CHILD ABUSE: recognition and resolution

BY VINCENT J. VITIELLO

Child abuse is the infliction of an intentional injury that harms a child; it can be physical, emotional, or sexual. Child neglect is the failure of a caretaking adult to provide for a child’s basic needs; it also may be physical or emotional. This overview explores the history, victim impact, social system and ecosystem components, recognition, and resolution of child abuse and neglect.

HISTORY

Child abuse and neglect are deeply rooted in history. In ancient Palestine, the sacrifice of firstborn sons was common. In the Bible, the Book of Chronicles tells of the Moabite King Mesha who burned his eldest son for the god Chemosh and of the Ammonites who offered their sons to their god Moloch.¹ In ancient Rome, fathers had the right to sell, mutilate, or kill their children; in China, female babies were drowned; and in Egypt, children were buried alive to serve deceased persons in the afterlife.² As late as 1204, in Rome, Tiber River fishermen would find bodies of children in their nets, and in 17th century France, many babies were thrown into sewers and left along roadways to die. (2)

Attitudes toward children mirrored the values attached to them amid various stages of societal growth and development. During the era of hunters and gatherers, male children were much more desirable since they were felt to be inherently better suited for the rigors and demands necessary for survival. As time elapsed, the agrarian regions considered both male and female children beneficial since they were necessary to work the fields, where they contributed to productivity. However, during the same period in large urban regions, children were unable to make economic contributions and were considered liabilities.

The industrial revolution in the United States brought with it exploitation of young children in unregulated factory labor. In 1866, a report to the Massachusetts Legislature stated that factory representatives went about canvassing for small children. The following comments were expressed: “A great deal of machinery has been stopped for want of small help, and overseers have been going around to draw small children from school as long as they are old enough to stand.” (2, 2)

In the big cities of the late 19th century, people of different classes lived and worked in proximity. The poor, particularly children, lived much of their lives on the streets. The moral reformers, who defined the social problems, were influenced by a growing tenderness toward children and a revulsion against personal violence. They considered child abuse and neglect not only moral wrongs but also a kind of pollution, poisoning the stock of future citizens and the order of civil society. As a result, child protection became one of a range of campaigns to control social disorder.³

In the United States, the 1874 “Little Mary Ellen” child abuse case in New York⁴ motivated a significant movement to recognize children’s rights. Mary Ellen had been physically and emotionally abused by her foster mother. Because no official agency existed to protect children’s rights, concerned neighbors approached the president of the New York Society for the Prevention of Cruelty to Animals. The public attention of the severe abuse inflicted on Mary Ellen prompted the organization of child protective efforts and the creation of the Society for the Prevention of Cruelty to Children (SPCC) in 1875. (4)

The early workers of the SPCC, which were located in major cities, were former law enforcement and military men readily identified with these agencies, since they were regarded as “arms of the law,” focusing on rescuing children and prosecuting parents. Not until 1903 did the SPCC philosophy shift from rescue and prosecution to prevention and remediation. (2, 4)

Child protection activities underwent major transformations and were integrated into the developing social work profession, specifically child welfare. This changed the nature of the workers and their conception of the problem, which led to the growth of the following four closely related approaches to child welfare: an emphasis on neglect vs. abuse, environmental explanations, a sense that the major problem was familial, and a preference for professional guidance instead of criminal prosecution remedies. (3, 69)

As child protective laws changed, reflecting the new understanding of parental motivation and the possibility of treatment for neglectful and abusive parents, the public developed a new awareness during the 1960s. Dr. Henry Kempe originated the “battered child syndrome” diagnosis, which caused the media to publicize the problem nationwide and resulted in all 50 states passing laws requiring mandatory reporting and child abuse and neglect treatment. (2, 6) It became mandatory for professionals who came in contact with children they believed to be maltreated to report their findings to the designated authorities. Even though child protective agencies had been dealing with child abuse and neglect since 1875, the so-called “rediscovery” of this issue brought renewed national concern and the implementation of many policies and approaches that are still being followed today.

Since private agencies carried out most of the early efforts to protect children, it was not until the passage of the Social Security Act of 1935, which placed child protective services within the mandates of public social service agencies, that the federal government intervened. (4, 74) Subsequently, the following federal legislation was enacted: the Child Abuse Prevention and Treatment Act of 1974 to ensure effective coordination of policies and the development of programs and services; the Indian Child Welfare Act of 1978 to address the special circumstances of Native American children; the Adoption Assistance Act of 1980, which was instituted to attempt to keep families together if possible and to provide adoption as a permanent plan if rehabilitation was not possible; and the Omnibus Budget Reconciliation Act of 1993, which provided additional funding for family support through social service block grants. (4, 89) Presently, states still administer child welfare services with funding assistance provided through Title IV and Title XX of the Social Security Act.

The public in general is much more aware of child abuse and neglect today than in the past because of mass media attention. According to the National Child Abuse and Neglect Reporting System, there were 2.974 million reported referrals of child maltreatment throughout the United States in 1999.⁵

IMPACT ON VICTIMS

The consequences of child abuse and neglect can be devastating. In some cases, these effects may be immediately obvious and in others may take years to manifest. The hidden nature of child abuse and neglect, however, continues to challenge many of the findings in this area. This is further compounded when these experiences are not evident until years after they occur. In addition, distinguishing consequences that are associated directly with the child abuse or neglect experience itself, rather than other social disorders, can be difficult. In spite of these dilemmas, evidence has been gathered over time to outline the impact child abuse and neglect have on the victims.

During infancy and toddler years, abused children tend to suffer insecure attachments to the primary caregiver; exhibit more aggressive behaviors; avoid other children; and have difficulty showing concern, empathy, and sadness at distress in others. (4, 86) In addition, physical abuse in infants and young children can cause brain injury and death. In fact, the majority of fatality victims are under five years of age.⁶

Nonorganic failure to thrive is a form of neglect usually suspected in infants who demonstrate significant weight gain following admission to a hospital or removal from their family. (6) Deprivational dwarfism is another form of neglect applied to children of small stature whose physical growth is impaired by the absence of proper nutritional requirements. (6, 211)

Physically abused children have been found to have more mild neurologic signs, serious physical injuries, and skin markings and scars than their nonabused peers. (6, 211) Children who have been sexually abused and some who have been physically neglected have shown heightened sexuality and signs of genital manipulation. (6, 211) Sexual abuse victims are particularly susceptible to developing self-abusive and antisocial behaviors. Substance abuse, depression, low self-esteem, and self-hate are common; and incest during childhood often leads to teenager or adult promiscuity and increases the potential for sexual exploitation. (4, 86)

Cognitive and language deficits have been found in abused children; and abused and neglected children with no evidence of neurological impairment have also shown delayed intellectual development, particularly in verbal intelligence. (6, 211) Prob-lematic school performance in the form of low grades, poor standardized test scores, and frequent retention in a grade is a fairly consistent finding in studies of abused and neglected children. (6, 212)

As the abused and neglected children age, they exhibit generalized antisocial behaviors, have low self-esteem and poor self concepts, are mistrustful, may be more dependent, may lack social skills, and may externalize their feelings through aggressiveness and disobedience or internalize them through self-destructive and less social behaviors. (4, 86) By adolescence, these childhood behaviors are often entrenched in a young person, resulting in the possibility of the abused or neglected eventually mistreating their own offspring, since they “successfully” learned the child rearing techniques of their own parents. (4, 86) It is estimated that the rate of intergenerational transmission is 30 percent, meaning that about one-third of the individuals who were abused or neglected as children will abuse or neglect their own children. (6, 223)

SOCIAL SYSTEM AND ECOSYSTEM ASPECTS

Child abuse and neglect are found among all socioeconomic and cultural groups; however, some significant contributing variables have been identified. Poverty, neighborhood dysfunction, substance abuse, mental health problems, children with special needs, un-employment, financial difficulties, isolation, and lack of social support are found in greater frequency within families where abusive and neglectful behaviors occur. (4, 86)

Within the family system, the following has been documented: Maltreating adults appear to share a common history characterized by insecure and unstable relations with their parents; maltreating mothers are often diagnosed as being clinically depressed; maltreating parents tend to be younger when they have their children, less mature, and more likely to exhibit symptoms of mental distress or illness; maltreating parents lack both intimate and extrafamilial support; maltreating mothers are more likely to be unmarried; and violence between partners and violence between parent and child are likely to co-occur.⁷

The following has been documented within the ecosystem: The majority of chronically maltreating families fall within the lowest social echelons, and economic stress, hardship, and dependency have been cited as the greatest threats to adequate family functioning; decades of research support the link between low socioeconomic status and styles of child rearing that emphasize authoritarian control and punitive disciplinary techniques, which increase the probability of child maltreatment; and increased irritability, arbitrary discipline, and physical punishment are common parental responses to economic stressors. (7, 161-162)

It is obvious that child maltreatment cannot be tied to a specific theory. Nonetheless, many linkages between certain characteristics and incidents of maltreatment have been established. Many of these relationships may not be significant by themselves; however, in combination with each other they appear to increasingly contribute to maltreatment.

Negative attitudes and attributions about children’s behavior and inaccurate knowledge and expectations about child development contribute to maltreatment, especially neglect; in addition, negative maternal attitudes toward an unwanted or unplanned pregnancy have been associated with later maltreatment. (6, 115)

The notion that maltreated children become maltreating parents has been the focus of a great deal of attention. The research concerning this issue is controversial, and although estimates of the percentages of intergenerational abuse vary, the most conclusive assessment appears to be that one-third of the people who were maltreated as children become adults who maltreat their children.⁸

Substance abuse is often cited as a principal risk factor of child maltreatment, yet the correlation is usually complicated by the presence of other social and economic variables that confuse the analysis of the contributing role of the alcohol or drug. (6, 119)

Although child maltreatment is reported across the socioeconomic spectrum, it is disproportionately reported among poor families; furthermore, child maltreatment, especially child neglect, is not simply concentrated among the poor but among the poorest of the poor. (6, 133) Also, although mater-nal age by itself is not a significant risk factor for child maltreatment, mothers with young children living below the poverty line are at the greatest risk for violent behavior toward children. (6, 133)

It has been demonstrated that periods of high job loss precede increases in child abuse; this finding is consistent with the hypothesis that unemployment can cause family stress, subsequently resulting in child abuse. (6, 134)

RECOGNITION

Suspected cases of child abuse and neglect must be reported. On assessing a child, the following concerns should be addressed.⁹

Is the method of injury the parent/caregiver reported consistent with the child’s injuries?
Is the injury typical for the child’s developmental level?
Does the child have multiple injuries at different stages of healing or on various areas of the body?
Is the child clean and at an appropriate weight for his or her age?
Does the child have any unusual marks or bruises (i.e. cigarette burns, etc.)?
Does the child have several types of injuries such as burns, fractures, and bruises?
Does the child have any burns on the hands or feet that involve a “glove” distribution or, in other words, that encircle a hand or foot like a glove?
Is there an unexplained decreased level of consciousness?
Is there a good relationship between the child and the caregiver?
Is there any rectal or vaginal bleeding?
Is the caregiver appropriately concerned about the child’s well-being?
Is the caregiver under the influence of alcohol or drugs?
Is the condition of the home unacceptable-unkempt, dirty, unsanitary, etc.?
Are there any signs of domestic violence among the caregivers/parents?

In addition, particular attention should be directed to the following signs (9, 775):

Bruises. Observe color and location. New bruises are pink or red; over time, bruises turn blue, then yellow-brown and faded. Bruises to the back, buttocks, and face are suspicious and are usually inflicted by a person.

Burns. Burns to the penis, testicles, vagina, and buttocks are usually inflicted by someone else, as are burns that encircle a hand or foot like a glove. Abuse is also suspected if cigarette burns or grid burns are found. Grid burns are those caused by a hot object such as a frying pan, a radiator, or an iron. The degree and pattern of the burn are uniform and suggest a grid or lattice-like pattern.

Fractures. Humerus or femur fractures do not occur without major trauma, such as a fall from a high place or a motor vehicle crash. Falls from bed are not usually associated with fractures.

Shaken baby syndrome. Infants may sustain life-threatening head traumas from being shaken or struck on the head. As a result of intentional, forceful shaking, there is bleeding in the head and damage to the cervical spine. The infant will be found unconscious or with an altered mental status, often without evidence of external trauma. The call for help may be for an infant who has stopped breathing or is unresponsive to the caregiver. The infant may appear to be in cardiopulmonary arrest, but what has likely occurred is that the shaking tore blood vessels in the brain, resulting in bleeding around the brain. The pressure from the blood results in a coma.

Neglect. Neglected children often are dirty, are too thin, or appear developmentally delayed because of lack of stimulation; they may be inadequately clothed or left alone.

Other indicators. An abused child may appear withdrawn, fearful, or hostile; the child may refuse to discuss how an injury occurred; the parent or caregiver may reveal a history of several accidents, conflicting stories, or a marked lack of concern.

RESOLUTIONS

Preventing child abuse and neglect is complicated by the many contributory factors associated with their occurrence. Various issues, especially those affecting the standard of living, such as affordable housing, economic assistance, job opportunities, health care, quality education, child care, violence, substance abuse, teenage pregnancy, and a multitude of others must be considered when attempts are made toward prevention.

Current models of maltreatment prevention were derived from the public health profession and are comprised of three stages. The first stage is based on the notion that it is better to protect people from the agents that contribute to child abuse and neglect instead of waiting until some form of maltreatment occurs. The second stage involves directing efforts toward people who are more susceptible to engaging in or being subjected to some form of child maltreatment. This may involve counseling target groups and providing various other services to designated sectors of communities. The third stage incorporates intervention after some form of child maltreatment has occurred. The objective at this point is to prevent further occurrences and may involve investigation by child protective services, treatment of physical and emotional injuries, counseling, self-help services, providing goods and services such as homemaker or respite care, legal action against the perpetrator, and removal of the child or offender from the home.

Treatment services involve examining interactions of family members, parental perceptions of the children, behavioral characteristics that may restrict parenting abilities and emotional reactions to stressful child rearing situations, and caring for the physical and emotional injuries of the victim. (6, 261) Family preservation programs have been designed to prevent removal of children from the home. They are structured to address multiple goals including protection of children, strengthening family bonds, providing stability in crisis situations, increasing family skills and competencies, and fostering family use of formal and informal helping resources. (6, 264)

The impetus and forcefulness of these endeavors depend on the political, public safety, legal, educational, and medical communities as much as on the social service community. It is only with a combined and cooperative effort on behalf of these branches of society that a unifying assault can be executed against all forms of child maltreatment.

Child abuse and neglect are not new issues. Unfortunately, the incidence of child maltreatment continues. Tremendous efforts are directed toward treatment after an act of abuse or neglect is committed and discovered. Obviously, this avenue must continue to be pursued vigorously; but at least an equal amount of energy must be directed toward preventing and controlling the antecedents known to lead to child maltreatment. It is acknowledged that addressing the array of contributing social ills is difficult. In addition, various attempts at rectifying these ills have not been very successful in the past. How-ever, this should not serve as the basis for reducing efforts but as the motive for refocusing and fine-tuning them.

References

Segal, J., and Herbert Yahraes, A Child’s Journey. (New York: McGraw-Hill, 1978), 172.
Ebeling, N.B., and Deborah A. Hill, Child Abuse and Neglect. (Boston: John Wright Press, 1983).
Gordon, L., Heroes of Their Own Lives: The Politics and History of Family Violence. (New York: Viking Press, 1988), 29.
Gustavsson, N.S. and Elizabeth A. Segal, Critical Issues in Child Welfare. (Thousand Oaks, Calif.: Sage Publications, 1994), 74.
National Child Abuse and Neglect Reporting System, Washington, DC. Telephone interview by author, February 26, 2002.
National Research Council Panel on Research on Child Abuse and Neglect, Commission on Behavioral and Social Sciences and Education, “Understanding Child Abuse and Neglect.” (Washington: National Academy Press, 1993). 210.
Ammerman, R. T. and Michel Hersen, Children at Risk: An Evaluation of Factors Contributing to Child Abuse and Neglect. (New York: Plenum Press, 1990), 154-158.
Janko, S., Vulnerable Children, Vulnerable Families: The Social Construction of Child Abuse. (New York: Teachers College Press, 1994), 50.
Browner, B., and Lenworth Jacobs, Emergency Care and Transportation of the Sick and Injured. (Sudbury, Mass.: Jones and Bartlett, 1998), 774-775.

Additional References

Gil, Eliana. Outgrowing the Pain. (New York: Dell Publishing, 1983).

Kempe, C. Henry and Ruth S. Kempe. Child Abuse. Cambridge: (Harvard University Press, 1978).

Starr, Raymond H. and David A. Wolfe. The Effects of Child Abuse and Neglect. (New York: Guilford Press, 1991).

VINCENT J. VITIELLO is a captain and executive officer with the Township of Maplewood (NJ) Fire Department. A state-certified fire official and Level 2 fire instructor, he has bachelor’s degrees in health and physical education from William Paterson University and in fire safety administration from Jersey City State University. He is a licensed social worker with master’s degrees in public administration from Kean University and in social work from Fordham University.