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	James L. Holly, M.D.

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Your Life Your Health - Child Abuse: Recognize It and Respond

James L. Holly,M.D.

April 12, 2007

Your Life Your Health - The Examiner

I grew up in a home where childen were highly valued. My mother-in-law always said, "I would never mind being a child or a dog in his home." The reference is to how well we cared for both. I learned to love children by watching my father love every child he met.

I loved "The Ransom of Red Chief." O'Henry spend much of his life in prison, yet he was an an outstanding short story writer. "The Ransom of Red Chief" was about a little boy who was kidnapped. The criminals demanded $200 for his return; his father demanded that they pay him $400 to take the boy back. Today, the humor in this essay is lost because of all of the meannss toward children we see and hear about everyday. But, in 1910, such abuse of children was rarely known except in big cities with child labor problems.

Those of us who love childeren abhor their abuse. As distasteful as the subject is, we must be able to identify child abuse and to help rescue abused children. There are four types of child maltreatment: neglect, physical abuse, sexual abuse, and emotional abuse. Each state must develop definitions that meet federal guidelines stated in the Child Abuse Prevention and Treatment Act. Most definitions include the following terminology:

Neglect is failure to provide for a child's basic needs (physical, educational, medical, and emotional).
Physical abuse is physical injury due to punching, beating, kicking, biting, burning, shaking, or otherwise harming a child. Even if the parent or caretaker did not intend to harm the child, such acts are considered abuse when done purposefully.
Sexual abuse includes fondling a child's genitals, incest, penetration, rape, sodomy, indecent exposure, and commercial exploitation through prostitution or the production of pornographic materials.
Emotional abuse is any pattern of behavior that harms a child's emotional development or sense of self-worth. It includes frequent belittling, rejection, threats, and withholding of love and support.

Occurrence

Data on the confirmed number of U.S. child maltreatment cases in 2002 are available from child protective service agencies; but these data are generally considered underestimates (DHHS 2005):

906,000 children in the United States were confirmed by child protective service agencies as being maltreated
Among children confirmed by child protective service agencies as being maltreated, 61% experienced neglect; 19% were physically abused; 10% were sexually abused; and 5% were emotionally or psychologically abused.
An estimated 1,500 children were confirmed to have died from maltreatment; 36% of these deaths were from neglect, 28% from physical abuse, and 29% from multiple maltreatment types.
Shaken-baby syndrome (SBS) is a form of child abuse affecting between 1,200 and 1,600 children every year. SBS is a collection of signs and symptoms resulting from violently shaking an infant or child (National Center on Shaken Baby Syndrome 2005).

Consequences of abuse

Children who experience maltreatment are at increased risk for adverse health effects and behaviors as adults—including smoking, alcoholism, drug abuse, eating disorders, severe obesity, depression, suicide, sexual promiscuity, and certain chronic diseases (Felitti et al. 1998; Runyan et al. 2002).
Maltreatment during infancy or early childhood can cause important regions of the brain to form improperly, leading to physical, mental, and emotional problems such as sleep disturbances, panic disorder, and attention-deficit/hyperactivity disorder (DHHS 2001).
About 25% to 30% of infant victims with SBS die from their injuries. Nonfatal consequences of SBS include varying degrees of visual impairment (e.g., blindness), motor impairment (e.g. cerebral palsy) and cognitive impairments (National Center on Shaken Baby Syndrome 2005).
Victims of child maltreatment who were physically assaulted by caregivers are twice as likely to be physically assaulted as adults (Tjaden et al. 2000).
Direct costs (judicial, law enforcement, and health system responses to child maltreatment) are estimated at $24 billion each year. The indirect costs (long-term economic consequences of child maltreatment) exceed an estimated $69 billion annually (Fromm 2001).

Groups at Risk

Children younger than 4 years are at greatest risk of severe injury or death. In 2003, children younger than 4 years accounted for 79% of child maltreatment fatalities, with infants under 1 year accounting for 44% of deaths (DHHS 2005).

Risk and Protective Factors

A combination of individual, relational, community, and societal factors contribute to the risk of child maltreatment. Although children are not responsible for the harm inflicted upon them, certain individual characteristics have been found to increase their risk of being maltreated. Risk factors are contributing factors—not direct causes. Examples of risk factors:

Disabilities or mental retardation in children that may increase caregiver burden
Social isolation of families
Parents' lack of understanding of children's needs and child development
Parents' history of domestic abuse
Poverty and other socioeconomic disadvantage, such as unemployment
Family disorganization, dissolution, and violence, including intimate partner violence
Lack of family cohesion
Substance abuse in family
Young, single nonbiological parents
Poor parent-child relationships and negative interactions
Parental thoughts and emotions supporting maltreatment behaviors
Parental stress and distress, including depression or other mental health conditions
Community violence

Protective factors are the opposite of risk factors and may lessen the risk of child maltreatment. Protective factors exist at individual, relational, community, and societal levels. Examples of protective factors:

Supportive family environment
Nurturing parenting skills
Stable family relationships
Household rules and monitoring of the child
Parental employment
Adequate housing
Access to health care and social services
Caring adults outside family who can serve as role models or mentors
Communities that support parents and take responsibility for preventing abuse (DHHS 2003)

Child Maltreatment: Prevention Strategies

Child maltreatment is a serious problem that can have lasting harmful effects on a child's life. The goal for child maltreatment prevention is simple—to stop child abuse and neglect from happening in the first place. Child maltreatment can be best prevented by supporting families through providing skills and resources. Here are some strategies to help prevent child maltreatment:

For Parents

One key way to prevent child maltreatment is for parents to develop nurturing parenting skills and build positive relationships with their children. Nurturing parental behaviors include:
Giving physical signs of affection such as hugs
Developing self-esteem in your children
Recognizing and understanding your children's feelings
Engaging in empathetic communication with your children
Learning alternative methods to shaking, hitting, or spanking
If you feel yourself losing control, take a break from the situation. Ask a friend or relative to watch your children for a while. Offer to help other parents so they can take a break.

For Communities

To help prevent child maltreatment, community resources and services to support families should be available and accessible. Communities can provide support in many ways:

Encourage volunteer efforts at organizations that provide family support services.
Partner with or sponsor organizations such as sports teams and local businesses to communicate prevention messages. Examples include training coaches on being good role models, getting businesses to put key messages on promotional materials, organizing a parent discussion at a business over lunchtime, and planning an event benefiting a prevention organization.
Work with prevention organizations and local media in developing community strategies that support parents and prevent abuse.
Teach children, parents, and educators prevention strategies that can help keep children safe.
Engage local legislators in increasing child maltreatment prevention efforts.
Support nonprofit organizations through financial contributions.
Encourage citizens to report suspected child abuse or neglect to child protective services (CPS) or a law enforcement agency. For more information, call Childhelp USA National Child Abuse Hotline at 1-800-4-A-CHILD (422-4453). Most states will keep your identity confidential. (DHHS 2003)

Remember, it is your life and it is your health, nothing will enrich both as helping a children have a better life.

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