Definition Child abuse can be defined as "the physical treatment and mental injuring, sexual abuse, negligent treatment, or maltreatment of a child under the age of 18 by a person who is responsible for the child's welfare under circumstances which indicate that the child's health and welfare is harmed or threatened thereby."
A non-accidental injury to a child is physical abuse. Failure to provide a child with basic emotional and physical needs is considered neglect. Neglect includes not providing a child with basic medical care. Sexual abuse is defined as any sexual activity between an adult and a child. This includes exhibitionism, fondling, oral-genital contact, or vaginal or anal penetration.
What are the signs and symptoms of the injury? Children who have been abused often present with a variety of psychological problems and symptoms. Therefore, no single symptom will necessarily indicate that abuse has occurred. The problem of identifying abuse is made more difficult, because many symptoms of abuse are also symptoms of other disorders or problems. For this reason, if abuse is suspected, it is extremely important to have the child evaluated by an experienced professional trained in diagnosing and treating abused children.
Emotional and behavioural symptoms of child abuse may include:
multiple bruises, often at various stages of healing
bone fractures
retinal or conjuctival bleeding (haemorrhage)
sudden and severe abdominal pain
blood in the urine
rectal or vaginal irritation or discharge
failure to achieve expected or normal weight and height growth
What are the causes and risks of the injury? Child abuse occurs in all social groups in this country. Girls and boys from all ages, ethnic and cultural groups, and socioeconomic levels are at risk for abuse. There are certain factors which leave some children at higher risk for being abused. Three particular areas of stress have been shown to increase the risk of abuse to a child.
1. Child-produced stresses which include a child who may be:
physically different (such as physically disabled)
mentally different (such as mentally retarded or learning disabled)
temperamentally different (such as difficult or substantially different temperament than other family members)
behaviourally different (such as hyperactive)
a foster or adopted child
2. Social-situational stresses include:
poverty, unemployment, significant change in family finances, poor housing, frequent moves, isolated
a violent parental relationship or one which is characterised by dominant-submissive patterns
a strained parent-child relationship (attachment problems, perinatal stress, punitive child-rearing style, scapegoating, role reversal, unwanted children)
3. Parent-produced stresses which include parents who:
have low self-esteem
were abused as a child
are depressed
are substance abusers
have a character disorder or psychiatric illness
are uneducated about basic child-rearing and/or have unrealistic expectations of their children.
What can be done to prevent the injury? Prevention of child abuse includes educating individuals and professionals about what abuse is. Providing information about the risks for either abusing or being abused is important. Developing trust within organisations and communities is helps people talk about abuse or potential abuse. Prevention also means taking an active role in promoting social change and making efforts to influence legislative reforms.
Education about community resources for victims of abuse is key. Reading books and articles about child abuse and supporting and promoting training and education on recognising and addressing child abuse are other strategies.
Ask directly about signs that may indicate abuse. For instance, if a neighbour child has unexplained bruising, ask that child how they were hurt. Even though children may not tell you exactly what happened, their reaction can give you more information about their situation. Keep in mind that simply asking the right questions can sometimes reduce the risk factor of social isolation. Showing concern can give the child someone to turn to if they need help.
How is the injury recognised? Child abuse is typically determined in several ways. Often, a professional will be the first to recognise and report suspected abuse. This may be a teacher, daycare worker, or doctor. In other instances, a family member or neighbour suspects abuse. Once abuse is suspected, the child should be evaluated by a physician and a mental health care worker.
The physician's evaluation will vary depending upon the type of abuse suspected. Unless sexual abuse is suspected, a gynecologic or rectal examination is not routinely performed. Unfortunately, unless the abuse is recent and rather severe, sexual abuse typically does not leave any specific physical marks
In instances where physical abuse is suspected, the physician will do a complete physical examination. For any injury or condition associated with child abuse, the physician should thoroughly question the caretaker.
Sometimes abuse is diagnosed indirectly. A physician may notice during an examination evidence of old injuries consistent with abuse.
What are the treatments for the injury? A child suspected of abuse should have any physical injuries or conditions immediately evaluated and treated by a physician. The treatment will be dependent upon the injury or condition.
There are, however, long-term emotional and psychological problems from being a victim of child abuse. Children who have been abused may benefit from counselling with a therapist specifically trained to do counselling with children. The counsellor will help them work through their feelings of low self-esteem, anger, and sense of helplessness that may have resulted from the abuse. They may also help the children learn and use new tools to protect themselves from additional abuse.
The parents or caretakers of the child should also receive counselling. Often, learning parenting skills, alternative discipline methods, and anger management techniques can be helpful.
Unfortunately, there are times when a caretaker is not able to adequately care for the child. In these instances, the child typically has to be removed from the home and placed in foster care in order to protect them from further abuse.
Author: Ann Reyes, Ph.D. Reviewer: eknowhow Medical Review Panel Editor: Dr John Hearne Last Updated: 2/2/2005 Contributors Potential conflict of interest information for reviewers available on request
