CHILD ABUSE

Child Abuse



Child Abuse

Introduction

The term child abuse encompasses many behaviors that adults perpetrate against children, including physical harm, sexual contact, emotional maltreatment, and material neglect of a child's physical, emotional, or medical needs. Those committing abusive acts can include not only the child's biological parents or legal guardians, but also caretakers, teachers, grandparents, members of the clergy, friends of the family, and other adults who have contact with the child. The effects of abuse on child health, growth, and development can include death, long-term physical injury, and psychiatric symptoms, such as depression and low self-esteem, that persist into adulthood, and often lead to suicidal thoughts, substance abuse, and perpetuating the cycle of violence on one's own children.

A range of acts can constitute physical child maltreatment, including attacking the child with an object; dunking the child into boiling water or otherwise causing burns, pushing, kicking, or slapping the child; physically confining a child with rope or other restraints; or attacking the child with a knife, razor blade, or other conventional weapon. One complication in detecting physical maltreatment is that corporal punishment of children is still legal and somewhat common in several countries, including the United States. This acceptance of corporal punishment often leads to confusion on the part of parents and other potential child abuse perpetrators as to where the line between acceptable physical force and abuse falls. Symptoms of physical child abuse can include fractures, burns, bruises, missing teeth, internal bleeding, and abrasions on the skin. While not all injuries to children are the result of child abuse, abused children often exhibit characteristic patterns of injuries, such as clustered bruises, torsional arm fractures, cigarette-sized burns, or other injuries not easily explainable in the context of a child's normal activities and developmental stage.

Discussion

One particularly common form of physical child abuse prevalent in infants under the age of one is shaken baby syndrome, which occurs when an individual violently shakes an infant, causing internal injuries resulting from gravitational acceleration and deceleration. One feature of shaken baby syndrome is that there is very little external evidence of abuse unless the infant's head strikes a wall or other object, but internally, the infant can suffer from retinal hemorrhages, subdural hematomas, and fracturing of the ribs or long bones. Shaken baby syndrome is a common cause of infant mortality, and even nonfatal injuries can be quite severe, and include blindness, cerebral palsy, and cognitive impairment. Clinicians should strongly suspect shaken baby syndrome or other physical abuse when an infant presents with injuries that are not explained by the normal milestones of development in infants.

Sexual abuse of children includes not only sexual intercourse or assault, but also fondling of a child's genitalia or breasts, masturbating in the presence of a clothed or unclothed child, inappropriate exposure of genitalia to a child, or forcing the child into unwanted sexual acts. Exploiting children for the production of pornographic films or for prostitution also constitutes sexual abuse. While not always easy to detect, research has indicated that ...