form of neglect. This can result in criminal action or action by local child protective services that may result in children being removed from the home and placed in foster care.

Emotional neglect is a condition in which children do not get adequate attention from their parents or guardians. Emotional abuse refers to children being harmed by emotionally negative behaviors by a caretaker.

  • With mild forms of emotional neglect or abuse, children can develop rebellious behaviors or become alienated from their parents.
  • In more severe cases of emotional neglect or abuse, especially with babies or very young children, neglect can result in very abnormal behaviors, such as these:
    • Listlessness
    • Profound detachment from the parents
    • Poor bonding with other people
    • Poor interactive skills with other children or at times inappropriate attachment to anyone who will pay attention to them
  • These abnormal behaviors in young children continue as they get older and can transform into other personality or mental disorders that can be difficult, if not impossible to treat.
  • Parents who feel their relationship to their children is causing problems, is stressful, or not working well should consider the following questions:
    • Are you spending time with your children in recreational and learning activities in which they are the focus of your attention?
    • Do you show your children love and affection?
    • Do you feel out of control of your children or detached from them and their activities?
    • Do you have excessive behavioral problems with your children?
    • Are you supervising your children's time during which you are caring for them or letting them be on their own and unsupervised?
    • Is there excessive yelling, anger, or punishment?
    • Do you engage in calling your child hurtful names or making negative statements toward them?
    • Do you yourself exhibit bad behaviors in front of your children that disregard the children such as drug use, profanity, physical violence, bigotry, or ignoring the child's feelings and concerns?
  • Parents who recognize any of these problems can avoid the consequences of emotional neglect through parental training courses, reading, and effort. Seeking a little help can achieve big results. Children are very responsive to any positive effort put forth by a parent to improve the parent-child relationship, especially when children are young. Children need to be shown that they are cared about and that you are aware of their need to be loved as they grow up.

Failure to Thrive and Munchausen Syndrome by Proxy

Failure to thrive is a condition in which children fail physically to develop to their normal full genetic potential. It is most commonly caused by medical conditions that can result in children not growing as expected. At times, though, it can also be caused by intentional or unintentional behavior on the part of the parent or caregiver.

  • The diagnosis is made when a doctor compares the growth of a child on standard growth charts and looks for changes in the rate of growth of a child. These measurements are usually taken during well-child visits to the family doctor.
  • Any significant decrease in the rate of growth of a child with respect to weight, height, or head size is suggestive of a child who is failing to thrive.
  • Medical conditions that affect growth are primarily considered; however, if no other explanation for the abnormal growth is present, neglect is strongly considered. Behaviors considered as neglectful include:
    • Denying a child food
    • Feeding a child the wrong foods
    • Emotionally neglecting a child
    • Allowing a child to remain ill (not seeking medical care)
  • Once failure to thrive is considered, parents must comply with their doctor's recommendations regarding testing and any other investigation into the child's failure to thrive. If not, the doctor's suspicion may increase that the parent is contributing to or causing the condition.
  • Although some children are destined to be small, they generally grow at a predictable rate. If a child is eating adequately and consuming an adequate number of calories and generally appears happy and healthy, regardless of size, there is little reason to worry.

Munchausen by proxy syndrome is a serious psychiatric disorder of parents or guardians of children. The parent or guardian referred to as the perpetrator intentionally or unintentionally manufactures signs and symptoms of a disease in the child under their care. They do this, not for the good of the child, but generally to satisfy their own abnormal need. By literally making the child sick, the caregiver gets attention by having excessive contact with doctors and hospitals. Children undergo unnecessary testing and treatment for diseases that they do not have.

  • This condition is difficult for doctors to identify. Often it is more obvious to other family members or friends who sense an excessive contact with medical providers for an apparently healthy child being orchestrated by the offending parent or guardian. If you suspect this is happening discuss the issue with your family physician or pediatrician. Your provider should be able to guide your response and help determine whether an intervention is needed.
  • Parents who might be at risk for Munchausen by proxy can ask themselves these questions with respect to seeking medical attention for their children:
    • Are you overly concerned about the health of your children?
    • Do you remain concerned about minor problems that you have been told not to worry about?
    • Do you find yourself obsessing over possible medical problems that might affect your children?
    • Have you ever intentionally made a child appear ill?
    • Do you have any motivation or will you derive any benefit if you make your child appear ill?
  • Parents who see this behavior in themselves should stop the medical attention-seeking behavior and seek psychiatric help as soon as possible.

Basic Parenting Skills

General parenting guidelines

Raising children can be a successful and satisfying experience. Without basic parenting skills, the task is difficult and frustrating.

Children seek love and discipline. Discipline takes the form of structured environment, rules, boundaries and complimenting appropriate behaviors, not just physical punishment and obedience. Love and encouragement is the complementary behavior to discipline. Both are necessary if you are to be a successful parent. Both are needed to create the correct balance of concern and caring required to raise well-adjusted and happy children. When love and discipline are blended correctly, your child will be mentally healthy, self-assured, responsible, self-controlled, and prepared for their own parenting experience.

The Limited Role of Corporal Punishment

It is important for parents to understand the limited role of spanking and corporal punishment. Many parents have successfully raised children without resorting to corporal punishment.

Alternatives to Corporal Punishment

The following nonphysical forms of punishment are effective alternatives to physical forms of punishment.

  • Timeouts
  • Sending children to their rooms
  • Taking away privileges of various types
  • Denying children enjoyable activities
  • It is important to remember that clarity and consistency regarding expectations and consequences are paramount when disciplining children. Even the youngest child who uses words can understand simple explanations from their caretakers about acceptable and unacceptable behaviors.

How Can I Report Child Abuse?

You may have questions about possible abuse in your own behavior or about the behavior of others. State law mandates that certain people, called mandated reporters, report any suspected child abuse to authorities. These are teachers, police, professional childcare providers, doctors and other health care workers.

Nonmandated reporters, however, which include almost everyone else, are frequently the first people to notice possible abuse. Ironically, nonmandated reporters are actually the people most likely to be able to identify potential abusers. They are the people who see abuse early enough to play an active role in preventing it and saving the abuser from the terrible consequences that are associated with committing an act of child abuse.

The first observer of abuse or abusive tendencies is in a position to intervene with the potential abuser before any substantial abuse has taken place.

Although we would like to think that abusers are receptive to having these tendencies pointed out, generally they are not. Counseling at this point can be life saving for both the person with abusive tendencies and the people who are being mistreated. Unfortunately, abusive tendencies frequently turn into abusive behaviors, which are usually difficult to stop. This forces the typical observer of abuse into the unenviable, but necessary, position of having to report the abuser to the proper authorities.

Reporting is the only effective step to control the abuser at this point and stop the abuse.

If reporting a pattern of abuse is delayed, the abuse situation usually gets worse until the abuser and his or her behaviors are discovered by others. At this point, law enforcement usually becomes aware of the situation and the degree of abuse may be much worse. Early intervention is the key.

What Are the Laws About Child Abuse?

Take care in interpreting certain behaviors in adults and children that suggest the possibility of abuse. Parents and all reporters of abuse must realize that accusations of abuse are taken very seriously by law enforcement, child abuse professionals, and prosecutors. While the reporter of abuse (mandated or nonmandated) is granted immunity from any liability when they make reports about possible abuse, such reports should be done in good faith only.

Some people are willing to use allegations of abuse to achieve their own goals at the expense of an accused person. Once allegations of abuse are made, the general belief by the authorities is that accusations are true until proven otherwise. False accusations can rarely be taken back without very significant damage to families and the lives of the accused person.

  • If you, as a parent, are concerned about abuse, take that concern to a professional. Avoid any interrogation of your child, which may produce unintended consequences that would interfere with the legal process that follows allegations of abuse. Excessive questioning will often produce unintended consequences that can interfere with the prosecution of abuse. Special techniques and formal interviews are the best forum for discovering and documenting allegations of sexual abuse. Contacting a family doctor or local child protection services usually results in adequate initial investigation of any concerns.
  • Parents and other adults should be aware that they have extraordinary powers to influence both a child's words and memory. Parents can, by exerting psychological pressure, either intentional or unintentionally elicit statements from children that are not true but could later be regarded as true.
  • False allegations can arise from family members, enemies, or from unhappy or disturbed children. Children can be manipulated by adults to make false accusations. The younger the child, the more susceptible the child is to manipulation.
  • False allegations of abuse occur in a small number (3%-5%) of all abuse reports. However, under certain circumstances, the percentage can increase. In divorce and custody disputes, in which allegations of abuse are raised, the percentage of false allegations has been reported to be as high as 35%. Stepchild-stepfather false accusations have also increased in frequency as well over the last 20 years as children use their knowledge of the legal system against parental figures who are putting legitimate boundaries on them as they enter adolescence.
  • Misinterpretation of medical findings or the observation of abnormal behaviors by overly protective authorities at school, daycare, and in medical facilities, have been responsible for many false allegations of abuse, even when all parties (including the children) deny that abuse has occurred. Sexualized behaviors, depression, or poor school performance to name a few, can be interpreted or misinterpreted, at times, as being the result of child abuse.

For the federal fiscal year 2012, more than 3.8 million children were the subjects of at least one report of child maltreatment. One fifth of these children were found to be victims with dispositions of "substantiated" (17.7 %), "indicated" (0.9%), and alternative response victim (0.5%).

Risk Factors That May Increase Risk of Child Abuse

Some factors can increase the risk for abuse or neglect. The presence of these factors does not always mean that maltreatment will occur. Children are never to blame for the harm others do to them.

Age: Children under 4 years of age are at greatest risk for severe injury and death from abuse.

Family environment: Abuse and neglect can occur in families where there is a great deal of stress. The stress can result from a family history of violence, drug or alcohol abuse, poverty, and chronic health problems. Families that do not have nearby friends, relatives, and other social support are also at risk.

Community: Poverty, on-going community violence, and weak connections between neighbors are related to a higher risk for child abuse and neglect.

Differing Cultural Norms for Child Rearing

Various cultures have different cultural norms with respect to appropriate behavior toward children.

  • Some cultures are more "touchy" than others.
  • Some believe in physical discipline to an extreme.
  • There are cultures in which certain things that are done to children out of caring create the appearance of child abuse.
  • In some cultures, rituals are performed. These same rituals may be unacceptable in the country in which you live.

In general, the laws of the country in which you live are the laws that must be obeyed.

How Can We Prevent Child Abuse?

Child abuse is prevented, first, through awareness, then early detection and intervention. Protecting children from abuse is the first and foremost concern of police and child protection authorities.

  • Educating children to recognize inappropriate behaviors (sexual and physical) and to report possible abuse to their parents or family at its earliest stages will help children avoid being abused, save families from dysfunctional interactions, identify real abusers almost immediately to law enforcement, and help in the early identification of family members with abusive tendencies before a criminal act occurs.
  • In an ideal world, psychiatric help would be available to treat those who abuse children. That is rarely the case. Most abusers, once they have acted out and committed acts of abuse, are arrested, charged, tried, convicted, sent to prison, and marked for life as sexual offenders.
  • To prevent abuse by changing the behavior of the abuser (whether they are a loved one or a friend), tendencies to be abusive must be identified before any actual abuse takes place. Once a tendency is identified, the best hope for treating this serious mental disorder is behavioral counseling.
Reviewed on 11/21/2017

Medically reviewed by Margaret Walsh, MD; American Board of Pediatrics

REFERENCES:

Chadwick, D.L. Color Atlas of Sexual Abuse. Chicago, Ill: Mosby, 1989.

Dwek, J.R. "The radiographic approach to child abuse." Clinical Orthopedics and Related Research 469.3 Mar. 2011: 776-789.

NICE Clinical Guidelines. When to Suspect Child Maltreatment; 2009.

Pandya, N.K, et al. "Unexplained Fractures: child abuse or bone disease? A systematic Review." Clinical Orthopedics and Related Research 469.3 Mar. 2011: 805-812.

http://www.acf.hhs.gov/programs/cb/pubs/cm10/index.htm (U.S. Department of Health and Human Service: Administration for Children and Families. 2010 Child Maltreatment Report)

Wilson, C.A. "Special issue of child maltreatment on implementation; some key developments in evidence-based models for the treatment of child maltreatment." Child Maltreatment 17.1 Feb. 2012: 102-106.

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