Child abuse and neglect are major social problems in the United States. The number of alleged abuse incidents reported to state and local child protective services has skyrocketed, and statistics today show that physical abuse is the leading cause of death for children younger than 1 year. The highest incidence of child abuse from birth to 18 years occurs in first year of life, and more than two thirds of victims of physical abuse are younger than 6 years.
Child abuse and mistreatment appear to be associated with poverty, unemployment, child disability, psychiatric problems in parents, substance abuse by parents, parents being abused as children, antisocial behavior of parents, and whether pregnancy was planned. However, these factors alone don’t seem to predict the occurrence of abuse. The problem may be more child neglect than abuse. Neglect sometimes results from depression or other mental illness in the parents. Some parents, especially young, first-time parents, may be overwhelmed by caring for a child, become frustrated, and direct anger and frustration at the child.
Children may have orthopedic injuries, bruises, or x-ray evidence of repeated fractures. Shaken infant syndrome is associated with high death rates and physical injury. Child abuse can result in bleeding into the brain, blindness, and injuries to abdominal organs. These injuries account for most of deaths from child abuse.
As many as 30% of cases of failure to thrive in children are thought to be caused by neglect. Failure to thrive may lead to severe behavioral problems later in life. Child abuse may also involve sexual abuse.
Abused children have significant problems in emotional, social, and behavioral functioning. They have difficulty trusting others. They may feel guilt and low self-esteem because they believe that they were responsible for the abuse. Abused children have poor social behavior and tend to show anger and aggression toward playmates and schoolmates. They are more likely to have major psychiatric problems such as posttraumatic stress disorder, depression, anxiety, phobias, and personality disorders.
Staff in most emergency departments note children who come in frequently, especially with orthopedic injuries, and who have bruises or on x-ray evidence of old fractures. Physicians and other medical caregivers must report suspected child abuse and can face sanctions for not doing so.
Neighbors, family members, or medical personnel who report suspected abuse may prompt treatment.
The primary, most important goal is protection of the child. Medical consequences of abuse must be evaluated and treated, and the child should have psychological therapy. Such treatment often involves using play therapy, including dolls and puppets. Abusers also require treatment, regardless of whether they become involved in the criminal justice system. Support groups for such parents have helped. Many states have a program for monitoring pregnancies to assess whether it is safe for those babies to return home.
Many adults have flashbacks to childhood physical and sexual abuse that make it more likely that they will have psychiatric disorders, including borderline and multiple personality disorder, eating disorders, posttraumatic stress disorder, and alcohol and drug abuse.
The best approach to child abuse is prevention. Evaluating the level of support and the support network for new parents, providing parenting classes, and encouraging new parents to discuss concerns and fears would help. Overwhelmed parents should not be embarrassed to seek medical help and counseling.
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