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					Child Abuse and Neglect:
Types, Signs, Symptoms, Causes and Getting Help




Each year, tens of thousands of children are traumatized by physical, sexual, and emotional
abusers or by caregivers who neglect them, making child abuse as common as it is shocking. The
scars can be deep and long-lasting, affecting not just abused children but society. You can learn
the signs and symptoms of child abuse and find out where to get help for the children and their
caregivers.

Child abuse facts
Most of us can’t imagine what would make an adult use violence against a child, and the worse
the behavior is, the more unimaginable it seems. But the incidence of parents and other
caregivers consciously, even willfully, committing acts that harm the very children they’re
supposed to be nurturing is a sad fact of human society that cuts across all lines of ethnicity and
class. Whether the abuse is rooted in the perpetrator’s mental illness, substance abuse, or
inability to cope, the psychological result for each abused child is often the same: deep emotional
scars and a feeling of worthlessness.

In the United States, the federal legislation that sets minimum standards for how states handle
child abuse defines child abuse and neglect as ―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.‖ In
2005, the most recent year for which the U.S. government has figures, 12.1 of every 1,000
American children, almost 900,000 in all, suffered abuse by adults, with parents of victims
accounting for almost 80 percent of the abusers. Every day, about four children die in the U.S.
because of abuse or neglect, most of them babies or toddlers. And those are just the cases
authorities know about: for every incidence of child abuse or neglect that gets reported, it’s
estimated that two others go unreported.

There are four primary types of child abuse:

   1. physical abuse
   2. sexual abuse
    3. emotional abuse
    4. neglect

While the first two categories get the most attention, perhaps because they involve physical
violence, neglect is far and away the most common form of child abuse, accounting for more
than 60 percent of all cases of child maltreatment.

Child neglect: types and warning signs
Neglect is a pattern of failing to provide for a child's basic needs, to the extent that the child’s
physical and/or psychological well-being are damaged or endangered. In child neglect, the
parents or caregivers are simply choosing not to do their job. There are three basic types of
neglect.

Physical Neglect               1. Failure to provide adequate food, clothing, or hygiene
                               2. Reckless disregard for the child’s safety, such as inattention to
                                  hazards in the home, drunk driving with kids in the car, leaving
                                  a baby unattended
                               3. Refusal to provide or delay in providing necessary health care
                                  for the child
                               4. Abandoning children without providing for their care or
                                  expelling children from the home without arranging for their
                                  care

Educational Neglect            1. Failure to enroll a child in school
                               2. Permitting or causing a child to miss too many days of school
                               3. Refusal to follow up on obtaining services for a child’s special
                                  educational needs

Emotional Neglect              1. Inadequate nurturing or affection
                               2. Exposure of the child to spousal abuse
                               3. Permitting a child to drink alcohol or use recreational drugs
                               4. Failure to intervene when the child demonstrates antisocial
                                  behavior
                               5. Refusal of or delay in providing necessary psychological care


Some signs of child neglect:

       Clothes that are dirty, ill-fitting, ragged, and/or not suitable for the weather
       Unwashed appearance; offensive body odor
       Indicators of hunger: asking for or stealing food, going through trash for food, eating too
        fast or too much when food is provided for a group
       Apparent lack of supervision: wandering alone, home alone, left in a car
       Colds, fevers, or rashes left untreated; infected cuts; chronic tiredness
      In schoolchildren, frequent absence or lateness; troublesome, disruptive behavior or its
       opposite, withdrawal
      In babies, failure to thrive; failure to relate to other people or to surroundings

A single occurrence of one of these indicators isn’t necessarily a sign of child neglect, but a
pattern of behaviors may demonstrate a lack of care that constitutes abuse.

Physical child abuse: types and warning signs
Physical child abuse is an adult’s physical act of aggression directed at a child that causes
injury, even if the adult didn’t intend to injure the child. Such acts of aggression include striking
a child with the hand, fist, or foot or with an object; burning the child with a hot object; shaking,
pushing, or throwing a child; pinching or biting the child; pulling a child by the hair; cutting off a
child’s air. Such acts of physical aggression account for between 15 and 20 percent of
documented child abuse cases each year.

Many physically abusive parents and caregivers insist that their actions are simply forms of
discipline, ways to make children learn to behave. But there’s a big difference between giving an
unmanageable child a swat on the backside and twisting the child’s arm until it breaks.
Physically abusive parents have issues of anger, excessive need for control, or immaturity that
make them unable or unwilling to see their level of aggression as inappropriate.

Sometimes the very youngest children, even babies not yet born, suffer physical abuse. Because
many chemicals pass easily from a pregnant woman’s system to that of a fetus, a mother’s use of
drugs or alcohol during pregnancy can cause serious neurological and physiological damage to
the unborn child, such as the effects of fetal alcohol syndrome; mothers can also pass on drugs or
alcohol in breast milk. A woman who drinks or uses drugs when she knows she’s pregnant can
be charged with child abuse in many jurisdictions if her baby is born with problems because of
the substance use.

Another form of child abuse involving babies is shaken baby syndrome, in which a frustrated
caregiver shakes a baby roughly to make the baby stop crying. The baby’s neck muscles can’t
support the baby’s head yet, and the brain bounces around inside its skull, suffering damage that
often leads to severe neurological problems and even death. While the person shaking the baby
may not mean to hurt him, shaking a baby in a way that can cause injury is a form of child abuse.

An odd form of physical child abuse is Munchausen’s syndrome by proxy, in which a parent
causes a child to become ill and rushes the child to the hospital or convinces doctors that the
child is sick. It’s a way for the parent to gain attention and sympathy, and its dangers to the child
constitute child abuse.

Is corporal punishment the same as physical abuse?

Corporal punishment, the use of physical force with the intent of inflicting bodily pain, but not
injury, for the purpose of correction or control, used to be a very common form of discipline:
most of us know it as spanking or paddling. And many of us were spanked as children without
damage to body or psyche.

The widespread use of physical punishment, however, doesn’t make it a good idea. Most child-
care experts have come to agree that corporal punishment sends the message to children that
physical force is an appropriate response to problems or opposition. The level of force used by
an angry or frustrated parent can easily get out of hand and lead to injury. Even if it doesn’t,
what a child learns from being hit as punishment is less about why conduct is right or wrong than
about behaving well — or hiding bad behavior — out of fear of being hit.

Signs of physical child abuse include visible marks of maltreatment, such as cuts, bruises, welts,
or well-defined burns, and reluctance to go home. If you ask a child about how he or she got hurt
and the child talks vaguely or evasively about falling off a fence or spilling a hot dish, think hard
before you accept the child’s story at face value.

Sexual abuse in children: types and warning signs
Sexual abuse, which accounts for about 10 percent of child abuse, is any sexual act between an
adult and a child. Such acts include:

      Behavior involving penetration – vaginal or anal intercourse and oral sex
      Fondling – Touching or kissing a child's genitals, making a child fondle an adult's
       genitals.
      Violations of privacy – Forcing a child to undress, spying on a child in the bathroom or
       bedroom.
      Exposing children to adult sexuality – Performing sexual acts in front of a child,
       exposing genitals, telling "dirty" stories, showing pornography to a child.
      Exploitation – Selling a child’s services as a prostitute or a performer in
       pornography.

The adult who sexually abuses a child or adolescent is usually someone the child knows and is
supposed to trust: a relative, childcare provider, family friend, neighbor, teacher, coach, or clergy
member. More than 80 percent of sex offenders are people the child or adolescent victims know.
It’s important to understand that no matter what the adult says in defense of his or her actions,
the child did not invite the sexual activity and the adult’s behavior is wrong. Sexual abuse is
never the child's fault.

Children are psychologically unable to handle sexual stimulation. Even toddlers, who haven’t
formulated the idea that the sexual abuse is wrong, will develop problems resulting from the
overstimulation. Older children who know and care for their abusers know that the sexual
behavior is wrong, but they may feel trapped by feelings of loyalty and affection. Abusers warn
their victims not to tell, threatening children with violence or ostracism, and the shame
associated with the sexual activity makes the child especially reluctant to tell. When sexual abuse
occurs within the family, children may worry that other family members won’t believe them and
will be angry with them if they tell — as is often the case. The layer of shame that accompanies
sexual abuse makes the behavior doubly traumatizing.
Some signs of sexual child abuse

Often children who have suffered sexual abuse show no physical signs, and the abuse goes
undetected unless a physician spots evidence of forced sexual activity. However, there are
behavioral clues to sexual abuse, including:

      Inappropriate interest in or knowledge of sexual acts
      Seductive behavior
      Reluctance or refusal to undress in front of others
      Extra aggression or, at the other end of the spectrum, extra compliance
      Fear of a particular person or family member

Children who use the Internet are also vulnerable to come-ons by adults online. Among the
warning signs of online sexual child abuse are these:

      Your child spends large amounts of time online, especially at night.
      You find pornography on your child's computer.
      Your child receives phone calls from people you don't know, or makes calls, sometimes
       long distance, to numbers you don't recognize.
      Your child receives mail, gifts, or packages from someone you don't know.
      Your child turns the computer monitor off or quickly changes the screen on the monitor
       when you come into the room.
      Your child becomes withdrawn from the family.
      Your child is using an online account belonging to someone else.

Emotional child abuse: types and warning signs
Emotional child abuse involves behavior that interferes with a child’s mental health or social
development: one website calls it ―the systematic tearing down of another human being.‖ Such
abuse can range from verbal insults to acts of terror, and it’s almost always a factor in the other
three categories of abuse. While emotional abuse by itself doesn’t involve the infliction of
physical pain or inappropriate physical contact, it can have more long-lasting negative
psychological effects than either physical abuse or sexual abuse.

Examples of emotional child abuse include:

Verbal abuse                        Belittling or shaming the child: name-calling, making
                                     negative comparisons to others, telling the child he or she is
                                     ―no good," "worthless," "a mistake."
                                    Habitual blaming: telling the child that everything is his or
                                     her fault.

Withholding affection               Ignoring or disregarding the child
                                    Lack of affection and warmth: Failure to hug, praise, express
                                     love for the child
Extreme punishment          These are actions that are meant to isolate and terrorize a child, such
                            as tying the child to a fixture or piece of furniture or locking a child
                            in a closet or dark room.
Corruption                  This involves causing a child to witness or participate in
                            inappropriate behavior, such as criminal activities, drug or alcohol
                            abuse, or acts of violence.

Emotional abuse can come not only from adults but from other children: siblings, neighborhood
or schoolyard bullies, peers in schools that permit a culture of social ostracism (the ―mean girl‖
syndrome). The signs of emotional child abuse include apathy, depression, and hostility. If it
happens at school, the child may be reluctant to go to school and develop or fake a physical
complaint.

Causes of child abuse
Why would someone abuse a defenseless child? What kind of person abuses a child? Not all
child abuse is deliberate or intended. Several factors in a person's life may combine to cause
them to abuse a child:

      Stress, including the stress of caring for children, or the stress of caring for a child with a
       disability, special needs, or difficult behaviors
      Lack of nurturing qualities necessary for child care
      Immaturity: a disproportionate number of parents who abuse their children are teenagers
      Difficulty controlling anger
      Personal history of being abused
      Isolation from the family or community
      Physical or mental health problems, such as depression and anxiety
      Alcohol or drug abuse
      Personal problems such as marital conflict, unemployment, or financial difficulties.

No one has been able to predict which of these factors will cause someone to abuse a child. A
significant factor is that abuse tends to be intergenerational – those who were abused as
children are more likely to repeat the act when they become parents or caretakers.

In addition, many forms of child abuse arise from ignorance. Sometimes a cultural tradition leads
to abuse. Such beliefs include:

      Children are property.
      Parents (especially fathers) have the right to control their children in any way they wish.
      Children need to be toughened up to face the hardships of life.
      Girls need to be genitally mutilated to assure virginity and later marriage.

Effects of child abuse
Child abuse can produce dire consequences during the victim’s childhood and adulthood. Some
effects of child abuse are obvious: a child is malnourished or has a cast on her arm; a nine-year-
old develops a sexually transmitted disease. But some physiological effects of child abuse, such
as cognitive difficulties or lingering health problems, may not show up for some time or be
clearly attributable to abuse. Other effects of child abuse are invisible or go off like time bombs
later in life.

Emotional Effects of Child Abuse

Just as all types of child abuse have an emotional component, all affect the emotions of the
victims. These effects include

      Low self-esteem                                       Alienation and withdrawal
      Depression and anxiety                                Personality disorders
      Aggressive behavior/anger issues                      Clinginess, neediness
      Relationship difficulties                             Flashbacks and nightmares


Many adults who were abused as children find it difficult to trust other people, endure physical
closeness, and establish intimate relationships.

Behavioral Effects of Child Abuse

Child abuse can play itself out not only in how its victims feel but in what they do years later.
Children who suffer abuse have much greater chances of being arrested later as juveniles and as
adults. Significant percentages of inmates in U.S. prisons were abused as children. One of every
three abused or neglected children will grow up to become an abusive parent.

Other behavioral effects include

      Problems in school and work                      Criminal or antisocial behavior
      Prostitution                                     Alcohol and drug abuse
      Teen pregnancy                                   Eating disorders
      Suicide attempts                                 Spousal abuse


Getting help for an abused child
Although many people are reluctant to get involved in other families’ lives, when it comes to
child abuse, you don’t have the option of keeping mum. If you know of a child being abused or
even suspect abuse, you have the responsibility to report it. In the United States, Canada, and
Australia, the concept of mandatory reporting of suspected child abuse is well established and
is beginning to catch on in other countries around the world. Laws on mandatory reporters
designate classes of professionals — typically school personnel, social workers, health care
workers, mental health professionals, childcare providers, and law enforcement personnel, but in
some states also clergy, film processors, and drug abuse counselors — who must report
suspected child abuse. Eighteen states and Puerto Rico require all citizens to report
suspected abuse or neglect.

By reporting, you can make a tremendous difference in the life of a child and the child’s family,
especially if you help stop the abuse early. Early identification and treatment can help mitigate
the long-term effects of abuse. If the abuse is stopped and the child receives competent
treatment, the abused child can begin to regain a sense of self-confidence and trust. Parents may
also benefit from support, parent training and anger management.

The best first place to call to report suspected child abuse is:

The Childhelp National Child Abuse Hotline: 1-800-4-A-CHILD (1-800-422-4453)

Staffers at the hotline can help:

      Victims: children and teens who have been abused
      Survivors of child abuse
      Abusers: people who have abused a child or who are afraid that they may abuse a child
      Witnesses to child abuse

Childhelp cannot make a report of child abuse for you, but it can set up a three-way call with
your local enforcement agency. You can also call your local enforcement agency directly to
report child abuse. Childhelp has a list of local phone numbers you can call for your county or
state in the U.S.

Reporting is anonymous. In most states, you do not have to give your name when you report
child abuse. The child abuser cannot find out who made the report of child abuse.

Other places to call include:

Help That You Need                             Phone Numbers
Emergency intervention                         911
Agencies to call to report suspected child Child Abuse Reporting Numbers
abuse. Organized by state within the U.S.
Telephone hotlines, particularly for sexual Toll-Free Crisis Hotline Numbers
child abuse, for missing or abducted children,
for rape and incest, and for runaway and
homeless children and their families
Helpline for teens who are having              Youth and Teens or 1-800-RUNAWAY
problems at home
Identification of paroled sex offenders        National Sex Offender Public Registry

                                              and

                                              Federal Bureau of Investigation’s
                                              Investigative Programs: Crimes Against
                                               Children (individual state databases)

Remember, too, that if your own child tells you that he or she has been abused, no matter how
horrifying or incredible the report sounds, you must listen to your child and be a source of
comfort — and action.

Preventing or stopping child abuse
Reducing the incidence of child abuse is a matter of education and intervention — and you can
help with both.

Education

In terms of education, you can support organizations and programs that work with the public to
encourage and teach good parenting skills and provide help for parents at risk of abusing their
children. Such programs include

      hotlines
      parent education programs
      emergency shelters
      in-home services
      family resource centers
      parent support groups
      mental health services

You can also teach your children how to deal with bullies and how to identify, fend off, and
report attempts at sexual abuse. And you can learn how to monitor your children’s Internet use
for signs of potential sexual abuse.

Intervention

In addition to reporting suspected child abuse when you learn about it, you can intervene
effectively if you encounter a parent or caregiver abusing or about to abuse a child by striking
the child or screaming at the child: it’s a matter of offering on-the-spot help rather than scolding
or threatening to call authorities. If you yourself are overwhelmed by childcare responsibilities,
frustrated by a baby who won’t stop crying, or in danger of harming your children, you can reach
out for help. Pick up the phone and call someone who can help, even if it’s someone — like the
voice at the end of a hotline — you don’t know.

All the topics mentioned in this section are addressed in websites listed below. Use the links to
find out more about child abuse and how you can help prevent it from happening.
Shaken baby/shaken impact syndrome (SBS) is a form of inflicted head trauma. Head injury, as a
form of child abuse, can be caused by direct blows to the head, dropping or throwing the child, or
shaking the child. Head trauma is the leading cause of death in child abuse cases in the United States.


How Does SBS Happen?

Unlike other forms of inflicted head trauma, SBS results from injuries caused by someone vigorously
shaking an infant. Because of the anatomy of infants, they're at particular risk for injury from this kind
of action. Therefore, the vast majority of incidents occur in infants who are younger than 1 year old.
The average age of victims is between 3 and 8 months, although SBS is occasionally seen in children
up to 4 years old.


The perpetrators in SBS cases are almost always parents or caregivers, who shake the baby out of
frustration or stress when the little one is crying inconsolably. Sadly, the shaking has the desired
effect: although at first the baby cries more out of fear, it eventually stops crying as the brain is
damaged.


Approximately 60% of shaken babies are male, and children of families who live at or below the
poverty level are at an increased risk for SBS as well as any type of child abuse. And it's estimated
that the perpetrators in 65% to 90% of cases are males — usually either the baby's father or the
mother's boyfriend, often someone in his early 20s.


When someone forcefully shakes a baby, the child's head rotates about uncontrollably because infants'
neck muscles aren't well developed and provide little support for their heads. The violent movement
pitches the infant's brain back and forth within the skull, rupturing blood vessels and nerves
throughout the brain and tearing the brain tissue. The brain strikes the inside of the skull, causing
bruising and bleeding to the brain.
The damage is even greater when the shaking ends with an impact (hitting a wall or a crib mattress,
for example), because the forces of acceleration and deceleration associated with an impact are so
strong. After the shaking, swelling in the brain can cause enormous pressure within the skull,
compressing blood vessels and increasing overall injury to its delicate structure.


Normal interaction with a child, like bouncing the baby on a knee, will not cause SBS, although it's
important to never shake a baby under any circumstances because gentle shaking can rapidly
escalate.


What Are the Effects?

SBS often causes irreversible damage. In the worst cases, the death rate is almost half of all babies
involved.


Children who survive may have:


       partial or total blindness
       hearing loss
       seizures
       developmental delays
       impaired intellect
       speech and learning difficulties
       problems with memory and attention
       severe mental retardation
       paralysis (some particularly traumatic episodes leave children in a coma)


Even in milder cases, in which babies looks normal immediately after the shaking, they may
eventually develop one or more of these problems. Sometimes the first sign of a problem isn't noticed
until the child enters the school system and exhibits behavioral problems or learning difficulties. But
by that time, it's more difficult to link these problems to a shaking incident from several years before.


Signs and Symptoms

In any SBS case, the duration and force of the shaking, the number of episodes, and whether impact
is involved all affect the severity of the infant's injuries. In the most violent cases, children may arrive
at the emergency room unconscious, suffering seizures, or in shock. But, in many cases, infants may
never be brought to medical attention if they don't exhibit such severe symptoms.
In less severe cases, a baby who has been shaken may experience:


       lethargy
       irritability
       vomiting
       poor sucking or swallowing
       decreased appetite
       lack of smiling or vocalizing
       rigidity
       seizures
       difficulty breathing
       altered consciousness
       unequal pupil size
       an inability to lift the head
       an inability to focus the eyes or track movement

How Is It Diagnosed?

Many cases of SBS are brought in for medical care as "silent injuries." In other words, parents or
caregivers don't often provide a history that the child has had abusive head trauma or a shaking
injury, so doctors don't know to look for subtle or physical signs. This "silent epidemic" can result in
children having injuries that aren't identified in the medical system.


And again, in many cases, babies who don't have severe symptoms may never be brought to a doctor.


Unfortunately, unless a doctor has reason to suspect SBS, mild cases (in which the infant seems
lethargic, fussy, or perhaps isn't feeding well) are often misdiagnosed as a viral illness or colic.
Without a diagnosis of shaken baby syndrome and any resulting intervention with the parents or
caregivers, these children may be shaken again, worsening any brain injury or damage.


If shaken baby syndrome is suspected, doctors may look for:


       hemorrhages in the retinas of the eyes (which are extremely rare in any accidental injuries,
        such as falls)
       skull fractures
       swelling of the brain
       subdural hematomas (blood collections pressing on the surface of the brain)
       rib and long bone (bones in the arms and legs) fractures
        bruises around the head, neck, or chest

The Child's Development and Education

What makes SBS so devastating is that it usually involves a total brain injury. Because the infant's
immature brain has little stored information and few developed capacities to make up for the deficit,
the brain's adaptive abilities are substantially impaired. For example, a child whose vision is severely
impaired won't be able to learn through observation, which decreases the child's overall ability to
learn.


The development of language, vision, balance, and motor coordination, all of which occur to varying
degrees after birth, are particularly likely to be affected in any child who has SBS.


Such impairment can require rigorous physical and occupational therapy to help the child acquire skills
that would have developed on their own had the brain injury not occurred. Therapists do this by
providing a sensory-rich environment, which forces the child to be attentive.


Therapists often work one on one with a child, concentrating on building the child's ability to pay
attention. They use sound and other stimuli to increase the child's interest in objects, such as
repeatedly squeaking a toy near the child's ear. As they get older, kids who were shaken as babies
may require special education and continued therapy to help with language development and daily
living skills, such as dressing themselves.


Before age 3, a child can receive speech or physical therapy through the Department of Public Health.
Federal law requires that each state provide these services for children who have developmental
disabilities as a result of being shaken as babies.


Some schools are also increasingly providing information and developmental assessments for children
under the age of 3. Parents can turn to a variety of rehabilitation and other therapists for early
intervention services for children after abusive head trauma. Developmental assessments can assist in
improving education outcomes as well as the overall well being of the child.


After a child who's been diagnosed with SBS turns 3, it's your school district's responsibility to provide
additional special educational services.


Preventing SBS

It is 100% preventable.
A key aspect of prevention of the syndrome is increasing awareness of the potential dangers of
shaking. Some hospital-based programs have helped new parents identify and prevent shaking
injuries and understand how to respond when infants cry.


Finding ways to alleviate the parent or caregiver's stress at the critical moments when a baby is crying
can significantly reduce the risk to the child. One method that may help is author Dr. Harvey Karp's
"five S's":


       Shushing (using "white noise," or rhythmic sounds that mimic the constant whir of noise in the
        womb, with things like vacuum cleaners, hair dryers, clothes dryers, a running tub, or a white
        noise CD)


       Side/stomach positioning (placing the baby on the left side — to help digestion — or on the
        belly while holding him or her, then putting the sleeping baby in the crib or bassinet on his
        or her back)


       Sucking (letting the baby breastfeed or bottle-feed, or giving the baby a pacifier or finger to
        suck on)


       Swaddling (wrapping the baby up snugly in a blanket to help him or her feel more secure)


       Swinging gently (rocking in a chair, using an infant swing, or taking a car ride to help
        duplicate the constant motion the baby felt in the womb)


If a baby in your care won't stop crying, you an also try the following:


       Make sure the baby's basic needs are met (for example, he or she isn't hungry and doesn't
        need to be changed).


       Check for signs of illness, like fever or swollen gums.


       Rock or walk with the baby.


       Sing or talk to the baby.


       Offer the baby a pacifier or a noisy toy.
        Take the baby for a ride in a stroller or strapped into a child safety seat in the car.


        Hold the baby close against your body and breathe calmly and slowly.


        Call a friend or relative for support or to take care of the baby while you take a break.


        If nothing else works, put the baby on his or her back in the crib, close the door, and check on
         the baby in 10 minutes.


        Call your child's doctor if nothing seems to be helping your infant, in case there is a medical
         reason for the fussiness.


To prevent potential SBS, parents and caregivers of infants need help with responding to their own stress. It's important
to talk to anyone caring for your baby about the dangers of shaking and how it can be prevented.   Physical and
Behavioral Indicators of Abuse
    Type of
                                  Physical Indicators                                Behavioral Indicators
    Abuse

                                                                                     Self destructive
                                                                                     Withdrawn and/or
                                                                                      aggressive - behavioral
                            Unexplained bruises (in various                          extremes
                             stages of healing)                                      Arrives at school early
                            Unexplained burns, especially                            or stays late as if afraid
                             cigarette burns or immersion                             to be at home
                             burns                                                   Chronic runaway
    Physical                Unexplained fractures,                                   (adolescents)
     Abuse                   lacerations or abrasions                                Complains of soreness
                            Swollen areas                                            or moves uncomfortably
                            Evidence of delayed or                                  Wears clothing
                             inappropriate treatment for                              inappropriate to
                             injuries                                                 weather, to cover body
                                                                                     Bizarre explanation of
                                                                                      injuries
                                                                                     Wary of adult contact


                            Abandonment                                             Regularly displays
    Physical                Unattended medical needs                                 fatigue or listlessness,
    Neglect                 Consistent lack of supervision                           falls asleep in class
                            Consistent hunger,                                      Steals food, begs from
                  inappropriate dress, poor                 classmates
                  hygiene                                  Reports that no
                 Lice, distended stomach,                  caretaker is at home
                  emaciated                                Frequently absent or
                 Inadequate nutrition                      tardy
                                                           Self destructive
                                                           School dropout
                                                            (adolescents)
                                                           Extreme loneliness and
                                                            need for affection


             Sexual abuse may be non-touching:
              obscene language, pornography,
                                                           Excessive
              exposure - or touching: fondling,
                                                            seductiveness
               molesting, oral sex, intercourse
                                                           Role reversal, overly
                                                            concerned for siblings
                 Torn, stained or bloody
                                                           Massive weight change
                  underclothing
                                                           Suicide attempts
   Sexual        Pain, swelling or itching in
                                                            (especially adolescents)
   Abuse          genital area
                                                           Inappropriate sex play
                 Difficulty walking or sitting
                                                            or premature
                 Bruises or bleeding in genital
                                                            understanding of sex
                  area
                                                           Threatened by physical
                 Venereal disease
                                                            contact, closeness
                 Frequent urinary or yeast
                  infections


                                                           Habit disorder (sucking,
               Emotional abuse may be name-
                                                            rocking, biting)
             calling, insults, put-downs, etc., or it
                                                           Antisocial, destructive
                may be terrorization, isolation,
                                                           Neurotic traits (sleep
              humiliation, rejection, corruption,
                                                            disorders, inhibition of
                             ignoring
                                                            play)
 Emotional
                                                           Passive and aggressive
  Abuse          Speech disorders
                                                            - behavioral extremes
                 Delayed physical development
                                                           Delinquent behavior
                 Substance abuse
                                                            (especially adolescents)
                 Ulcers, asthma, severe
                                                           Developmentally
                  allergies
                                                            delayed



Remember:
DISCIPLINE helps a child learn a lesson that will carry over and positively affect future behavior. ABUSE
affects the future in a negative way, leading to anger, hatred and more deviant behavior.
DISCIPLINE enhances the child's sense of self worth, helping the child learn self-control and thus
becoming comfortable within the family and in society. ABUSE robs the child of self worth and causes
him/her to feel outcast and resentful.
DISCIPLINE is not shame or guilt. ABUSE is shame or guilt which satisfies the needs of the parents at
the moment and destroys the self image of the child in a hostile manner.
DISCIPLINE is taught by example. But so is abuse!




Factors Affecting the Consequences of Child Abuse

Not all abused and neglected children will experience long-term consequences. Outcomes of
individual cases vary widely and are affected by a combination of factors, including:

        The child's age and developmental status when the abuse or neglect occurred

        The type of abuse (physical abuse, neglect, sexual abuse, etc.)

        Frequency, duration, and severity of abuse

        The relationship between the victim and his or her abuser (Chalk, Gibbons, &
        Scarupa, 2002).

Researchers also have begun to explore why, given similar conditions, some children
experience long-term consequences of abuse and neglect while others emerge relatively
unscathed. The ability to cope, and even thrive, following a negative experience is
sometimes referred to as "resilience." A number of protective factors may contribute to an
abused or neglected child's resilience. These include individual characteristics, such as
optimism, self-esteem, intelligence, creativity, humor, and independence. Protective factors
can also include the family or social environment, such as a child's access to social support;
in particular, a caring adult in the child's life can be an important protective factor.
Community well-being, including neighborhood stability and access to health care, is also a
protective factor (Thomlison, 1997).

Physical Health Consequences

The immediate physical effects of abuse or neglect can be relatively minor (bruises or cuts)
or severe (broken bones, hemorrhage, or even death). In some cases the physical effects
are temporary; however, the pain and suffering they cause a child should not be
discounted. Meanwhile, the long-term impact of child abuse and neglect on physical health
is just beginning to be explored. Below are some outcomes researchers have identified:
Shaken baby syndrome. The immediate effects of shaking a baby, which is a common
form of child abuse in infants, can include vomiting, concussion, respiratory distress,
seizures, and death. Long-term consequences can include blindness, learning disabilities,
mental retardation, cerebral palsy, or paralysis (Conway, 1998).

Impaired brain development. Child abuse and neglect have been shown, in some cases,
to cause important regions of the brain to fail to form properly, resulting in impaired
physical, mental, and emotional development (Perry, 2002; Shore, 1997). In other cases,
the stress of chronic abuse causes a "hyperarousal" response by certain areas of the brain,
which may result in hyperactivity, sleep disturbances, and anxiety, as well as increased
vulnerability to post-traumatic stress disorder, attention deficit/hyperactivity disorder,
conduct disorder, and learning and memory difficulties (Dallam, 2001; Perry, 2001).

Poor physical health. A study of 700 children who had been in foster care for 1 year found
that more than one-quarter of the children had some kind of recurring physical or mental
health problem (U.S. Department of Health and Human Services, 2003). A study of 9,500
HMO participants showed a relationship between various forms of household dysfunction
(including childhood abuse) and long-term health problems such as sexually transmitted
diseases, heart disease, cancer, chronic lung disease, skeletal fractures, and liver disease
(Felitti et al., 1998; Hillis, Anda, Felitti, Nordenberg, & Marchbanks, 2000).

Psychological Consequences

The immediate emotional effects of abuse and neglect—isolation, fear, and an inability to
trust—can translate into lifelong consequences, including low self-esteem, depression, and
relationship difficulties. Researchers have identified links between child abuse and neglect
and the following:

Poor mental and emotional health. In one long-term study, as many as 80 percent of
young adults who had been abused met the diagnostic criteria for at least one psychiatric
disorder at age 21. These young adults exhibited many problems, including depression,
anxiety, eating disorders, and suicide attempts (Silverman, Reinherz, & Giaconia, 1996).
Other psychological and emotional conditions associated with abuse and neglect include
panic disorder, dissociative disorders, attention-deficit/hyperactivity disorder, posttraumatic
stress disorder, and reactive attachment disorder (Teicher, 2000).

Cognitive difficulties. The National Survey of Child and Adolescent Well-Being found that
children placed in out-of-home care due to abuse or neglect tended to score lower than the
general population on measures of cognitive capacity, language development, and academic
achievement (U.S. Department of Health and Human Services, 2003).

Social difficulties. Children who are abused and neglected by caretakers often do not form
secure attachments to them. These early attachment difficulties can lead to later difficulties
in relationships with other adults as well as with peers (Morrison, Frank, Holland, & Kates,
1999).

Behavioral Consequences

Not all victims of child abuse and neglect will experience behavioral consequences;
however, child abuse and neglect appear to make the following more likely:
Difficulties during adolescence. Studies have found abused and neglected children to be
at least 25 percent more likely to experience problems such as delinquency, teen
pregnancy, low academic achievement, drug use, and mental health problems (Kelley,
Thornberry, & Smith, 1997).

Juvenile delinquency and adult criminality. A National Institute of Justice study
indicated being abused or neglected as a child increased the likelihood of arrest as a
juvenile by 59 percent. Abuse and neglect increased the likelihood of adult criminal behavior
by 28 percent and violent crime by 30 percent (Widom & Maxfield, 2001).

Alcohol and other drug abuse. Research consistently reflects an increased likelihood that
abused and neglected children will smoke cigarettes, abuse alcohol, or take illicit drugs.
According to a report from the National Institute on Drug Abuse, as many as two-thirds of
people in drug treatment programs reported being abused as children (Swan, 1998).

Abusive behavior. Abusive parents often have experienced abuse during their own
childhoods. It is estimated approximately one-third of abused and neglected children will
eventually victimize their own children (Prevent Child Abuse New York, 2003).

Societal Consequences

While child abuse and neglect almost always occur within the family, the impact does not
end there. Society as a whole pays a price for child abuse and neglect, in terms of both
direct and indirect costs.

Direct costs. Direct costs include those associated with maintaining a child welfare system
to investigate allegations of child abuse and neglect, as well as expenditures by the judicial,
law enforcement, health, and mental health systems to respond to and treat abused
children and their families. A 2001 report by Prevent Child Abuse America estimates these
costs at $24 billion per year.

Indirect costs. Indirect costs represent the long-term economic consequences of child
abuse and neglect. These include juvenile and adult criminal activity, mental illness,
substance abuse, and domestic violence. They can also include loss of productivity due to
unemployment and underemployment, the cost of special education services, and increased
use of the health care system. Prevent Child Abuse America recently estimated these costs
at more than $69 billion per year (2001).

Summary

Much research has been done about the possible consequences of child abuse and neglect.
The effects vary depending on the circumstances of the abuse or neglect, personal
characteristics of the child, and the child's environment. Consequences may be mild or
severe; disappear after a short period or last a lifetime; and affect the child physically,
psychologically, behaviorally, or in some combination of all three ways. Ultimately, due to
related costs to public entities such as the health care, human services, and educational
systems, abuse and neglect impact not just the child and family, but society as a whole.

				
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