What to Know about Child Abuse
What do I need to know about child abuse?
Child abuse is common. The newspapers and TV news are so full of reports about child mistreatment that you cannot help but wonder how safe your child really is. Although it is a mistake to become overprotective and make your child fearful, it is important to recognize the actual risks and familiarize yourself with the signs of abuse. Approximately three million cases of child abuse and neglect involving almost 5.5 million children are reported each year. The majority of cases reported to Child Protective Services involve neglect, followed by physical and sexual abuse. There is considerable overlap among children who are abused, with many suffering a combination of physical abuse, sexual abuse, and/or neglect.
Most child abuse occurs within the family. Risk factors include parental depression or other mental health issues, a parental history of childhood abuse, and domestic violence. Child neglect and mistreatment is also more common in families living in poverty and among parents who are teenagers or are drug or alcohol abusers. Although it is certainly true that child abuse occurs outside the home, most often children are abused by a caregiver or someone they know, not a stranger.
Sexual abuse is any sexual activity that a child cannot comprehend or consent to. It includes acts such as fondling, oral-genital contact, and genital and anal intercourse, as well as exhibitionism, voyeurism, and exposure to pornography. Studies have suggested that up to one in four girls and one in eight boys will be sexually abused before they are eighteen years old. Physical abuse occurs when a child’s body is injured as a result of hitting, kicking, shaking, burning, or other show of force. One study suggests that about 1 in 20 children has been physically abused in their lifetime.
Child neglect can include physical neglect (failing to provide food, clothing, shelter, or other physical necessities), emotional neglect (failing to provide love, comfort, or affection), or medical neglect (failing to provide needed medical care). Psychological or emotional abuse results from all of the above, but also can be associated with verbal abuse, which can harm a child’s self-worth or emotional wellbeing.
Signs and Symptoms
It is not always easy to recognize when a child has been abused. Children who have been mistreated are often afraid to tell anyone, because they think they will be blamed or that no one will believe them. Sometimes they remain quiet because the person who abused them is someone they love very much, or because of fear, or both. Parents also tend to overlook signs and symptoms of abuse, because they don’t want to face the truth. This is a serious mistake. A child who has been abused needs special support and treatment as early as possible. The longer he continues to be abused or is left to deal with the situation on his own, the less likely he is to make a full recovery.
Parents should always be alert to any unexplainable changes in the child’s body or behavior. While injuries are often specific for an incident of physical abuse, behavioral change tends to reflect the anxiety that results from a stressful situation of any type. There are no behaviors that pinpoint a particular type of child abuse.
- Any injury (bruise, burn, fracture, abdominal or head injury) that cannot be explained
- Genital pain or bleeding, as well as a sexually transmitted disease
Behavioral Changes that Raise Concern about Possible Abuse
- Fearful behavior (nightmares, depression, unusual fears)
- Abdominal pain, bedwetting (especially if the child has already been toilet trained)
- Attempts to run away
- Extreme sexual behavior that seems inappropriate for the child’s age
- Sudden change in self-confidence
- Headaches or stomachaches with no medical cause
- Abnormal fears, increased nightmares
- School failure
- Extremely passive or aggressive behavior
- Failure to gain weight (especially in infants) or sudden dramatic weight gain
- Desperately affectionate behavior or social withdrawal
- Big appetite and stealing food
In most cases, children who are abused or neglected suffer greater emotional than physical damage. Emotional and psychological abuse and neglect deny the child the tools needed to cope with stress, and to learn life’s lessons. So a child who is severely mistreated may become depressed or develop suicidal, withdrawn, or violent behavior. As he gets older, he may use drugs or alcohol, try to run away, refuse discipline, or abuse others. As an adult, he may develop marital and sexual difficulties, depression, or suicidal behavior. Identifying a child victim is the first step. Recognizing the importance of early trauma to future development is crucial to assisting the victim.
Not all abuse victims have severe reactions. Usually the younger the child, the longer the abuse continues, and the closer the child’s relationship with the abuser, the more serious the emotional damage will be. A close relationship with a very supportive adult can increase resiliency, reducing some of the impact.
If you suspect your child has been abused, get help immediately through your pediatrician or a local child protective agency. Physicians are legally obligated to report all suspected cases of abuse or neglect to state authorities. Your pediatrician also will detect and treat any medical injuries or ailments, recommend a therapist, and provide necessary information to investigators. The doctor also may testify in court if necessary to obtain legal protection for the child or criminal prosecution of a sexual abuse suspect. Criminal prosecution is rarely sought in mild physical abuse cases but will occur in cases involving sexual abuse.
If he has been abused, your child will benefit from the services of a qualified mental health professional. You and other members of the family may be advised to seek counseling so that you’ll be able to provide the support and comfort your child needs. If someone in your family is responsible for the abuse, a mental health professional may be able to treat that person successfully, as well.
If your child has been abused, you may be the only person who can help him. There is no good reason to delay reporting your suspicions of abuse. Denying the problem will only make the situation worse, allowing the abuse to continue unchecked and decreasing your child’s chance for a full recovery.
In any case of abuse, the child’s safety is of primary concern. He or she needs to be in a safe environment free of the potential for continuing abuse.
The major reasons for physical and psychological mistreatment of children within the family often are parental feelings of isolation, stress, and frustration. Parents need support and as much information as possible in order to raise their children responsibly. They need to be taught how to cope with their own feelings of frustration and anger without venting them on children. They also need the companionship of other adults who will listen and help during times of crisis. Support groups through local community organizations often are helpful first steps to diminish some of the isolation or frustration parents may be feeling. Parents who were themselves victims of abuse as children are in particular need of support. Confronting, addressing, and healing old wounds take uncommon courage and insight, but doing so is often the best assurance that the cycle of abuse is not passed on to the next generation.
Personal supervision of and involvement in your child’s activities are the best ways to prevent physical and sexual abuse outside the home. Any school or child care program you select for your child should allow unrestricted and unannounced parental visits without prearrangement. Parents should be allowed to help in the classroom on a volunteer basis and be informed about the selection or changes of staff members. Parents should pay careful attention to their child’s reports about and reactions to his experiences at school. Always investigate if your child tells you he’s been mistreated or if he undergoes a sudden unexplained change in behavior.
Although you don’t want to frighten your child, you can teach him some basic rules of safety in a nonthreatening manner. Teach him to keep his distance from strangers, not to wander away from you in unfamiliar territory, to say “no” when someone asks him to do something against his will, and always to tell you if someone hurts him or makes him feel bad. Always remember that open, two-way communication with your child provides the best chance that you will know when a problem occurs. Emphasize that he will not get in trouble if he tells you about abuse or other confusing events. Emphasize that you need to know this to be able to keep him safe and that he will be OK if he tells you. Instead of teaching him that he’s surrounded by danger, teach him that he is strong, capable, and can count on you to keep him safe, as long as he can tell you about it. Teach him that it is not OK for adults to touch his body if he does not consent or understand what is happening.
© Copyright 2015 American Academy of Pediatrics. All rights reserved.