Child Clinical Intervention Part I Child Abuse

Physical abuse of children occurs throughout every social strata, although there may be an increased incidence among those living in poverty. Abuse often occurs at moments of great stress, and the perpetrator strikes out in anger at the child. The perpetrator may also have been abused as a child and may have poor impulse control. Because of the relative size and strength difference between adults and children, the abused child can be severely injured or killed. Abuse frequently occurs from shaking an infant, which causes bleeding over the brain (subdural hematoma) and is often referred to as 'shaken baby syndrome'. The incidence of child abuse is remarkably high and fairly accurately reported. The total abuse rate is 25.2 per 1000 children with physical abuse counting for 5.7 per 1000, sexual abuse 2.5 per 1000, emotional abuse 3.4 per 1000 and neglect accounting for the vast majority 15.9 per 1000 children. Risk factors include poverty, lack of education, single parenthood, alcohol or drug abuse and a host of other factors. However, child abuse occurs in all strata of society."

As is abundantly clear, from the above quote issued by the National Institute of Health child abuse is serious business. Children are one of the most vulnerable members of society. In addition, given their general impressionable nature, the abused can eventually become the abuser. This source of this vicious circle has to be controlled and eliminated.

Part I of this paper will deal with the three most common kinds of child abuse - physical, sexual and emotional. I will list out clinical issues, behavioral issues, symptoms, signs and tests for these specific kinds of child abuse.

Perpetrators:

More than 80% of victims (84%) were abused by a parent or parents. Mothers acting alone were responsible for 47% of neglect victims and 32% of physical abuse victims. Non-relatives, fathers acting alone, and other relatives were responsible for 29%, 22% and 19%, respectively, of sexual abuse victims."

This is one of the most worrying aspects of child abuse. If child abuse were primarily committed by unknown third parties, we could have taken extreme measures to supervise children. However, since parents and relatives constitute the largest percentage of abusers, we get into a 'who will guard the guardians.' Parents are naturally assumed to be the ones most interested in the welfare of their children. When they abuse their own children, the problem can be quite tough to deal with.

And before, we begin looking at the individual kinds of child abuse, here is a sobering thought:

Child fatalities are the most tragic consequence of maltreatment. Approximately 1,200 children died of abuse or neglect in the year 2000-a rate of 1.71 children per 100,000 children in the population. The increase in the rate of fatalities compared to earlier years is hypothesized to be largely attributable to improved reporting.

Youngest children were the most vulnerable. Children younger than one-year-old accounted for 44% of child fatalities and 85% of child fatalities were younger than 6 years of age."

When so many children out there are abused to a point that they die, we have to sit up and pay attention. Child abuse is not just another social problem. It is an issue that attacks the core of decency and social behavior. And given it feeds on itself to an extent makes it all the more dangerous. This part of the paper will attempt to inform the reader of the some of the major issues related with child abuse. After all, awareness is the first step for improving a bad situation.

Child Physical Abuse

Physical abuse, which is 19% of all substantiated cases of child abuse, is the most visible form of abuse and may be defined as any act which results in a non-accidental trauma or physical injury. Inflicted physical injury most often represents unreasonable, severe corporal punishment or unjustifiable punishment. This usually happens when a frustrated or angry parent strikes, shakes or throws a child. Physical abuse injuries result from punching, beating, kicking, biting, burning or otherwise harming a child. While any of these injuries can occur accidentally when a child is at play, physical abuse should be suspected if the explanations do not fit the injury or if a pattern of frequency is apparent. The longer the abuse continues, the more serious the injuries to the child and the more difficult it is to eliminate the abusive behavior."

It is easy for mass media to paint a picture of a physical child abuser as a 'monster', but that does not seem to be helping. Given the size and strength differential between the abuser and the child, some...

What complicates this situation is that children are naturally prone to injuries and often do not raise suspicion when injured. Additionally, the child may not know that he/she is being abused and hence may choose to not talk about it. What is worse that in many cases, the child may be led to believe that this physical abuse is the child's fault. This leads to physical abuse, compounded by emotional abuse.
Indicators: There are several physical indicators of physical child abuse. None of these is deterministic. Depending on the explanation and frequency of occurrence, these could indicate abuse.

Physical Indicators of Physical Child Abuse:

bite marks unusual bruises lacerations burns high incidence of accidents or frequent injuries fractures in unusual places injuries, swellings to face and extremities discoloration of skin"

Damage done by physical child abuse does not stop at physical indicators. Given the mental make up of children, physical abuse can change the way they think and approach life. This could lead to altered behavior. Hence, in addition to physical indicators, one has to carefully watch out for behavior indicators of physical child abuse.

Behavioral Indicators in Child avoids physical contact with others apprehensive when other children cry wears clothing to purposely conceal injury, i.e. long sleeves refuses to undress for gym or for required physical exams at school gives inconsistent versions about occurrence of injuries, burns, etc.

A seems frightened by parents often late or absent from school comes early to school, seems reluctant to go home afterwards has difficulty getting along with others, little respect for others overly compliant, withdrawn, gives in readily and allows others to do for him/her without protest plays aggressively, often hurting peers complains of pain upon movement or contact has a history of running away from home reports abuse by parents"

As any parent would report, a lot of behavioral characteristics mentioned above exist in their children to varying degrees. These might be natural and often not a cause of worry. And this is exactly the reason detecting physical child abuse is not easy.

Clinical Issues: At a clinic, several symptoms can indicate physical child abuse. Some of these would require a doctor or a qualified practitioner to make a finding. Here is a list

Symptoms appearance at an emergency room with an injured child and an improbable explanation delayed appearance at an emergency room with an injured child bruise marks shaped like hands, fingers, or objects (belt) specific patterns of scalding seen when a conscious child is immersed in hot water burns from an electric stove, radiator, heater or other hot objects on the child's hands or buttocks cigarette burns on exposed areas or the genitals black eyes in an infant human bite marks lash marks choke marks around neck circular marks around wrists or ankles (twisting) sutures - separated bulging soft spot (fontanel) on the infants head unexplained unconsciousness in infant"

Additionally, there are tests that can be run to understand the nature and extent of the physical damage. These tests will not indicate whether abuse or accident has occurred, but they can provide clues and also be used to decide on a line of treatment and therapy.

Physical examination may show other injuries, such as:

multiple retinal hemorrhages (bleeding in the back of the eye) internal damage such as bleeding or rupture of an organ from blunt trauma any fracture in an infant that is too young to walk or crawl evidence of epiphyseal fractures (often multiple) of long bones or spiral type fractures that result from twisting fractured ribs evidence of skull fracture(s) (occasionally multiple fractures of different ages may be present) subdural hematoma (collection of blood in the brain) without plausible explanation"

Child Sexual Abuse: Abusive nature does not occur in isolation. Often a sexual abuser could also be a physical abuser. But specifically in the case of sexual child abuse, there are two important things to keep in mind:

1) Even a grown up might see some behavior of the offender, mere as 'affectionate'.

2) Sexual child abuse is far more prevalent in the case of the female child.

The sexual development and perspective of a child is very much underdeveloped compared to that of an adult. As a result, the child may not know how to deal with sexual abuse. This makes it tougher for the grown up to detect sexual child abuse cases. Nonetheless, the behavioral changes of sexually abused children might provide an indicator.

Behavioral Warning Signs A Child May Have…