• Physical abuse: Physical abuse includes not only direct physical attacks on a child (hitting, shaking, burning, striking with an object) but also failing or refusing to protect a child from physical injury.
• Emotional abuse: Emotional abuse includes repeated verbal shaming or cursing at a child, terrorizing the child, refusing to speak to the child, isolating, or rejecting the child. Some experts include the kidnapping of a child by a parent or other relative during or after a divorce.
• Sexual abuse: Sexual abuse includes exposing a child to pornography or adult sexual behavior as well as fondling, intercourse, or oral-genital contact with a child. Sexual abuse on the part of an adult related to the child by blood or marriage is called incest.
• Neglect: Neglect refers to omitting or refusing to provide the child with food, shelter, clothing, schooling, or medical care.
Child abuse was called battered child syndrome when it was first identified in the 1950s because repeated physical injuries to children could be documented by x rays and photographs of external injuries. The definition of abuse was expanded over the years to include neglect, emotional abuse, and sexual abuse. The maltreatment of children and teenagers is more widespread than many people realize; while at least 900,000 children are reported to child protective services in an average year as victims of abuse, researchers think that one out of every seven children between the ages of two and seventeen (eight to nine million children) in the United States is coping with some type of abuse or neglect. The consequences of abuse depend partly on the type of abuse or neglect, the number of perpetrators involved and their relationship to the child, the child’s age at the time of abuse, and whether and when the child or family gets help.
Children physically abused in infancy are at high risk of permanent brain damage from shaken baby syndrome, including vision disorders, learning difficulties, and cerebral palsy. Children abused emotionally at any age are at risk of depression, panic disorder, memory problems, sleep disorders, eating disorders, anxiety disorders, and suicide attempts. One study reported that 80 percent of a sample of young adults who had been emotionally abused as children had developed one or more psychiatric disorders by age twenty. Childhood abuse also has significant longterm effects on a person’s behavior in adult life. Such adults are 1.5 times more likely to abuse drugs or alcohol than those from healthier families. Adults who were abused as children are more likely to be sexually promiscuous, drop out of school, and have problems getting and keeping a job. A National Institute of Justice study done in 2001 indicated that being abused or neglected as a child increased the likelihood of adult criminal behavior by 28 percent and violent crime by 30 percent. Last, the experience of childhood abuse makes it difficult for adult survivors to form lasting and healthy relationships.
Most child abuse occurs at the hands of someone the child knows, usually a parent, other relative, caregiver, or neighbor. According to the Centers for Disease Control and Prevention (CDC), about twelve children in every 1,000 in the United States were reported to child protective services as victims of child maltreatment in 2006, the last year for which data are available. Of these 900,000 children, 64 percent were victims of neglect, 17 percent were physically abused, 9 percent were sexually abused, and 7 percent were emotionally abused. Girls are slightly more likely to be abused than boys; 52 percent of children reported as victims
of abuse were girls.
Some other studies have reported higher rates of emotional abuse— as high as 75 percent—when emotional abuse is considered as a factor in other forms of abuse or neglect. Of adults who abuse children, the majority are women—58 percent. Infants are the most likely age group to suffer abuse; the CDC reported that twenty-four out of every 1,000 children below the age of twelve months were abused in 2006, compared to fourteen per 1,000 for children between one and three years of age, thirteen per 1,000 for children between three and seven, eleven per 1,000 for children between eight and fifteen, and six per 1,000 for teenagers sixteen to seventeen years of age. Race and ethnicity are also factors. In 2006, the rate of child abuse among African Americans was twenty per 1,000 children; for Native Americans, sixteen per 1,000; and for children of mixed race, fifteen per 1,000.
Child abuse and neglect can lead to death. The CDC reported that more than 1,500 children of all ages died in the United States in 2006 as the direct result of abuse and neglect. Seventy-eight percent of these deaths occurred in children below the age of four years.
Nursing Care Plan Signs and SymptomsThe basic cause of child abuse and neglect is inadequate parenting. Parents can become abusive or neglectful toward their children for a number of different reasons:
• They were abused themselves as children and do not see abusive attitudes and behaviors as abnormal.
• They suffer from mental illness.
• They lack information about the timetable of normal development in children. For example, they may think that a baby should be toilet-trained at three months of age and they become angry when the baby “fails.”
• They belong to a culture that emphasizes harsh physical discipline as the way to rear children.
• They lack impulse control.
• They abuse drugs or alcohol.
The signs or symptoms of child abuse or neglect vary from child to child, but the following are typical:
• Physical abuse: The child has frequent and unexplained bruises, broken bones, burns, black eyes, or scars; does not want to go home from school; shrinks away from adults; seems frightened of his or her parents.
• Emotional abuse: The child seems either too mature or too childish for his or her age; is delayed in emotional development; is either extremely submissive or extremely aggressive toward other children; is not emotionally attached to the parents; has attempted suicide.
• Sexual abuse: The child has sudden changes in appetite, nightmares, or bedwetting; is diagnosed with a sexually transmitted disease; knows about or describes sexual behavior in an adult way; has difficulty walking or sitting; does not want to change clothes for or participate in gym class.
• Neglect: The child begs or steals food; is frequently dirty or has severe body odor; does not have clothes suitable for the weather; says that there is no one home to give care.
Nursing Care Plan DiagnosisThe diagnosis of child abuse can be complicated because some types of abuse do not leave physical evidence. Teachers, police, doctors, dentists, and in some states clergy are required by law to report suspected child abuse to local law enforcement. Although each state sets its own policies for investigation and protective action, in most states the police and child protective services will investigate the situation and if appropriate, remove the child from the home temporarily or permanently. Final decisions about the child’s placement are usually made through the state’s family court system.
The child will be given a complete physical examination to look for evidence of traumatic injuries. X rays, computed tomography (CT) scans, or other imaging studies are usually ordered to check for evidence of fractures, bleeding in the brain, damage to the eyes or internal organs, and other injuries. The child may be given a blood test to check for sexually transmitted diseases. The doctor will also rule out a few rare bone or blood diseases that can cause the skin to bruise easily or bones to fracture from very minor injuries.
Nursing Care Plan TreatmentThe treatment of child abuse is complex and often involves long-term psychotherapy for the parents or other perpetrators as well as the child. Most states require some kind of counseling for the parents. Children who have suffered severe or long-term abuse often need special education programs as well as physical therapy or medical treatment for their physical injuries.
Nursing Care Plan Prognosis
The prognosis of recovery from child abuse varies considerably. Some survivors, sometimes called resilient children, are able to cope with physical injuries and painful memories and do very well in adult life. Others resort to drug and alcohol abuse, criminal behavior, risk-taking, and
other self-destructive behaviors; they may eventually attempt or commit suicide. Factors that improve a child’s chances of recovering from abuse or neglect include caring adults in the extended family or neighborhood who can serve as role models for the child; a community that takes responsibility for preventing child abuse; and high intelligence in the child.
Nursing Care Plan PreventionPrevention of child abuse is a long-term process that requires participation by individuals, families, communities, and the health care and legal systems. Some programs that are yielding good results include home visitation programs aimed at reducing violence in families; foster grandparent programs; educating young parents about children’s needs and normal developmental patterns; support groups for single or stressed parents; hotlines for reporting child abuse; and public awareness programs. Other preventive strategies include teaching children to identify abnormal and abusive behaviors and to report them to family members or other appropriate adults. This approach often helps to identify family members with abusive tendencies before serious injury occurs.
Medical researchers have devoted intense attention to child abuse in recent years. As of 2008, the National Institutes of Health (NIH) was supporting 280 separate studies of treatments and prevention strategies for child abuse. The treatments include various forms of psychotherapy for abused children and reducing drug abuse and other self-harming behaviors in adults who had been abused in childhood. Prevention strategies that are being studied include psychotherapy for abusive parents, parent education programs, home visitation programs, and family strengthening programs.