Child abuse
Child abuse (also called child endangerment or child maltreatment) is physical, sexual, emotional and/or psychological maltreatment or neglect of a child, especially by a parent or a caregiver. Child abuse may include any act or failure to act by a parent or a caregiver that results in actual or potential wrongful harm to a child and can occur in a child's home, or in organizations, schools, or communities the child interacts with.
"Child maltreatment" redirects here. For the journal, see Child Maltreatment (journal).
The terms child abuse and child maltreatment are often used interchangeably, although some researchers make a distinction between them, treating child maltreatment as an umbrella term to cover neglect, exploitation, and trafficking.
Different jurisdictions have different requirements for mandatory reporting and have developed different definitions of what constitutes child abuse, and therefore have different criteria to remove children from their families or to prosecute a criminal charge.
History[edit]
As late as the 19th century, cruelty to children, perpetrated by employers and teachers, was commonplace and widespread, and corporal punishment was customary in many countries. But, in the first half of the 19th century, pathologists studying filicide (the parental killing of children) reported cases of death from paternal rage,[1] recurrent physical maltreatment,[2] starvation,[3] and sexual abuse.[4] In an 1860 paper, French forensic medical expert Auguste Ambroise Tardieu gathered together a series of 32 such cases, of which 18 were fatal, the children dying from starvation and/or recurrent physical abuse; it included the case of Adeline Defert, who was returned by her grandparents at the age of 8, and for 9 years tortured by her parents – whipped every day, hung up by her thumbs and beaten with a nailed plank, burnt with hot coals and her wounds bathed in nitric acid, and deflorated with a baton.[5] Tardieu made home visits and observed the effect on the children; he noticed that the sadness and fear on their faces disappeared when they were placed under protection. He commented, "When we consider the tender age of these poor defenceless beings, subjected daily and almost hourly to savage atrocities, unimaginable tortures and harsh privation, their lives one long martyrdom – and when we face the fact that their tormentors are the very mothers who gave them life, we are confronted with one of the most appalling problems that can disturb the soul of a moralist, or the conscience of justice".[6] His observations were echoed by Boileau de Castélnau (who introduced the term misopédie – hatred of children),[7] and confirmed by Aubry[8] and several theses.[9][10][11]
These early French observations failed to cross the language barrier, and other nations remained ignorant of the cause of many traumatic lesions in infants and toddlers; almost one hundred years would pass before humankind began to systematically confront Tardieu's "appalling problem". In the 20th century, evidence began to accumulate from pathology and paediatric radiology, particularly in relation to chronic subdural haematoma and limb fractures: subdural haematoma had a curious bimodal distribution, idiopathic in infants and traumatic in adults,[12] while unexplained ossifying periostitis of the long bones was similar to that occurring after breech extractions.[13] In 1946, John Caffey, the American founder of paediatric radiology, drew attention to the association of long bone fractures and chronic subdural haematoma,[14] and, in 1955, it was noticed that infants removed from the care of aggressive, immature and emotionally ill parents developed no new lesions.[15]
As a result, professional inquiry into the topic began again in the 1960s.[16] The July 1962 publication of the paper "The Battered Child-Syndrome" authored principally by pediatrician C. Henry Kempe and published in The Journal of the American Medical Association represents the moment that child maltreatment entered mainstream awareness. Before the article's publication, injuries to children—even repeated bone fractures—were not commonly recognized as the results of intentional trauma. Instead, physicians often looked for undiagnosed bone diseases or accepted parents' accounts of accidental mishaps such as falls or assaults by neighborhood bullies.[17]: 100–103
The study of child abuse emerged as an academic discipline in the early 1970s in the United States. Elisabeth Young-Bruehl maintained that despite the growing numbers of child advocates and interest in protecting children which took place, the grouping of children into "the abused" and the "non-abused" created an artificial distinction that narrowed the concept of children's rights to simply protection from maltreatment, and blocked investigation of how children are discriminated against in society generally. Another effect of the way child abuse and neglect have been studied, according to Young-Bruehl, was to close off consideration of how children themselves perceive maltreatment and the importance they place on adults' attitudes toward them. Young-Bruehl wrote that when the belief in children's inherent inferiority to adults is present in society, all children suffer whether or not their treatment is labeled as "abuse".[17]: 15–16
Two of the many academics who studied and published about child abuse and neglect, Jeanne M. Giovannoni and Rosina M. Bercerra, published Defining Child Abuse in 1979. In it (according to the publishers) they utilize the methodology of social research to define child abuse, illuminate strategies for remedying and preventing child abuse, and examine how professionals and the community view child mistreatment.[18][19]
Definitions[edit]
Definitions of what constitutes child abuse vary among professionals, between social and cultural groups, and across time.[20][21] The terms abuse and maltreatment are often used interchangeably in the literature.[22]: 11 Child maltreatment can also be an umbrella term covering all forms of child abuse and child neglect.[16] Defining child maltreatment depends on prevailing cultural values as they relate to children, child development, and parenting.[23] Definitions of child maltreatment can vary across the sectors of society which deal with the issue,[23] such as child protection agencies, legal and medical communities, public health officials, researchers, practitioners, and child advocates. Since members of these various fields tend to use their own definitions, communication across disciplines can be limited, hampering efforts to identify, assess, track, treat, and prevent child maltreatment.[22]: 3 [24]
In general, abuse refers to (usually deliberate) acts of commission while neglect refers to acts of omission.[16][25] Child maltreatment includes both acts of commission and acts of omission on the part of parents or caregivers that cause actual or threatened harm to a child.[16] Some health professionals and authors consider neglect as part of the definition of abuse, while others do not; this is because the harm may have been unintentional, or because the caregivers did not understand the severity of the problem, which may have been the result of cultural beliefs about how to raise a child.[26][27] Delayed effects of child abuse and neglect, especially emotional neglect, and the diversity of acts that qualify as child abuse, are also factors.[27]
The World Health Organization (WHO) defines child abuse and child maltreatment as "all forms of physical and/or emotional ill-treatment, sexual abuse, neglect or negligent treatment or commercial or other exploitation, resulting in actual or potential harm to the child's health, survival, development or dignity in the context of a relationship of responsibility, trust or power."[28] The WHO also says, "Violence against children includes all forms of violence against people under 18 years old, whether perpetrated by parents or other caregivers, peers, romantic partners, or strangers."[29] In the United States, the Centers for Disease Control and Prevention (CDC) uses the term child maltreatment to refer to both acts of commission (abuse), which include "words or overt actions that cause harm, potential harm, or threat of harm to a child", and acts of omission (neglect), meaning "the failure to provide for a child's basic physical, emotional, or educational needs or to protect a child from harm or potential harm".[22]: 11 The United States federal Child Abuse Prevention and Treatment Act defines child abuse and neglect as, at minimum, "any recent act or failure to act on the part of a parent or caretaker which results in death, serious physical or emotional harm, sexual abuse or exploitation" or "an act or failure to act which presents an imminent risk of serious harm".[30][31]
Suspicion for physical abuse is recommended when injuries occur in a child who is not yet able to walk independently.[175] Additionally, having multiple injuries that are in different stages of healing and having injuries in unusual location, such as the torso, ears, face, or neck, may prompt evaluation for child abuse.[175] Medical professionals may also become suspicious of child abuse when a caregiver is not able to provide an explanation for an injury that is consistent with the type or severity of the injury.[176]
In many jurisdictions, suspected abuse, even if not necessarily proven, requires reporting to child protection agencies, such as the Child Protection Services in the United States. Recommendations for healthcare workers, such as primary care providers and nurses, who are often suited to encounter suspected abuse are advised to firstly determine the child's immediate need for safety. A private environment away from suspected abusers is desired for interviewing and examining. Leading statements that can distort the story are avoided. As disclosing abuse can be distressing and sometimes even shameful, reassuring the child that he or she has done the right thing by telling and that they are not bad or that the abuse was not their fault helps in disclosing more information. Dolls are sometimes used to help explain what happened. In Mexico, psychologists trial using cartoons to speak to children who may be more likely to disclose information than to an adult stranger.[177] For the suspected abusers, it is also recommended to use a nonjudgmental, nonthreatening attitude towards them and to withhold expressing shock, in order to help disclose information.[178]
A key part of child abuse work is assessment. A few methods of assessment include projective tests, clinical interviews, and behavioral observations.[179]
A particular challenge arises where child protection professionals are assessing families where neglect is occurring. Neglect is a complex phenomenon without a universally-accepted definition[180] and professionals cite difficulty in knowing which questions to ask to identify neglect.[181] Younger children, children living in poverty, and children with more siblings are at increased risk of neglect.[182]
Treatments[edit]
A number of treatments are available to victims of child abuse.[204] However, children who experience childhood trauma do not heal from abuse easily.[205] Trauma-focused cognitive behavioral therapy, first developed to treat sexually abused children, is now used for victims of any kind of trauma.[204] It targets trauma-related symptoms in children including PTSD, clinical depression and anxiety. It also includes a component for non-offending parents. Several studies have found that sexually abused children undergoing TF-CBT improved more than children undergoing certain other therapies. Data on the effects of TF-CBT for children who experienced non-sexual abuse was not available as of 2006.[204] The purpose of dealing with the thoughts and feelings associated with the trauma is to deal with nightmares, flashbacks and other intrusive experiences that might be spontaneously brought on by any number of discriminative stimuli in the environment or in the individual's brain. This would aid the individual in becoming less fearful of specific stimuli that would arouse debilitating fear, anger, sadness or other negative emotion. In other words, the individual would have some control or mastery over those emotions.[78]
Rational Cognitive Emotive Behavior Therapy is another available treatment and is intended to provide abused children and their adoptive parents with positive behavior change, corrective interpersonal skills, and greater control over themselves and their relationships.[78]
Parent–child interaction therapy was designed to improve the child-parent relationship following the experience of domestic violence. It targets trauma-related symptoms in infants, toddlers, and preschoolers, including PTSD, aggression, defiance, and anxiety. It is supported by two studies of one sample.[204]
Child Abuse is not only negatively affecting the child, but also the people around them. Many of these situations that happen outside of family households are still ruining relationships within the familial status. There are resources that are available to help that not many people are informed about due to the societal norms that are created that stop people from reaching out for assistance.
School-based programs have also been developed to treat children who are survivors of abuse.[206] This approach teaches children, parents, teachers, and other school staff how to identify the signs of child maltreatment as well as skills that can be helpful in preventing child maltreatment.[207]
Other forms of treatment include group therapy, play therapy, and art therapy. Each of these types of treatment can be used to better assist the client, depending on the form of abuse they have experienced. Play therapy and art therapy are ways to get children more comfortable with therapy by working on something that they enjoy (coloring, drawing, painting, etc.). The design of a child's artwork can be a symbolic representation of what they are feeling, relationships with friends or family, and more. Being able to discuss and analyze a child's artwork can allow a professional to get a better insight of the child.[208]
Interventions targeting the offending parents are rare. Parenting training can prevent child abuse in the short term, and help children with a range of emotional, conduct and behavioral challenges, but there is insufficient evidence about whether it has impact on parents who already abuse their children.[209] Abuse-focused cognitive behavioral therapy may target offending parents, but most interventions exclusively target victims and non-offending parents.[204]
Ethics[edit]
One of the most challenging ethical dilemmas arising from child abuse relates to the parental rights of abusive parents or caretakers with regard to their children, particularly in medical settings.[299] In the United States, the 2008 New Hampshire case of Andrew Bedner drew attention to this legal and moral conundrum. Bedner, accused of severely injuring his infant daughter, sued for the right to determine whether or not she remain on life support; keeping her alive, which would have prevented a murder charge, created a motive for Bedner to act that conflicted with the apparent interests of his child.[299][300][301] Bioethicists Jacob M. Appel and Thaddeus Mason Pope recently argued, in separate articles, that such cases justify the replacement of the accused parent with an alternative decision-maker.[299][302]
Child abuse also poses ethical concerns related to confidentiality, as victims may be physically or psychologically unable to report abuse to authorities. Accordingly, many jurisdictions and professional bodies have made exceptions to standard requirements for confidentiality and legal privileges in instances of child abuse. Medical professionals, including doctors, therapists, and other mental health workers typically owe a duty of confidentiality to their patients and clients, either by law or the standards of professional ethics, and cannot disclose personal information without the consent of the individual concerned. This duty conflicts with an ethical obligation to protect children from preventable harm. Accordingly, confidentiality is often waived when these professionals have a good faith suspicion that child abuse or neglect has occurred or is likely to occur and make a report to local child protection authorities. This exception allows professionals to breach confidentiality and make a report even when children or their parents or guardians have specifically instructed to the contrary. Child abuse is also a common exception to physician–patient privilege: a medical professional may be called upon to testify in court as to otherwise privileged evidence about suspected child abuse despite the wishes of children or their families.[303] Some child abuse policies in Western countries have been criticized both by some conservatives, who claim such policies unduly interfere in the privacy of the family, and by some feminists of the left wing, who claim such policies disproportionally target and punish disadvantaged women who are often themselves in vulnerable positions.[304] There has also been concern that ethnic minority families are disproportionally targeted.[305][306]
Legislation[edit]
Canada[edit]
Laws and legislation against child abuse are enacted on the provincial and Federal Territories level. Investigations into child abuse are handled by Provincial and Territorial Authorities through government social service departments and enforcement is through local police and courts.[307]
Germany[edit]
In Germany, the abuse of vulnerable persons (including children) is punishable according to the German Criminal code § 225 with a from 6 months to 10 years, in aggravated cases at least 1 year (to 15 years pursuant to § 38). If the case is only an attempt, the penalty can be lower (§ 23). However, crimes against children must be prosecuted within 10 years (in aggravated cases 20 years) of the victims reaching 30 years of age (§ 78b and § 78).[308]
As of 2020, Germany and the Netherlands are 2 out of all 27 EU countries that do not have any reporting obligations for civilians or professionals. There is no mandatory reporting law, which would grant reporters of child abuse anonymity and immunity.[309]
United States[edit]
In the 1960s, mandatory reporting in the United States was introduced and had been adopted in some form by all 50 states by 1970.[310][311]: 3
In 1974, the Child Abuse Prevention and Treatment Act (CAPTA) was introduced and began an upswing in reported child sexual abuse cases which lasted until the 1990s.[312] The Child Abuse Victims Rights Act of 1986 gave victims of child abuse the ability to file lawsuits against abuse perpetrators and their employers after the statute of limitations had expired.[312] The Victims of Child Abuse Act of 1990 further gave victims of abuse capacity to press charges by permitting the court to assign lawyers to advise, act in the best interest of, and elevate the voices of child victims of abuse.[313] The Adoption and Safe Families Act (1997) followed, shifting emphasis away from court-sanctioned reunification of families to giving parents or guardians time-bound opportunities for rehabilitation prior to making long term plans for children.[314] Child Abuse Reform and Enforcement Act was enacted in 2000 to further reduce the incidence of child abuse and neglect.
Shifting legislative focus more heavily towards sexual abuse and exploitation of children, Adam Walsh Child Protection and Safety Act was passed in 2006 to increase penalties and registration for child sexual abuse, exploitation, and transportation crimes. top Exploitation Through Trafficking Act passed in 2013 aimed at preventing the prosecution of sexually exploited youth being sex trafficked, redirecting abused and exploited youth from the criminal justice system to the child welfare system.[315][316] This and other laws redirecting victims of child sex trafficking to the child welfare system are known as "Safe Harbor" laws.[316]
As of April 2019, 18 states had legislation requiring that mandated reporters report based on suspicion of child abuse of neglect.[317]
Advocacy organizations[edit]
United States[edit]
There are organizations at national, state, and county levels in the United States that provide community leadership in preventing child abuse and neglect.
Mary Ellen Wilson, also called Mary Ellen McCormack, was an American whose case of child abuse, the first documented case of child abuse in the United States,[318] led to the creation of the New York Society for the Prevention of Cruelty to Children, which was incorporated in 1875.[319][320] It was the world's first child protective agency.[321]
Prevent Child Abuse America,[322] founded in 1976, operates in 46 states to provide child abuse and neglect protection.[323]
Founded in 1985, the National Children's Advocacy Center,[324] along with National Children's Alliance,[325] coordinates efforts and sets standards and policy for child advocacy centers across the US and abroad.
The Children's Trust Fund Alliance,[326] established in 1989, provides funding support to state level child abuse organisations.
Many investigations into child abuse in the US are handled on the local level by 924[325] child advocacy centers, some of which are distributed among 34[324] other countries.
Other organizations focus on specific prevention strategies. The National Center on Shaken Baby Syndrome focuses its efforts on the specific issue of preventing child abuse that is manifested as shaken baby syndrome.[327]
NICHD, also known as the National Institute of Child Health & Human Development is an organization that helps victims of child abuse through one of its branches. Through the Child Development and Behavior (CDB) Branch, NICHD raises awareness efforts by supporting research projects to better understand the short- and long-term impacts of child abuse and neglect. They provide programs and observe National Child Abuse Prevention Month every April since 1984.[328] The United States Children's Bureau, a federal agency tasked to improve child abuse protection leads activities for the Month, including the release of updated statistics about child abuse and neglect, candlelight vigils, and fundraisers to support prevention activities and treatment for victims. The Bureau also sponsors a "Blue Ribbon Campaign", in which people wear blue ribbons in memory of children who have died from abuse, or in honor of individuals and organizations that have taken important steps to prevent child abuse and neglect.[328]
Canada[edit]
Charitable organizations exist in each province to assist children and families with abuse. Organizations such as the Canadian Red Cross,[329] Kids Help Phone,[330] and Guardians of the Children Canada,[331] are able to direct people to locally available resources.