Child Abuse - Wikipedia, The Free Encyclopedia PDF

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ChildabuseWikipedia,thefreeencyclopedia
Childabuse
FromWikipedia,thefreeencyclopedia
Childabuseorchildmaltreatmentisphysical,sexual,orpsychologicalmistreatmentorneglectofachildor
children,especiallybyaparentorothercaregiver.Itmayincludeanyactorfailuretoactbyaparentorother
caregiverthatresultsinactualorpotentialharmtoachild,andcanoccurinachild'shome,orinthe
organizations,schoolsorcommunitiesthechildinteractswith.
Thetermschildabuseandchildmaltreatmentareoftenusedinterchangeably,butsomeresearchersmakea
distinctionbetweenthem,treatingchildmaltreatmentasanumbrellatermtocoverneglect,exploitation,and
trafficking.
Differentjurisdictionshavedevelopedtheirowndefinitionsofwhatconstituteschildabuseforthepurposesof
removingachildfromhis/herfamilyand/orprosecutingacriminalcharge.
Contents
1 Definitions
2 Types
2.1 Physicalabuse
2.2 Sexualabuse
2.3 Psychologicalabuse
2.4 Neglect
3 Effects
3.1 Emotional
3.2 Physical
3.2.1 AdverseChildhoodExperiencesStudy
3.3 Psychological
4 Causes
4.1 Worldwide
5 Disclosureanddiagnosis
6 Assessment
7 Prevention
8 Treatment
9 Prevalence
9.1 UnitedStates
10 Societyandculture
10.1 History
10.2 Childlabor
10.3 Childtrafficking
10.4 Femalegenitalmutilation
10.5 Childmarriage
10.6 Violenceagainstchildrenaccusedofwitchcraft
11 Ethics
12 Organizations
13 Seealso
14 References
15 Furtherreading
16 Externallinks
Definitions
https://en.wikipedia.org/wiki/Child_abuse
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Definitionsofwhatconstituteschildabusevaryamongprofessionals,andbetweensocialandculturalgroups,
aswellasacrosstime.[1][2]Thetermsabuseandmaltreatmentareoftenusedinterchangeablyinthe
literature.[3]:11Childmaltreatmentcanalsobeanumbrellatermcoveringallformsofchildabuseandchild
neglect.[4]Definingchildmaltreatmentdependsonprevailingculturalvaluesastheyrelatetochildren,child
development,andparenting.[5]Definitionsofchildmaltreatmentcanvaryacrossthesectorsofsocietywhich
dealwiththeissue,[5]suchaschildprotectionagencies,legalandmedicalcommunities,publichealthofficials,
researchers,practitioners,andchildadvocates.Sincemembersofthesevariousfieldstendtousetheirown
definitions,communicationacrossdisciplinescanbelimited,hamperingeffortstoidentify,assess,track,treat,
andpreventchildmaltreatment.[3]:3[6]
Ingeneral,abuserefersto(usuallydeliberate)actsofcommissionwhileneglectreferstoactsofomission.[4][7]
Childmaltreatmentincludesbothactsofcommissionandactsofomissiononthepartofparentsorcaregivers
thatcauseactualorthreatenedharmtoachild.[4]Somehealthprofessionalsandauthorsconsiderneglectaspart
ofthedefinitionofabuse,whileothersdonotthisisbecausetheharmmayhavebeenunintentional,or
becausethecaregiversdidnotunderstandtheseverityoftheproblem,whichmayhavebeentheresultof
culturalbeliefsabouthowtoraiseachild.[8][9]Delayedeffectsofchildabuseandneglect,especiallyemotional
neglect,andthediversityofactsthatqualifyaschildabuse,arealsofactors.[9]
TheWorldHealthOrganization(WHO)defineschildabuseandchildmaltreatmentas"allformsofphysical
and/oremotionalilltreatment,sexualabuse,neglectornegligenttreatmentorcommercialorotherexploitation,
resultinginactualorpotentialharmtothechild'shealth,survival,developmentordignityinthecontextofa
relationshipofresponsibility,trustorpower."[10]IntheUnitedStates,theCentersforDiseaseControland
Prevention(CDC)usesthetermchildmaltreatmenttorefertobothactsofcommission(abuse),whichinclude
"wordsorovertactionsthatcauseharm,potentialharm,orthreatofharmtoachild",andactsofomission
(neglect),meaning"thefailuretoprovideforachild'sbasicphysical,emotional,oreducationalneedsorto
protectachildfromharmorpotentialharm".[3]:11TheUnitedStatesfederalChildAbusePreventionand
TreatmentActdefineschildabuseandneglectas,atminimum,"anyrecentactorfailuretoactonthepartofa
parentorcaretakerwhichresultsindeath,seriousphysicaloremotionalharm,sexualabuseorexploitation"
and/or"anactorfailuretoactwhichpresentsanimminentriskofseriousharm".[11][12]
Types
TheWorldHealthOrganizationdistinguishesfourtypesofchildmaltreatment:physicalabusesexualabuse
emotionalandpsychologicalabuseandneglect.[13]
Physicalabuse
Amongprofessionalsandthegeneralpublic,peopleoftendonotagreeonwhatbehaviorsconstitutephysical
abuseofachild.[14]Physicalabuseoftendoesnotoccurinisolation,butaspartofaconstellationofbehaviors
includingauthoritariancontrol,anxietyprovokingbehavior,andalackofparentalwarmth.[15]TheWHO
definesphysicalabuseas:
intentionaluseofphysicalforceagainstthechildthatresultsinorhasahighlikelihoodof
resultinginharmforthechild'shealth,survival,developmentordignity.Thisincludeshitting,
beating,kicking,shaking,biting,strangling,scalding,burning,poisoningandsuffocating.Much
physicalviolenceagainstchildreninthehomeisinflictedwiththeobjectofpunishing.[13]
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JoanDurrantandRonEnsomwritethatmostphysicalabuseisphysicalpunishment"inintent,form,and
effect".[16]Overlappingdefinitionsofphysicalabuseandphysicalpunishmentofchildrenhighlightasubtleor
nonexistentdistinctionbetweenabuseandpunishment.[17]Forinstance,PauloSergioPinheirowritesinthe
UNSecretaryGeneral'sStudyonViolenceAgainstChildren:
Corporalpunishmentinvolveshitting('smacking','slapping','spanking')children,withthehandor
withanimplementwhip,stick,belt,shoe,woodenspoon,etc.Butitcanalsoinvolve,for
example,kicking,shakingorthrowingchildren,scratching,pinching,biting,pullinghairorboxing
ears,forcingchildrentostayinuncomfortablepositions,burning,scaldingorforcedingestion(for
example,washingchildren'smouthsoutwithsoaporforcingthemtoswallowhotspices).[18]
Mostnationswithchildabuselawsdeemthedeliberateinflictionofseriousinjuries,oractionsthatplacethe
childatobviousriskofseriousinjuryordeath,tobeillegal.Bruises,scratches,burns,brokenbones,
lacerations,aswellasrepeated"mishaps,"androughtreatmentthatcouldcausephysicalinjury,canbephysical
abuse.[19]Multipleinjuriesorfracturesatdifferentstagesofhealingcanraisesuspicionofabuse.
ThepsychologistAliceMiller,notedforherbooksonchildabuse,tooktheviewthathumiliations,spankings
andbeatings,slapsintheface,etc.areallformsofabuse,becausetheyinjuretheintegrityanddignityofa
child,eveniftheirconsequencesarenotvisiblerightaway.[20]
Sexualabuse
Childsexualabuse(CSA)isaformofchildabuseinwhichanadultorolderadolescentabusesachildfor
sexualstimulation.[21]Sexualabusereferstotheparticipationofachildinasexualactaimedtowardthe
physicalgratificationorthefinancialprofitofthepersoncommittingtheact.[19][22]FormsofCSAinclude
askingorpressuringachildtoengageinsexualactivities(regardlessoftheoutcome),indecentexposureofthe
genitalstoachild,displayingpornographytoachild,actualsexualcontactwithachild,physicalcontactwith
thechild'sgenitals,viewingofthechild'sgenitaliawithoutphysicalcontact,orusingachildtoproducechild
pornography.[21][23][24]Sellingthesexualservicesofchildrenmaybeviewedandtreatedaschildabusewith
servicesofferedtothechildratherthansimpleincarceration.[25]
Effectsofchildsexualabuseonthevictim(s)includeguiltandselfblame,flashbacks,nightmares,insomnia,
fearofthingsassociatedwiththeabuse(includingobjects,smells,places,doctor'svisits,etc.),selfesteem
difficulties,sexualdysfunction,chronicpain,addiction,selfinjury,suicidalideation,somaticcomplaints,
depression,[26]posttraumaticstressdisorder,[27]anxiety,[28]othermentalillnessesincludingborderline
personalitydisorder[29]anddissociativeidentitydisorder,[29]propensitytorevictimizationinadulthood,[30]
bulimianervosa,[31]andphysicalinjurytothechild,amongotherproblems.[32]Childrenwhoarethevictims
arealsoatanincreasedriskofsexuallytransmittedinfectionsduetotheirimmatureimmunesystemsandahigh
potentialformucosaltearsduringforcedsexualcontact.[33]Sexualvictimizationatayoungagehasbeen
correlatedwithseveralriskfactorsforcontractingHIVincludingdecreasedknowledgeofsexualtopics,
increasedprevalenceofHIV,engagementinriskysexualpractices,condomavoidance,lowerknowledgeof
safesexpractices,frequentchangingofsexualpartners,andmoreyearsofsexualactivity.[33]
IntheUnitedStates,approximately15%to25%ofwomenand5%to15%ofmenweresexuallyabusedwhen
theywerechildren.[34][35][36]Mostsexualabuseoffendersareacquaintedwiththeirvictimsapproximately30%
arerelativesofthechild,mostoftenbrothers,sisters,fathers,mothers,unclesorcousinsaround60%areother
acquaintancessuchasfriendsofthefamily,babysitters,orneighboursstrangersaretheoffendersin
approximately10%ofchildsexualabusecases.[34]Inoveronethirdofcases,theperpetratorisalsoaminor.[37]
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In1999theBBCreportedontheRAHIFoundation'ssurveyofsexualabuseinIndia,inwhich76%of
respondentssaidtheyhadbeenabusedaschildren,40%ofthosestatingtheperpetratorwasafamily
member.[38]
Psychologicalabuse
Therearemultipledefinitionsofchildpsychologicalabuse:
In2013,theAmericanPsychologicalAssociation(APA)addedChildPsychologicalAbusetotheDSM
5,describingitas"nonaccidentalverbalorsymbolicactsbyachild'sparentorcaregiverthatresult,or
havereasonablepotentialtoresult,insignificantpsychologicalharmtothechild."[39]
In1995,APSACdefineditas:spurning,terrorizing,isolating,exploiting,corrupting,denyingemotional
responsiveness,orneglect"or"Arepeatedpatternofcaregiverbehaviororextremeincident(s)that
conveytochildrenthattheyareworthless,flawed,unloved,unwanted,endangered,oronlyofvaluein
meetinganother'sneeds"[40]
IntheUnitedStates,stateslawsvary,butmosthavelawsagainst"mentalinjury"[41]
Somehavedefineditastheproductionofpsychologicalandsocialdefectsinthegrowthofachildasa
resultofbehaviorsuchasloudyelling,coarseandrudeattitude,inattention,harshcriticism,and
denigrationofthechild'spersonality.[19]Otherexamplesincludenamecalling,ridicule,degradation,
destructionofpersonalbelongings,tortureorkillingofapet,excessivecriticism,inappropriateor
excessivedemands,withholdingcommunication,androutinelabelingorhumiliation.[42]
In2014,theAPAstatedthat:[43]
"Childhoodpsychologicalabuse[is]asharmfulassexualorphysicalabuse."
"Nearly3millionU.S.childrenexperiencesomeformof[psychological]maltreatmentannually."
Psychologicalmaltreatmentis"themostchallengingandprevalentformofchildabuseandneglect."
"Giventheprevalenceofchildhoodpsychologicalabuseandtheseverityofharmtoyoungvictims,it
shouldbeattheforefrontofmentalhealthandsocialservicetraining"
In2015,additionalresearchconfirmedthese2014statementsoftheAPA.[44][45]
Victimsofemotionalabusemayreactbydistancingthemselvesfromtheabuser,internalizingtheabusive
words,orfightingbackbyinsultingtheabuser.Emotionalabusecanresultinabnormalordisruptedattachment
development,atendencyforvictimstoblamethemselves(selfblame)fortheabuse,learnedhelplessness,and
overlypassivebehavior.[42]
Neglect
Childneglectisthefailureofaparentorotherpersonwithresponsibilityforthechild,toprovideneededfood,
clothing,shelter,medicalcare,orsupervisiontothedegreethatthechild'shealth,safetyorwellbeingmaybe
threatenedwithharm.Neglectisalsoalackofattentionfromthepeoplesurroundingachild,andthenon
provisionoftherelevantandadequatenecessitiesforthechild'ssurvival,whichwouldbealackinginattention,
love,andnurture.[19]
Someobservablesignsofchildneglectinclude:thechildisfrequentlyabsentfromschool,begsorstealsfood
ormoney,lacksneededmedicalanddentalcare,isconsistentlydirty,orlackssufficientclothingforthe
weather.[46]The2010ChildMaltreatmentReport(NCANDS),ayearlyUnitedStatesfederalgovernmentreport
basedondatasuppliedbystateChildProtectiveServices(CPS)AgenciesintheU.S.,states,"asinprioryears,
neglectwasthemostcommonformofmaltreatment".[47]
Neglectfulactscanbedividedintosixsubcategories:[7]
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SupervisoryNeglect:characterizedbytheabsenceofaparentorguardianwhichcanleadtophysical
harm,sexualabuseorcriminalbehavior
PhysicalNeglect:characterizedbythefailuretoprovidethebasicphysicalnecessities,suchasasafeand
cleanhome
MedicalNeglect:characterizedbythelackofprovidingmedicalcare
EmotionalNeglect:characterizedbyalackofnurturance,encouragementandsupport
EducationalNeglect:characterizedbythecaregiverslacktoprovideaneducationandadditional
resourcestoactivelyparticipateintheschoolsystemand
Abandonment:whentheparentorguardianleavesachildaloneforalongperiodoftimewithouta
babysitter.
Neglectedchildrenmayexperiencedelaysinphysicalandpsychosocialdevelopment,possiblyresultingin
psychopathologyandimpairedneuropsychologicalfunctionsincludingexecutivefunction,attention,processing
speed,language,memoryandsocialskills.[48]Researchersinvestigatingmaltreatedchildrenhaverepeatedly
foundthatneglectedchildreninfosterandadoptivepopulationsmanifestdifferentemotionalandbehavioral
reactionstoregainlostorsecurerelationshipsandarefrequentlyreportedtohavedisorganizedattachmentsand
aneedtocontroltheirenvironment.Suchchildrenarenotlikelytoviewcaregiversasbeingasourceofsafety,
andinsteadtypicallyshowanincreaseinaggressiveandhyperactivebehaviorswhichmaydisrupthealthyor
secureattachmentwiththeiradoptedparents.Thesechildrenhaveapparentlylearnedtoadapttoanabusiveand
inconsistentcaregiverbybecomingcautiouslyselfreliant,andareoftendescribedasglib,manipulativeand
disingenuousintheirinteractionswithothersastheymovethroughchildhood.[49]Childrenwhoarevictimsof
neglecthaveamoredifficulttimeformingandmaintainingrelationships,suchasromanticorfriendship,later
inlifeduetothelackofattachmenttheyhadintheirearlierstagesoflife.
Effects
Childabusecanresultinimmediateadversephysicaleffectsbutitisalsostronglyassociatedwith
developmentalproblems[50]andwithmanychronicphysicalandpsychologicaleffects,includingsubsequent
illhealth,includinghigherratesofchronicconditions,highriskhealthbehaviorsandshortenedlifespan.[51][52]
Maltreatedchildrenmaygrowuptobemaltreatingadults.[53][54][55]A1991sourcereportedthatstudies
indicatethat90percentofmaltreatingadultsweremaltreatedaschildren.[56]Almost7millionAmerican
infantsreceivechildcareservices,suchasdaycare,andmuchofthatcareispoor.[50]
Emotional
Childabusecancausearangeofemotionaleffects.Childrenwhoareconstantlyignored,shamed,terrorizedor
humiliatedsufferatleastasmuch,ifnotmore,thaniftheyarephysicallyassaulted.[57]Abusedchildrencan
growupexperiencinginsecurities,lowselfesteem,andlackofdevelopment.Manyabusedchildrenexperience
ongoingdifficultieswithtrust,socialwithdrawal,troubleinschool,andformingrelationships.[57]
Theeffectsofabusedchildrencanalsodifferwhenitcomestobabiesandyoungchildren.Babiesandpre
schoolchildrenwhoarebeingemotionallyabusedorneglectedmaybeoverlyaffectionatetowardsstrangersor
peopletheyhaventknownforverylong.[58]Theycanlackconfidenceorbecomeanxious,appeartonothavea
closerelationshipwiththeirparent,exhibitaggressivebehaviororactnastytowardsotherchildrenand
animals.[58]Olderchildrenmayusefoullanguageoractinamarkedlydifferentwaytootherchildrenatthe
sameage,struggletocontrolstrongemotions,seemisolatedfromtheirparents,lacksocialskillsorhavefew,if
any,friends.[58]
Childrencanalsoexperiencereactiveattachmentdisorder(RAD).RADisdefinedasmarkedlydisturbedand
developmentallyinappropriatesocialrelatedness,thatusuallybeginsbeforetheageof5years.[59]RADcan
presentasapersistentfailuretostartorrespondinadevelopmentallyappropriatefashiontomostsocial
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situations.Thelongtermimpactofemotionalabusehasnotbeenstudiedwidely,butrecentstudieshavebegun
todocumentitslongtermconsequences.Emotionalabusehasbeenlinkedtoincreaseddepression,anxiety,and
difficultiesininterpersonalrelationships(Spertus,Wong,Halligan,&Seremetis,2003).[59]Victimsofchild
abuseandneglectaremorelikelytocommitcrimesasjuvenilesandadults.[60]
Overall,emotionaleffectscausedbychildabusecanresultinlongtermandshorttermeffectsthatultimately
affectachild'supbringinganddevelopment.
Physical
Theimmediatephysicaleffectsofabuseorneglectcanberelatively
minor(bruisesorcuts)orsevere(brokenbones,hemorrhage,oreven
death).Insomecasesthephysicaleffectsaretemporaryhowever,the
painandsufferingtheycauseachildshouldnotbediscounted.Rib
fracturesmaybeseenwithphysicalabuse.[61]
Thelongtermimpactofchildabuseandneglectonphysicalhealthand
developmentcanbe:
Shakenbabysyndrome.Shakingababyisacommonformof
Ribfracturesinaninfantsecondary
childabusethatoftenresultsinpermanentneurologicaldamage
tochildabuse
(80%ofcases)ordeath(30%ofcases).[62]Damageresultsfrom
intracranialhypertension(increasedpressureintheskull)after
bleedinginthebrain,damagetothespinalcordandneck,andriborbonefractures.[63]
Impairedbraindevelopment.Childabuseandneglecthavebeenshown,insomecases,tocause
importantregionsofthebraintofailtoformorgrowproperly,resultinginimpaireddevelopment.[64][65]
Thesealterationsinbrainmaturationhavelongtermconsequencesforcognitive,language,andacademic
abilities.[66]
Poorphysicalhealth.Inadditiontopossibleimmediateadversephysicaleffects,householddysfunction
andchildhoodmaltreatmentarestronglyassociatedwithmanychronicphysicalandpsychological
effects,includingsubsequentillhealthinchildhood,[67]adolescence[68]andadulthood,withhigherrates
ofchronicconditions,highriskhealthbehaviorsandshortenedlifespan.[51][52]Adultswhoexperienced
abuseorneglectduringchildhoodaremorelikelytosufferfromphysicalailmentssuchasallergies,
arthritis,asthma,bronchitis,highbloodpressure,andulcers.[52][69][70][71]Theremaybeahigherriskof
developingcancerlaterinlife,[72]aswellaspossibleimmunedysfunction.[73]
Exposuretoviolenceduringchildhoodisassociatedwithshortenedtelomeresandwithreduced
telomeraseactivity.[74]Theincreasedrateoftelomerelengthreductioncorrelatestoareductionin
lifespanof7to15years.[73]
AdverseChildhoodExperiencesStudy
TheAdverseChildhoodExperiencesStudyisalongrunninginvestigationintotherelationshipbetween
childhoodadversity,includingvariousformsofabuseandneglect,andhealthproblemsinlaterlife.Theinitial
phaseofthestudywasconductedinSanDiego,Californiafrom1995to1997.[75]TheWorldHealth
Organizationsummarizesthestudy'sfindingsasfollows:
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Possiblewaysforadversechildhoodexperiencessuchasabuse
andneglecttoinfluencehealthandwellbeingthroughoutthe
lifespan,accordingtotheCentersforDiseaseControland
Prevention. [75]
TheAdverseChildhoodExperiences(ACE)study,inwhichsome17,300middleaged,middle
classandmostlyemployedresidentsofthestateofCaliforniaparticipated,suggeststhatchildhood
maltreatmentandhouseholddysfunctioncontributetothedevelopmentdecadeslaterofthe
chronicdiseasesthatarethemostcommoncausesofdeathanddisabilityintheUnitedStates.The
studyexaminedthelongtermeffectsofmaltreatmentandhouseholddysfunctionduringchildhood,
including:psychological,physicalandsexualabuseviolenceagainstthemotherandlivingwith
householdmemberswhowereeithersubstanceabusers,mentallyillorsuicidal,orelsehadbeenin
prison.Astrongrelationshipwasseenbetweenthenumberofadverseexperiences(including
physicalandsexualabuseinchildhood)andselfreportsofcigarettesmoking,obesity,physical
inactivity,alcoholism,drugabuse,depression,attemptedsuicide,sexualpromiscuityandsexually
transmitteddiseasesinlaterlife.Furthermore,peoplewhoreportedhighernumbersofnegative
experiencesinchildhoodweremuchmorelikelytoexhibitmultiplehealthriskbehaviours,which
thestudysuggestedwereadoptedascopingdevices.Similarly,themoreadversechildhood
experiencesreported,themorelikelythepersonwastohaveheartdisease,cancer,stroke,diabetes,
skeletalfractures,liverdiseaseandpoorhealthasanadult.Maltreatmentandotheradverse
childhoodexperiencesmaythusbeamongthebasicfactorsthatunderliehealthrisks,illnessand
death,andcouldbeidentifiedbyroutinescreeningofallpatients.AlthoughtheACEstudyandits
findingsrelatetoaspecificpopulationwithintheUnitedStates,itisreasonabletoassumethat
similartrendsmightbefoundincountrieswithdifferentlevelsofeconomicandsocial
development.[13]
Alongtermstudyofadultsretrospectivelyreportingadversechildhoodexperiencesincludingverbal,physical
andsexualabuse,aswellasotherformsofchildhoodtraumafound25.9%ofadultsreportedverbalabuseas
children,14.8%reportedphysicalabuse,and12.2%reportedsexualabuse.DatafromtheCentersforDisease
ControlandPrevention(CDC)andBehavioralRiskFactorSurveillanceSystemcorroboratethesehighrates.[76]
Thereisahighcorrelationbetweenthenumberofdifferentadversechildhoodexperiences(A.C.E.s)andrisk
forpoorhealthoutcomesinadultsincludingcancer,heartattack,mentalillness,reducedlongevitydrugand
alcoholabuse.[77]AnanonymousselfreportingsurveyofWashingtonStatestudentsfinds67%of8th,10th
and12thgradestudentsactuallyattemptsuicide.Ratesofdepressionaretwiceashigh.Otherriskbehaviorsare
evenhigher.[78]Thereisarelationshipbetweenchildphysicalandsexualabuseandsuicide.[79]Forlegaland
culturalreasonsaswellasfearsbychildrenofbeingtakenawayfromtheirparentsmostchildhoodabusegoes
unreportedandunsubstantiated.
Psychological
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Childrenwhohaveahistoryofneglectorphysicalabuseareatriskofdevelopingpsychiatricproblems,[80][81]
oradisorganizedattachmentstyle.[82][83][84]Inaddition,childrenwhoexperiencechildabuseand/orneglectare
59%morelikelytobearrestedasjuveniles,28%morelikelytobearrestedasadults,and30%morelikelyto
commitviolentcrime.[85]Disorganizedattachmentisassociatedwithanumberofdevelopmentalproblems,
includingdissociativesymptoms,[86]aswellasanxiety,depressive,andactingoutsymptoms.[87][88]Astudyby
DanteCicchettifoundthat80%ofabusedandmaltreatedinfantsexhibitedsymptomsofdisorganized
attachment.[89][90]Whensomeofthesechildrenbecomeparents,especiallyiftheysufferfromposttraumatic
stressdisorder(PTSD),dissociativesymptoms,andothersequelaeofchildabuse,theymayencounterdifficulty
whenfacedwiththeirinfantandyoungchildren'sneedsandnormativedistress,whichmayinturnleadto
adverseconsequencesfortheirchild'ssocialemotionaldevelopment.[91][92]Despitethesepotentialdifficulties,
psychosocialinterventioncanbeeffective,atleastinsomecases,inchangingthewaysmaltreatedparentsthink
abouttheiryoungchildren.[93]
Victimsofchildhoodabusealsosufferfromdifferenttypesofphysicalhealthproblemslaterinlife.Some
reportedlysufferfromsometypeofchronichead,abdominal,pelvic,ormuscularpainwithnoidentifiable
reason.[94]Eventhoughthemajorityofchildhoodabusevictimsknoworbelievethattheirabuseis,orcanbe,
thecauseofdifferenthealthproblemsintheiradultlife,forthegreatmajoritytheirabusewasnotdirectly
associatedwiththoseproblems,indicatingthatsufferersweremostlikelydiagnosedwithotherpossiblecauses
fortheirhealthproblems,insteadoftheirchildhoodabuse.[94]Onelongtermstudyfoundthatupto80%of
abusedpeoplehadatleastonepsychiatricdisorderatage21,withproblemsincludingdepression,anxiety,
eatingdisorders,andsuicideattempts.[95]OneCanadianhospitalfoundthatbetween36%and76%ofwomen
mentalhealthoutpatientshadbeenabused,ashad58%ofwomenand23%ofmenschizophrenicinpatients.[96]
Arecentstudyhasdiscoveredthatacrucialstructureinthebrain'srewardcircuitsiscompromisedbychildhood
abuseandneglect,andpredictsDepressiveSymptomslaterinlife.[97]
Inthecaseof23ofthe27illnesseslistedinthequestionnaireofaFrenchINSEEsurvey,somestatistically
significantcorrelationswerefoundbetweenrepeatedillnessandfamilytraumasencounteredbythechildbefore
theageof18years.AccordingtoGeorgesMenahem,theFrenchsociologistwhofoundoutthesecorrelations
bystudyinghealthinequalities,theserelationshipsshowthatinequalitiesinillnessandsufferingarenotonly
social.Healthinequalityalsohasitsoriginsinthefamily,whereitisassociatedwiththedegreesoflasting
affectiveproblems(lackofaffection,parentaldiscord,theprolongedabsenceofaparent,oraseriousillness
affectingeitherthemotherorfather)thatindividualsreporthavingexperiencedinchildhood.[98]
Manychildrenwhohavebeenabusedinanyformdevelopsomesortofpsychologicalproblem.These
problemsmayinclude:anxiety,depression,eatingdisorders,OCD,codependency,orevenalackofhuman
connections.Thereisalsoaslighttendencyforchildrenwhohavebeenabusedtobecomechildabusers
themselves.IntheU.S.in2013,ofthe294,000reportedchildabusecasesonly81,124receivedanysortof
counselingortherapy.Treatmentisgreatlyimportantforabusedchildren.[99]
Ontheotherhand,therearesomechildrenwhoareraisedinchildabuse,butwhomanagetodounexpectedly
welllaterinliferegardingthepreconditions.Suchchildrenhavebeentermeddandelionchildren,asinspired
fromthewaythatdandelionsseemtoprosperirrespectiveofsoil,sun,drought,orrain.[100]Suchchildren(or
currentlygrownups)areofhighinterestinfindingfactorsthatmitigatetheeffectsofchildabuse.
Causes
Childabuseisacomplexphenomenonwithmultiplecauses.[101]Nosinglefactorcanbeidentifiedastowhy
someadultsbehaveviolentlytowardchildren.TheWorldHealthOrganization(WHO)andtheInternational
SocietyforPreventionofChildAbuseandNeglect(ISPCAN)identifymultiplefactorsatthelevelofthe
individual,theirrelationships,theirlocalcommunity,andtheirsocietyatlarge,thatcombinetoinfluencethe
occurrenceofchildmaltreatment.Attheindividuallevel,suchfactorsincludeage,sex,andpersonalhistory,
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whileatthelevelofsociety,factorscontributingtochildmaltreatmentincludeculturalnormsencouraging
harshphysicalpunishmentofchildren,economicinequality,andthelackofsocialsafetynets.[13]WHOand
ISPCANstatethatunderstandingthecomplexinterplayofvariousriskfactorsisvitalfordealingwiththe
problemofchildmaltreatment.[13]
TheAmericanpsychoanalystElisabethYoungBruehlmaintainsthatharmtochildrenisjustifiedandmade
acceptablebywidelyheldbeliefsinchildren'sinherentsubserviencetoadults,resultinginalargely
unacknowledgedprejudiceagainstchildrenshetermschildism.Shecontendsthatsuchprejudice,whilenotthe
immediatecauseofchildmaltreatment,mustbeinvestigatedinordertounderstandthemotivationsbehinda
givenactofabuse,aswellastoshedlightonsocietalfailurestosupportchildren'sneedsanddevelopmentin
general.[102]:46FoundingeditoroftheInternationalJournalofChildren'sRights,MichaelFreeman,also
arguesthattheultimatecausesofchildabuselieinprejudiceagainstchildren,especiallytheviewthathuman
rightsdonotapplyequallytoadultsandchildren.Hewrites,"therootsofchildabuselienotinparental
psychopathologyorinsocioenvironmentalstress(thoughtheirinfluencescannotbediscounted)butinasick
culturewhichdenigratesanddepersonalizes,whichreduceschildrentoproperty,tosexualobjectssothatthey
becomethelegitimatevictimsofbothadultviolenceandlust".[103]
Parentswhophysicallyabusetheirspousesaremorelikelythanothers
tophysicallyabusetheirchildren.[104]However,itisimpossibletoknow
whethermaritalstrifeisacauseofchildabuse,orifboththemarital
strifeandtheabusearecausedbytendenciesintheabuser.[104]
Sometimes,parentssetexpectationsfortheirchildthatareclearly
beyondthechild'scapability.Whenparents'expectationsarefarbeyond
whatisappropriatetothechild(e.g.,preschoolchildrenwhoare
expectedtobetotallyresponsibleforselfcareorprovisionof
nurturancetoparents)theresultingfrustrationcausedbythechild'snon
complianceisbelievedtofunctionasacontributoryifnotnecessary
causeofchildabuse.[105]
Agirlwhowasburnedduring
religiousviolenceinOrissa,India.
Mostactsofphysicalviolenceagainstchildrenareundertakenwiththe
intenttopunish.[106]IntheUnitedStates,interviewswithparentsrevealthatasmanyastwothirdsof
documentedinstancesofphysicalabusebeginasactsofcorporalpunishmentmeanttocorrectachild's
behavior,whilealargescaleCanadianstudyfoundthatthreequartersofsubstantiatedcasesofphysicalabuse
ofchildrenhaveoccurredwithinthecontextofphysicalpunishment.[107]Otherstudieshaveshownthat
childrenandinfantswhoarespankedbyparentsareseveraltimesmorelikelytobeseverelyassaultedbytheir
parentsorsufferaninjuryrequiringmedicalattention.Studiesindicatethatsuchabusivetreatmentoften
involvesparentsattributingconflicttotheirchild'swillfulnessorrejection,aswellas"coercivefamily
dynamicsandconditionedemotionalresponses".[16]Factorsinvolvedintheescalationofordinaryphysical
punishmentbyparentsintoconfirmedchildabusemaybethepunishingparent'sinabilitytocontroltheiranger
orjudgetheirownstrength,andtheparentbeingunawareofthechild'sphysicalvulnerabilities.[15]
Someprofessionalsarguethatculturalnormsthatsanctionphysicalpunishmentareoneofthecausesofchild
abuse,andhaveundertakencampaignstoredefinesuchnorms.[108][109][110]
Childrenresultingfromunintendedpregnanciesaremorelikelytobeabusedorneglected.[111][112]Inaddition,
unintendedpregnanciesaremorelikelythanintendedpregnanciestobeassociatedwithabusive
relationships,[113]andthereisanincreasedriskofphysicalviolenceduringpregnancy.[114]Theyalsoresultin
poorermaternalmentalhealth,[114]andlowermotherchildrelationshipquality.[114]
Thereissomelimitedevidencethatchildrenwithmoderateorseveredisabilitiesaremorelikelytobevictims
ofabusethannondisabledchildren.[115]Astudyonchildabusesoughttodetermine:theformsofchildabuse
perpetratedonchildrenwithdisabilitiestheextentofchildabuseandthecausesofchildabuseofchildren
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withdisabilities.Aquestionnaireonchildabusewasadaptedandusedtocollectdatainthisstudy.Participants
comprisedasampleof31pupilswithdisabilities(15childrenwithvisionimpairmentand16childrenwith
hearingimpairment)selectedfromspecialschoolsinBotswana.Thestudyfoundthatthemajorityof
participantswereinvolvedindoingdomesticchores.Theywerealsosexually,physicallyandemotionally
abusedbytheirteachers.Thisstudyshowedthatchildrenwithdisabilitieswerevulnerabletochildabusein
theirschools.[116]
Substanceabusecanbeamajorcontributingfactortochildabuse.OneU.S.studyfoundthatparentswith
documentedsubstanceabuse,mostcommonlyalcohol,cocaine,andheroin,weremuchmorelikelytomistreat
theirchildren,andwerealsomuchmorelikelytorejectcourtorderedservicesandtreatments.[117]Another
studyfoundthatovertwothirdsofcasesofchildmaltreatmentinvolvedparentswithsubstanceabuse
problems.Thisstudyspecificallyfoundrelationshipsbetweenalcoholandphysicalabuse,andbetweencocaine
andsexualabuse.[118]Alsoparentalstresscausedbysubstanceincreasesthelikelihoodoftheminorexhibiting
internalizingandexternalizingbehaviors.[119]Althoughtheabusevictimdoesnotalwaysrealizetheabuseis
wrong,theinternalconfusioncanleadtochaos.Innerangerturnstoouterfrustration.Onceaged17/18,drink
anddrugsareusedtonumbthehurtfeelings,nightmaresanddaytimeflashbacks.Acquisitivecrimestopayfor
thechemicalsareinevitableifthevictimisunabletofindemployment.[120]
Unemploymentandfinancialdifficultiesareassociatedwithincreasedratesofchildabuse.[121]In2009CBS
NewsreportedthatchildabuseintheUnitedStateshadincreasedduringtheeconomicrecession.Itgavethe
exampleofafatherwhohadneverbeentheprimarycaretakerofthechildren.Nowthatthefatherwasinthat
role,thechildrenbegantocomeinwithinjuries.[122]
Worldwide
Childabuseisaninternationalphenomenon.Povertyandsubstanceabusearecommonsocialproblems
worldwide,andnomatterthelocation,showasimilartrendinthecorrelationtochildabuse.
Althoughthesefactorscanlikelycontributetochildmaltreatment,differencesinculturalperspectivesplaya
significantroleinthetreatmentofchildren.Incertainnations,thebattleforequalitywithinthesexesplaysa
largepartinachildsupbringing.DuringtheSovietperiod,therewereconflictsregardingthetraditional
housewifeversustheemphasisonequalitywithinthesexes.Somewomenfeltaconsiderableamountof
pressuretocarryouttheirmotherlyduties,obtainingan"authoritarian"parentingstyle,actingdominatingand
emotionallydistanttowardsherchildrenwhileoverlyinvolvedinherowncareer.[123]Manywereencouraged
tousemorefirmanddirectdisciplinarymethods,aswellasbeoverbearingandoverprotectiveoftheir
children.[123]
WiththeendoftheCommunistEra,manypositivechangeshavefollowed.Whilethereisanewopennessand
acceptanceregardingparentingstylesandcloserelationshipswithchildren,childabusestillremainsaserious
concern.Althoughitisnowmorepubliclyrecognized,ithascertainlynotceasedtoexist.Whilecontrolling
parentingmaybelessofaconcern,financialdifficulty,unemployment,andsubstanceabusestillremaintobe
dominatingfactorsinchildabusethroughoutEasternEurope.[123]
AstudyconductedbymembersfromseveralBalticandEasternEuropeancountries,togetherwithspecialists
fromtheUnitedStates,examinedthecausesofchildabuseinthecountriesofLatvia,Lithuania,Macedoniaand
Moldova.Inthesecountries,respectively,33%,42%,18%and43%ofchildrenreportedatleastonetypeof
childabuse.[124]Accordingtotheirfindings,therewasaseriesofcorrelationsbetweenthepotentialriskfactors
ofparentalemploymentstatus,alcoholabuse,andfamilysizewithintheabuseratings.[123]Inthreeofthefour
countries,parentalsubstanceabusewasconsiderablycorrelatedwiththepresenceofchildabuse,andalthough
itwasalowerpercentage,stillshowedarelationshipinthefourthcountry(Moldova).[123]Eachcountryalso
showedaconnectionbetweenthefathernotworkingoutsideofthehomeandeitheremotionalorphysicalchild
abuse.[123]
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Theseculturaldifferencescanbestudiedfrommanyperspectives.Mostimportantly,overallparentalbehavior
isgenuinelydifferentinvariouscountries.Eachculturehastheirown"rangeofacceptability,"andwhatone
mayviewasoffensive,othersmayseemastolerable.Behaviorsthatarenormaltosomemaybeviewedas
abusivetoothers,alldependingonthesocietalnormsofthatparticularcountry.[123]
Asianparentingperspectives,specifically,holddifferentidealsfromAmericanculture.Manyhavedescribed
theirtraditionsasincludingphysicalandemotionalclosenessthatensuresalifelongbondbetweenparentand
child,aswellasestablishingparentalauthorityandchildobediencethroughharshdiscipline.[125]Balancing
disciplinaryresponsibilitieswithinparentingiscommoninmanyAsiancultures,includingChina,Japan,
Singapore,VietnamandKorea.[125]Tosomecultures,forcefulparentingmaybeseenasabuse,butinother
societiessuchasthese,theuseofforceislookedatasareflectionofparentaldevotion.[125]
Thedifferencesintheseculturalbeliefsdemonstratetheimportanceofexaminingallcrossculturalperspectives
whenstudyingtheconceptofchildabuse.
Asof2006,between25,000and50,000childreninKinshasa,DemocraticRepublicoftheCongo,hadbeen
accusedofwitchcraftandabandoned.[126]InMalawiitisalsocommonpracticetoaccusechildrenofwitchcraft
andmanychildrenhavebeenabandoned,abusedandevenkilledasaresult.[127]IntheNigeria,AkwaIbom
StateandCrossRiverStateabout15,000childrenwerebrandedaswitches.[128]
InApril2015,publicbroadcastingshowedthatrateofchildabuseinSouthKoreahadincreasedto13%
comparedwiththepreviousyear,and75%ofattackerswerethechildren'sownparents.[129]
Disclosureanddiagnosis
Suspicionforphysicalabuseisrecommendedwhenaninjuryoccursin
achildwhodoesnotyetmoveindependently,injuriesareinunusual
areas,morethanoneinjuryatdifferentstagesofhealing,symptomsof
possibleheadtrauma,andinjuriestomorethanonebodysystem.[130]
Inmanyjurisdictions,abusethatissuspected,notnecessarilyproven,
requiresreportingtochildprotectionagencies,suchastheChild
ProtectionServicesintheUnitedStates.Recommendationsfor
healthcareworkers,suchasprimarycareprovidersandnurses,whoare
oftensuitedtoencountersuspectedabuseareadvisedtofirstly
Dollsaresometimesusedtohelp
determinethechildsimmediateneedforsafety.Aprivateenvironment
discloseabuse.
awayfromsuspectedabusersisdesiredforinterviewingandexamining.
Leadingstatementsthatcandistortthestoryareavoided.Asdisclosing
abusecanbedistressingandsometimesevenshameful,reassuringthechildthatheorshehasdonetheright
thingbytellingandthattheyarenotbadorthattheabusewasnottheirfaulthelpsindisclosingmore
information.Dollsaresometimesusedtohelpexplainwhathappened.Forthesuspectedabusers,itisalso
recommendedtouseanonjudgmental,nonthreateningattitudetowardsthemandtowithholdexpressingshock,
inordertohelpdiscloseinformation.[131]
Assessment
Akeypartofchildabuseworkisassessment.
Aparticularchallengeariseswherechildprotectionprofessionalsareassessingfamilieswhereneglectis
occurring.Professionalsconductingassessmentsoffamilieswhereneglectistakingplacearesaidtosometimes
makethefollowingerrors:[132]
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Failuretoasktherighttypesofquestion,including
Whetherneglectisoccurring
Whyneglectisoccurring
Whatthesituationislikeforthechild
Whetherimprovementsinthefamilyarelikelytobesustained
Whatneedstobedonetoensurethelongtermsafetyofthechild?
Prevention
Asupportgroupstructureisneededtoreinforceparentingskillsandcloselymonitorthechild'swellbeing.
Visitinghomenurseorsocialworkervisitsarealsorequiredtoobserveandevaluatetheprogressofthechild
andhis/hercaretakingsituation.
Thesupportgroupstructureandvisitinghomenurseorsocialworkervisitsarenotmutuallyexclusive.Many
studieshavedemonstratedthatthetwomeasuresmustbecoupledtogetherforthebestpossibleoutcome.[133]
Children'sschoolprogramsregarding"goodtouchbadtouch"canprovidechildrenwithaforuminwhichto
roleplayandlearntoavoidpotentiallyharmfulscenarios.Pediatricianscanhelpidentifychildrenatriskof
maltreatmentandintervenewiththeaidofasocialworkerorprovideaccesstotreatmentthataddresses
potentialriskfactorssuchasmaternaldepression.[134]Videoconferencinghasalsobeenusedtodiagnosechild
abuseinremoteemergencydepartmentsandclinics.[135]Unintendedconceptionincreasestheriskof
subsequentchildabuse,andlargefamilysizeincreasestheriskofchildneglect.[112]Thusacomprehensive
studyfortheNationalAcademyofSciencesconcludedthataffordablecontraceptiveservicesshouldformthe
basisforchildabuseprevention.[112][136]"Thestartingpointforeffectivechildabuseprogrammingis
pregnancyplanning,"accordingtoananalysisforUSSurgeonGeneralC.EverettKoop.[112][137]
AprilhasbeendesignatedChildAbusePreventionMonthintheUnitedStatessince1983.[138]U.S.President
BarackObamacontinuedthattraditionbydeclaringApril2009ChildAbusePreventionMonth.[139]Oneway
theFederalgovernmentoftheUnitedStatesprovidesfundingforchildabusepreventionisthrough
CommunityBasedGrantsforthePreventionofChildAbuseandNeglect(CBCAP).[140]
Resourcesforchildprotectionservicesaresometimeslimited.AccordingtoHosin(2007),"aconsiderable
numberoftraumatizedabusedchildrendonotgainaccesstoprotectivechildprotectionstrategies."[141]Briere
(1992)arguesthatonlywhen"lowerlevelviolence"ofchildrenceasestobeculturallytoleratedwilltherebe
changesinthevictimizationandpoliceprotectionofchildren.[142]
Treatment
Anumberoftreatmentsareavailabletovictimsofchildabuse.[143]However,childrenwhoexperience
childhoodtraumadonothealfromabuseeasily.[144]Therearefocusedcognitivebehavioraltherapy,first
developedtotreatsexuallyabusedchildren,isnowusedforvictimsofanykindoftrauma.Ittargetstrauma
relatedsymptomsinchildrenincludingposttraumaticstressdisorder(PTSD),clinicaldepressionandanxiety.
Italsoincludesacomponentfornonoffendingparents.Severalstudieshavefoundthatsexuallyabused
childrenundergoingTFCBTimprovedmorethanchildrenundergoingcertainothertherapies.Dataonthe
effectsofTFCBTforchildrenwhoexperiencedonlynonsexualabusewasnotavailableasof2006.[143]The
purposeofdealingwiththethoughtsandfeelingsassociatedwiththetraumaistodealwithnightmares,
flashbacksandotherintrusiveexperiencesthatmightbespontaneouslybroughtonbyanynumberof
discriminativestimuliintheenvironmentorintheindividualsbrain.Thiswouldaidtheindividualin
becominglessfearfulofspecificstimulithatwouldarousedebilitatingfear,anger,sadnessorothernegative
emotion.Inotherwords,theindividualwouldhavesomecontrolormasteryoverthoseemotions.[49]
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Abusefocusedcognitivebehavioraltherapywasdesignedforchildrenwhohaveexperiencedphysicalabuse.It
targetsexternalizingbehaviorsandstrengthensprosocialbehaviors.Offendingparentsareincludedinthe
treatment,toimproveparentingskills/practices.Itissupportedbyonerandomizedstudy.[143]
RationalCognitiveEmotiveBehaviorTherapyconsistsoftendistinctbutinterdependentsteps.Thesestepsfall
intooneofthreetheoreticalorientations(i.e.,rationalorsolutionfocused,cognitiveemotive,andbehavioral)
andareintendedtoprovideabusedchildrenandtheiradoptiveparentswithpositivebehaviorchange,corrective
interpersonalskills,andgreatercontroloverthemselvesandtheirrelationships.Theyare:1)determiningand
normalizingthinkingandbehaving,2)evaluatinglanguage,3)shiftingattentionawayfromproblemtalk4)
describingtimeswhentheattachmentproblemisn'thappening,5)focusingonhowfamilymembers
"successfully"solveproblematicattachmentbehavior6)acknowledging"unpleasantemotions"(i.e.,angry,
sad,scared)underlyingnegativeinteractionalpatterns,7)identifyingantecedents(controllingconditions)and
associatednegativecognitiveemotiveconnectionsinbehavior(reciprocalroleofthoughtandemotionin
behavioralcausation),8)encouragingpreviouslyabusedchildrentoexperienceor"own"negativethoughtsand
associatedaversiveemotionalfeelings,9)modelingandrewardingpositivebehaviorchange(withthemselves
andinrelationships),and10)encouragingandrewardingthinkingandbehavingdifferently.Thistypeof
therapyshiftsvictimsthoughtsawayfromthebadandchangestheirbehavior.[49]
Parentchildinteractiontherapywasdesignedtoimprovethechildparentrelationshipfollowingtheexperience
ofdomesticviolence.Ittargetstraumarelatedsymptomsininfants,toddlers,andpreschoolers,including
PTSD,aggression,defiance,andanxiety.Itissupportedbytwostudiesofonesample.[143]
Otherformsoftreatmentincludegrouptherapy,playtherapy,andarttherapy.Eachofthesetypesoftreatment
canbeusedtobetterassisttheclient,dependingontheformofabusetheyhaveexperienced.Playtherapyand
arttherapyarewaystogetchildrenmorecomfortablewiththerapybyworkingonsomethingthattheyenjoy
(coloring,drawing,painting,etc.).Thedesignofachild'sartworkcanbeasymbolicrepresentationofwhat
theyarefeeling,relationshipswithfriendsorfamily,andmore.Beingabletodiscussandanalyzeachild's
artworkcanallowaprofessionaltogetabetterinsightofthechild.[145]
Prevalence
Childabuseiscomplexanddifficulttostudy.AccordingtotheWorldHealthOrganization(WHO),estimatesof
theratesofchildmaltreatmentvarywidelybycountry,dependingonhowchildmaltreatmentisdefined,the
typeofmaltreatmentstudied,thescopeandqualityofdatagathered,andthescopeandqualityofsurveysthat
askforselfreportsfromvictims,parents,andcaregivers.Despitetheselimitations,internationalstudiesshow
thataquarterofalladultsreportexperiencingphysicalabuseaschildren,andthatand1in5womenand1in13
menreportexperiencingchildhoodsexualabuse.Emotionalabuseandneglectarealsocommonchildhood
experiences.[146]
Asof2014,anestimated41,000childrenunder15arevictimsofhomicideeachyear.TheWHOstatesthatthis
numberunderestimatesthetrueextentofchildhomicideasignificantproportionofchilddeathscausedby
maltreatmentareincorrectlyattributedtounrelatedfactorssuchasfalls,burns,anddrowning.Also,girlsare
particularlyvulnerabletosexualviolence,exploitationandabuseinsituationsofarmedconflictandrefugee
settings,whetherbycombatants,securityforces,communitymembers,aidworkers,orothers.[146]
UnitedStates
TheNationalResearchCouncilwrotein1993that"...theavailableevidencesuggeststhatchildabuseand
neglectisanimportant,prevalentproblemintheUnitedStates[...]Childabuseandneglectareparticularly
importantcomparedwithothercriticalchildhoodproblemsbecausetheyareoftendirectlyassociatedwith
adversephysicalandmentalhealthconsequencesinchildrenandfamilies".[147]:6
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In2012,ChildProtectiveServices(CPS)agenciesestimatedthatapproximately9outof1000childreninthe
UnitedStateswerevictimsofchildmaltreatment.Most(78%)werevictimsofneglect.Physicalabuse,sexual
abuse,andothertypesofmaltreatment,werelesscommon,makingup18%,9%,and11%ofcases,respectively
("othertypes"includedemotionalabuse,parentalsubstanceabuse,andinadequatesupervision).However,CPS
reportsmayunderestimatethetruescopeofchildmaltreatment.AnonCPSstudyestimatedthatoneinfour
childrenexperiencesomeformofmaltreatmentintheirlifetimes,accordingtotheCentersforDiseaseControl
andPrevention(CDC).[148]
DavidFinkelhortrackedChildMaltreatmentReport(NCANDS)datafrom1990to2010.Hestatesthatsexual
abusehaddeclined62%from1992to2009.Thelongtermtrendforphysicalabusewasalsodownby56%
since1992.Thedeclineinsexualabuseaddstoanalreadysubstantialpositivelongtermtrend.Hestates:"Itis
unfortunatethatinformationaboutthetrendsinchildmaltreatmentarenotbetterpublicizedandmorewidely
known.Thelongtermdeclineinsexualandphysicalabusemayhaveimportantimplicationsforpublic
policy."[149]
DouglasJ.Besharov,thefirstDirectoroftheU.S.CenteronChildAbuseandNeglect,states"theexistinglaws
areoftenvagueandoverlybroad"[150]andthereisa"lackofconsensusamongprofessionalsandChild
ProtectiveServices(CPS),personnelaboutwhatthetermsabuseandneglectmean".[151]SusanOrr,former
headoftheUnitedStatesChildren'sBureauU.S.DepartmentofHealthandServicesAdministrationfor
ChildrenandFamilies,20012007,statesthat"muchthatisnowdefinedaschildabuseandneglectdoesnot
meritgovernmentalinterference".[152]
Achildabusefatalityoccurswhenachild'sdeathistheresultofabuseorneglect,orwhenabuseand/orneglect
arecontributingfactorstoachild'sdeath.IntheUnitedStates,1,730childrendiedin2008duetofactors
relatedtoabusethisisarateof2per100,000U.S.children.[153]Familysituationswhichplacechildrenatrisk
includemoving,unemployment,andhavingnonfamilymemberslivinginthehousehold.Anumberofpolicies
andprogramshavebeenputinplaceintheU.S.totrytobetterunderstandandtopreventchildabusefatalities,
including:safehavenlaws,childfatalityreviewteams,trainingforinvestigators,shakenbabysyndrome
preventionprograms,andchildabusedeathlawswhichmandateharshersentencingfortakingthelifeofa
child.[154]
Societyandculture
History
Thewholeofrecordedhistorycontainsreferencestoactsthatcanbedescribedaschildabuseorchild
maltreatment,butprofessionalinquiryintothetopicisgenerallyconsideredtohavebeguninthe1960s.[4]The
1962publicationofthearticle"TheBatteredChildSyndrome"bypediatricpsychiatristC.HenryKempe
representsthemomentthatchildmaltreatmententeredmainstreamawareness.Beforethearticle'spublication,
injuriestochildrenevenrepeatedbonefractureswerenotcommonlyrecognizedastheresultsofintentional
trauma.Instead,physiciansoftenlookedforundiagnosedbonediseasesoracceptedparents'accountsof
accidentalmishapssuchasfallsorassaultsbyneighborhoodbullies.[102]:100103
Throughoutthe20thcentury,untilthe1970s,insomeWesterncountries,childrenfromethnicminorityorigin
wereforcefullyremovedfromtheirfamiliesandcommunities,bystateandchurchauthorities,andforcedto
"assimilate".SuchpoliciesincludetheStolenGenerations(inAustraliaforAustralianAboriginalandTorres
StraitIslanderchildren)andtheCanadianIndianresidentialschoolsystem(inCanadaforFirstNations,Mtis
andInuit),withsuchchildrenoftensufferingsevereabuse.[155][156][157][158][159][160][161]
Thestudyofchildabuseandneglectemergedasanacademicdisciplineintheearly1970sintheUnitedStates.
ElisabethYoungBruehlmaintainsthatdespitethegrowingnumbersofchildadvocatesandinterestin
protectingchildrenwhichtookplace,thegroupingofchildreninto"theabused"andthe"nonabused"created
anartificialdistinctionthatnarrowedtheconceptofchildren'srightstosimplyprotectionfrommaltreatment,
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andblockedinvestigationofthewaysinwhichchildrenarediscriminatedagainstinsocietygenerally.Another
effectofthewaychildabuseandneglecthavebeenstudied,accordingtoYoungBruehl,wastocloseoff
considerationofhowchildrenthemselvesperceivemaltreatmentandtheimportancetheyplaceonadults'
attitudestowardthem.YoungBruehlwritesthatwhenthebeliefinchildren'sinherentinferioritytoadultsis
presentinsociety,allchildrensufferwhetherornottheirtreatmentislabeledas"abuse".[102]:1516
Childlabor
Childlaborreferstotheemploymentofchildreninanyworkthatdepriveschildrenoftheirchildhood,
interfereswiththeirabilitytoattendregularschool,orismentally,physically,sociallyormorallydangerous
andharmful.[162]TheInternationalLabourOrganizationconsiderssuchlabortobeaformofexploitationand
abuseofchildren.[163][164]Childlaborreferstothoseoccupationswhichinfringethedevelopmentofchildren
(duetothenatureofthejoband/orthelackofappropriateregulation)anddoesnotincludeageappropriateand
properlysupervisedjobsinwhichminorsmayparticipate.AccordingtoILO,globally,around215million
childrenwork,manyfulltime.Manyofthesechildrendonotgotoschool,donotreceivepropernutritionor
care,andhavelittleornotimetoplay.Morethanhalfofthemareexposedtotheworstformsofchildlabor,
suchaschildprostitution,drugtrafficking,armedconflictsandotherhazardousenvironments.[165]Thereexist
severalinternationalinstrumentsprotectingchildrenfromchildlabor,includingtheMinimumAgeConvention,
1973andtheWorstFormsofChildLabourConvention.
Childtrafficking
Childtraffickingistherecruitment,transportation,transfer,harbouring
orreceiptofchildrenforthepurposeofexploitation.[166]Childrenare
traffickedforpurposessuchasofcommercialsexualexploitation,
bondedlabour,cameljockeying,childdomesticlabour,drugcouriering,
childsoldiering,illegaladoptions,begging.[167][168][169]Itisdifficultto
obtainreliableestimatesconcerningthenumberofchildrentrafficked
eachyear,primarilyduetothecovertandcriminalnatureofthe
practice.[170][171]TheInternationalLabourOrganizationestimatesthat
1.2millionchildrenaretraffickedeachyear.[172]
InSwitzerland,betweenthe1850sandthemid20thcentury,hundreds
ofthousandsofchildrenwereforcefullyremovedfromtheirparentsby
theauthorities,andsenttoworkonfarms,livingwithnewfamilies.
Thesechildrenusuallycamefrompoororsingleparents,andwereused
asfreelaborbyfarmers,andwereknownascontractchildrenor
Verdingkinder.[173][174][175][176]
Otherpoliciesoforganizedchildabductionandsellingofchildreninthe
20thcenturyincludetheLostchildrenofFrancoism(inSpain)andthe
disappearanceofthechildrenofMothersofthePlazadeMayo(in
Argentina).
AchildsoldierinElSalvador,1990.
Femalegenitalmutilation
Femalegenitalmutilation(FGM)isdefinedbytheWorldHealthOrganization(WHO)as"allproceduresthat
involvepartialortotalremovaloftheexternalfemalegenitalia,orotherinjurytothefemalegenitalorgansfor
nonmedicalreasons."[178]Itispracticedmainlyin28countriesinAfrica,andinpartsofAsiaandtheMiddle
East.[179][180]FGMismostlyfoundinageographicalarearangingacrossAfrica,fromeasttowestfrom
SomaliatoSenegal,andfromnorthtosouthfromEgypttoTanzania.[181]FGMismostoftencarriedouton
younggirlsagedbetweeninfancyand15years.[178]FGMisclassifiedintofourtypes,ofwhichtype3
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infibulationisthemostextremeform.[178]The
consequencesofFGMincludephysical,emotionaland
sexualproblems,andincludeseriousrisksduring
childbirth.[182][183]InWesterncountriesthispracticeis
illegalandconsideredaformofchildabuse.[183][184]The
countrieswhichchoosetoratifytheIstanbulConvention,
thefirstlegallybindinginstrumentinEuropeinthefieldof
violenceagainstwomenanddomesticviolence,[185]are
boundbyitsprovisionstoensurethatFGMis
criminalized.[186]InAustralia,allstatesandterritorieshave
outlawedFGM.[187]IntheUnitedStates,performingFGM
onanyoneundertheageof18becameillegalin1996with
theFederalProhibitionofFemaleGenitalMutilation
Act.[188]
AmapshowingtheprevalenceofFGM,according
toa2013UNICEFreport. [177]
Childmarriage
Achildmarriageisamarriagebetweentwominors,orbetweenanadultandaminor,oftenbeforetheminor
hasreachedpuberty.Childmarriagesarecommoninmanypartsoftheworld,especiallyinpartsofAsiaand
Africa.Sincechildrenundertheageof18arenotcapableofgiving"freeandfullconsent"tomarriage,child
marriagesareconsideredatypeofforcedmarriage.Suchmarriageshavesignificantpotentialtoconstitutea
formofchildabuse.[189]Inmanycountriessuchpracticesarelawful,andevenwherelawsprohibitchild
marriage,theyareoftenunenforced.[190]
Indiahasmorechildbridesthananynationintheworldwith40%oftheworldtotalhappeninghere.[191]The
countrieswiththehighestratesofchildmarriageare:Niger(75%),CentralAfricanRepublicandChad(68%),
andBangladesh(66%).[192]
Violenceagainstchildrenaccusedofwitchcraft
Customarybeliefsinwitchcraftarecommoninmanypartsoftheworld,evenamongtheeducated.Thisis
especiallythecaseinpartsofAfrica.[193]WitchcraftaccusationsagainstchildreninAfricahavereceived
increasinginternationalattentioninthefirstdecadeofthe21stcentury.Childrenwhoarespecificallyatriskof
suchaccusationsincludeorphans,streetchildren,albinos,disabledchildren,childrenwhoareunusuallygifted,
childrenwhowerebornprematurelyorinunusualpositions,andtwins.[194]Beingaccusedofwitchcraftin
Africaisverydangerous,asawitchisculturallyunderstoodtobethesymbolofevil,andthecauseofallills.
Consequently,thoseaccusedofbeingawitchareostracizedandsubjectedtopunishment,tortureandeven
murdered.[195][196]
ReportsbyUNICEF,UNHCR,SaveTheChildrenandHumanRightsWatchhavehighlightedtheviolenceand
abusetowardschildrenaccusedofwitchcraftinAfrica.[197][198][199][200]A2010UNICEFreportdescribes
childrenasyoungaseightbeingburned,beatenandevenkilledaspunishmentforsuspectedwitchcraft.The
reportnotesthataccusationsagainstchildrenarearecentphenomenonwomenandtheelderlywereformerly
morelikelytobeaccused.UNICEFattributestheriseinvulnerablechildrenbeingabusedinthiswayto
increasedurbanizationandsocialdisruptioncausedbywar.[201]
InsouthernEthiopia,childrenwithphysicalabnormalitiesareconsideredtoberituallyimpureormingi,the
latterarebelievedtoexertanevilinfluenceuponothers,sodisabledinfantshavetraditionallybeendisposedof
withoutaproperburial.[202]
Ethics
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Oneofthemostchallengingethicaldilemmasarisingfromchildabuserelatestotheparentalrightsofabusive
parentsorcaretakerswithregardtotheirchildren,particularlyinmedicalsettings.[203]IntheUnitedStates,the
2008NewHampshirecaseofAndrewBednerdrewattentiontothislegalandmoralconundrum.Bedner,
accusedofseverelyinjuringhisinfantdaughter,suedfortherighttodeterminewhetherornotsheremainon
lifesupportkeepingheralive,whichwouldhavepreventedamurdercharge,createdamotiveforBednertoact
thatconflictedwiththeapparentinterestsofhischild.[203][204][205]BioethicistsJacobM.AppelandThaddeus
MasonPoperecentlyargued,inseparatearticles,thatsuchcasesjustifythereplacementoftheaccusedparent
withanalternativedecisionmaker.[203][206]
Childabusealsoposesethicalconcernsrelatedtoconfidentiality,asvictimsmaybephysicallyor
psychologicallyunabletoreportabusetoauthorities.Accordingly,manyjurisdictionsandprofessionalbodies
havemadeexceptionstostandardrequirementsforconfidentialityandlegalprivilegesininstancesofchild
abuse.Medicalprofessionals,includingdoctors,therapists,andothermentalhealthworkerstypicallyowea
dutyofconfidentialitytotheirpatientsandclients,eitherbylawand/orthestandardsofprofessionalethics,and
cannotdisclosepersonalinformationwithouttheconsentoftheindividualconcerned.Thisdutyconflictswith
anethicalobligationtoprotectchildrenfrompreventableharm.Accordingly,confidentialityisoftenwaived
whentheseprofessionalshaveagoodfaithsuspicionthatchildabuseorneglecthasoccurredorislikelyto
occurandmakeareporttolocalchildprotectionauthorities.Thisexceptionallowsprofessionalstobreach
confidentialityandmakeareportevenwhenthechildorhis/herparentorguardianhasspecificallyinstructedto
thecontrary.Childabuseisalsoacommonexceptiontophysicianpatientprivilege:amedicalprofessional
maybecalledupontotestifyincourtastootherwiseprivilegedevidenceaboutsuspectedchildabusedespite
thewishesofthechildandhis/herfamily.[207]SomechildabusepoliciesinWesterncountrieshavebeen
criticizedbothbysomeconservatives,whoclaimsuchpoliciesundulyinterfereintheprivacyofthefamily,
andbysomefeministsoftheleftwing,whoclaimsuchpoliciesdisproportionallytargetandpunish
disadvantagedwomenwhoareoftenthemselvesinvulnerablepositions.[208]
Organizations
Thereareorganizationsatnational,state,andcountylevelsintheUnitedStatesthatprovidecommunity
leadershipinpreventingchildabuseandneglect.TheNationalAllianceofChildren'sTrustFundsandPrevent
ChildAbuseAmericaaretwonationalorganizationswithmemberorganizationsatthestatelevel.
ManyinvestigationsintochildabusearehandledonthelocallevelbyChildAdvocacyCenters.Startedover25
yearsagoatwhatisnowknownastheNationalChildren'sAdvocacyCenter[209]inHuntsville,Alabamaby
DistrictAttorneyRobert"Bud"Cramerthesemultidisciplinaryteamshavemettocoordinatetheireffortsso
thatcasesofchildabusecanbeinvestigatedquicklyandefficiently,ultimatelyreducingtraumatothechildand
garneringbetterconvictions.[210][211]TheseChildAdvocacyCenters(knownasCACs)havestandardssetby
theNationalChildren'sAlliance.[212]
Otherorganizationsfocusonspecificpreventionstrategies.TheNationalCenteronShakenBabySyndrome
focusesitseffortsonthespecificissueofpreventingchildabusethatismanifestedasshakenbabysyndrome.
Mandatedreportertrainingisaprogramusedtopreventongoingchildabuse.
NICHD,alsoknownastheNationalInstituteofChildHealth&HumanDevelopmentisabroadorganization,
buthelpsvictimsofchildabusethroughoneofitsbranches.ThroughtheChildDevelopmentandBehavior
(CDB)Branch,NICHDraisesawarenesseffortsbysupportingresearchprojectstobetterunderstandtheshort
andlongtermimpactsofchildabuseandneglect.TheyprovideprogramsandobserveNationalChildAbuse
PreventionMontheveryAprilsince1984.TheUnitedStatesChildren'sBureauleadsactivitiesfortheMonth,
includingthereleaseofupdatedstatisticsaboutchildabuseandneglect,candlelightvigils,andfundraisersto
supportpreventionactivitiesandtreatmentforvictims.TheBureaualsosponsorsa"BlueRibbonCampaign,"
inwhichpeoplewearblueribbonsinmemoryofchildrenwhohavediedfromabuse,orinhonorofindividuals
andorganizationsthathavetakenimportantstepstopreventchildabuseandneglect.[213]
17/26
9/22/2016
Seealso
AMBERAlert
Abuse
AdverseChildhood
ExperiencesStudy
Attachmenttheory
Attachmenttherapy
Barnardo's
ChildabuseinNewZealand
Childmurder
Cinderellaeffect
Complexposttraumatic
stressdisorder
Corporalpunishmentinthe
Corporalpunishmentinthe
home
Domesticviolence
Dysfunctionalfamily
Emotionaldysregulation
Infanticide(zoology)
Institutionalabuse
IrishSocietyforthe
PreventionofCrueltyto
Children
Karly'sLaw
LloyddeMause
Mandatoryreporter
MommieDearest
MommieDearest
Narcissisticabuse
Parentalabusebychildren
Parentalbullyingofchildren
Powerandcontrolinabusive
relationships
Reactiveattachmentdisorder
Schoolcorporalpunishment
Sociologyofthefamily
Songsaboutchildabuse
WAVETrust
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Furtherreading
CrossonTower,C.(2008).UnderstandingChildAbuseandNeglect.Boston,MA:PearsonEducation.
ISBN0205503268.OCLC150902303.
Finkelhor,D.(19February2008).ChildhoodVictimization:Violence,Crime,andAbuseintheLivesof
YoungPeople.OxfordNewYork:OxfordUniversityPress.p.244.ISBN9780195342857.
OCLC162501989.
Hoyano,L.KeenanC.(2007).ChildAbuse:LawandPolicyAcrossBoundaries.OxfordNewYork:
OxfordUniversityPress.ISBN019829946X.OCLC79004390.
Korbin,JillE.(1983).Childabuseandneglect:crossculturalperspectives.Berkeley,CA:Universityof
CaliforniaPress.ISBN0520050703.OCLC144570871.
Miller,Alice(1990)."ThouShaltNotBeAware":Society'sBetrayaloftheChild,inseries,Meridian
Book[s].Trans.byHeildegardeandHunterHannum.NewYork:Penguin.x,329p.Trans.fromthe
German,titledDusollstnichtmerken.ISBN0452009294pbk
Turton,Jackie(2008).ChildAbuse,Gender,andSociety.NewYork:Routledge.p.161.ISBN0415
365058.OCLC144570871.
Young,Leontine(1964).Wednesday'schildren:Astudyofchildneglectandabuse.NewYork:McGraw
Hill.OCLC192177.
Externallinks
Childabuse(https://www.dmoz.org/Society/Issues/Children%2C_
Wikisourcehasthetextof
Youth_and_Family/Child_Abuse/)atDMOZ
a1911Encyclopdia
Childmaltreatment(http://www.who.int/topics/child_abuse/en/),
Britannicaarticleabout
WorldHealthOrganization
Childabuse.
WorldReportonViolenceAgainstChildren(http://www.unviolen
cestudy.org/),SecretaryGeneraloftheUnitedNations
WikimediaCommonshas
PreventChildAbuseAmerica(http://www.preventchildabuse.or
mediarelatedtoChild
g/)
abuse.
Pete(http://www.youtube.com/watch?v=u2JXCFWcIeE)(award
winning2004shortfilm)
"ColdnosedComfort"(http://www.courthousedogs.com/pdf/KellyBaltimoreCAC.pdf)(usingaservice
dogtoaidchildabusevictims),MarylandLawyer
Retrievedfrom"https://en.wikipedia.org/w/index.php?title=Child_abuse&oldid=737333151"
Categories: Childabuse Crimes Familytherapy Violenceagainstchildren
Thispagewaslastmodifiedon2September2016,at03:06.
TextisavailableundertheCreativeCommonsAttributionShareAlikeLicenseadditionaltermsmay
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