Child abuse

Child abuse is the physical or psychological/emotional mistreatment of children. In the United

States, the Centers for Disease Control and Prevention (CDC) define child maltreatment as any
act or series of acts of commission or omission by a parent or other caregiver that results in
harm, potential for harm, or threat of harm to a child.Most child abuse occurs in a child's home,
with a smaller amount occurring in the organizations, schools or communities the child interacts
with. There are four major categories of child abuse: neglect, physical abuse,
psychological/emotional abuse, and sexual abuse.

Different jurisdictions have developed their own definitions of what constitutes child abuse for
the purposes of removing a child from his/her family and/or prosecuting a criminal charge. The
mental health journal[clarification needed] states that child abuse is defined 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, an act or failure to act which presents an imminent risk of
serious harm".

Types

Child abuse can take several forms:The four main types of abuse are physical, sexual,
psychological, and neglect.

Neglect

Neglect is the instance in which the responsible adult fails to adequately provide for various
needs, including physical (failure to provide adequate food, clothing, or hygiene), emotional
(failure to provide nurturing or affection) or educational (failure to enroll a child in school).

Physical abuse

Physical abuse is physical aggression directed at a child by an adult. It can involve striking,
burning, choking or shaking a child. The transmission of toxins to a child through its mother
(such as with fetal alcohol syndrome) can also be considered physical abuse in some
jurisdictions.

The distinction between child discipline and abuse is often poorly defined. Cultural norms about
what constitutes abuse vary widely: among professionals as well as the wider public, people do
not agree on what behaviors constitute abuse.

Some human service professionals claim that cultural norms that sanction physical punishment
are one of the causes of child abuse, and have undertaken campaigns to redefine such norms.

In the United States, the National Association of Social Workers has issued statements that even
the mildest forms of physical punishment, such as moderate spanking, can lower children's self-
esteem, constitute acts of violence, and teach children that physical force is an acceptable way to
resolve conflicts. Against this latter argument, the philosopher Prof. David Benatar points out
that one might as well say that fining people teaches that forcing others to give up some of their
property is an acceptable way to respond to those who act in a way that one does not like. "If
beatings send a message, why don't detentions, imprisonments, fines, and a multitude of other
punishments convey equally undesirable messages?" He adds that "there is all the difference in
the world between legitimate authorities – the judiciary, parents, or teachers – using punitive
powers responsibly to punish wrongdoing, and children or private citizens going around beating
each other, locking each other up, and extracting financial tributes (such as lunch money). There
is a vast moral difference here and there is no reason why children should not learn about it.
Punishing children when they do wrong seems to be one important way of doing this."

In the United Kingdom, sociology professor Frank Furedi suggests that many advocates of a total
ban on physical punishment are actually against all forms of punishing children. He sees the
underlying agenda as an anti-parent crusade, and argues that the much-cited Murray Straus
research is far less clear-cut than the claims made on its behalf by what he calls "anti-smacking
zealots".

The use of any kind of force against children as a disciplinary measure is illegal in 24 countries
around the world.See corporal punishment in the home for more information.

Child sexual abuse

Child sexual abuse is a form of child abuse in which an adult or older adolescent abuses a child
for sexual stimulation. Forms of CSA include asking or pressuring a child to engage in sexual
activities (regardless of the outcome), indecent exposure of the genitals to a child, displaying
pornography to a child, actual sexual contact against a child, physical contact with the child's
genitals, viewing of the child's genitalia without physical contact, or using a child to produce
child pornography.

The effects of child sexual abuse include depression, post-traumatic stress

disorder,anxiety,ropensity to re-victimization in adulthood, and physical injury to the child,
among other problems.[ Sexual abuse by a family member is a form of incest, and can result in
more serious and long-term psychological trauma, especially in the case of parental incest.

Approximately 15% to 25% of women and 5% to 15% of men were sexually abused when they
were children. Most sexual abuse offenders are acquainted with their victims; approximately
30% are relatives of the child, most often brothers, fathers, uncles or cousins; around 60% are
other acquaintances such as friends of the family, babysitters, or neighbors; strangers are the
offenders in approximately 10% of child sexual abuse cases.

Psychological/Emotional Abuse

Out of all the different forms of abuse, emotional abuse is the hardest to identify. This form of
abuse includes name-calling, ridicule, degradation, destruction of personal belongings, torture or
destruction of a pet, excessive criticism, inappropriate or excessive demands, witholding
communication, and routine labeling or humiliation.
Some ways that victims of emotional abuse may react is by distancing themselves from the
abuser, internalizing the abusive words, and to fight back by insulting the abuser. Emotional
abuse can result in abnormal or disrupted attachment disorder, a tendency for the victim to blame
themselves for the abuse, learned helplessness, and overly passive behavior.

Prevalence

According to the (American) National Committee to Prevent Child Abuse, in 1997 neglect
represented 54% of confirmed cases of child abuse, physical abuse 22%, sexual abuse 8%,
emotional maltreatment 4%, and other forms of maltreatment 12%.

A UNICEF report on child well-being stated that the United States and the United Kingdom
ranked lowest among industrial nations with respect to the wellbeing of children. This study also
found that child neglect and child abuse are far more common in single-parent families than in
families where both parents are present.

In the USA, neglect is defined as the failure to meet the basic needs of children including
housing, clothing, food and access to medical care. Researchers found over 91,000 cases of
neglect over the course of one year (from October 2005 to 30 September 2006) with their
information coming from a database of cases verified by protective services agencies.

Neglect could also take the form of "financial abuse" by not buying the child adequate materials
for survival.

The U.S. Department of Health and Human Services reports that for each year between 2000 and
2005, "female parents acting alone" were most likely to be perpetrators of child abuse.

Causes

Child abuse is a complex problem which has multiple causes. Understanding the causes of abuse
is crucial to addressing the problem of child abuse. Parents who physically abuse their spouses
are more likely to physically abuse their children. However, it is difficult to know whether
marital strife is a cause of child abuse, or if both the marital strife and abuse are caused by
tendencies in the abuser.

Substance abuse is a major contributing factor to child abuse. One study found that parents with
documented substance abuse, most commonly alcohol, cocaine, and heroin, were much more
likely to mistreat their children, and were also much more likely to reject court-ordered services
and treatments.

Another study found that over two thirds of cases of child maltreatment involved parents with
substance abuse problems. This study specifically found relationships between alcohol and
physical abuse, and between cocaine and sexual abuse.
In 2009 CBS News reported that child abuse in the United States had increased during the
economic recession. It gave the example of a father who had never been the primary care-taker
of the children. Now that the father was in that role, the children began to come in with injuries.

Effects

Children with a history of neglect or physical abuse are at risk of developing psychiatric
problems, or a disorganized attachment style. Disorganized attachment is associated with a
number of developmental problems, including dissociative symptoms as well as anxiety,
depressive, and acting-out symptoms. A study by Dante Cicchetti found that 80% of abused and
maltreated infants exhibited symptoms of disorganized attachment

Victims of childhood abuse, it is claimed, also suffer from different types of physical health
problems later in life. Some reportedly suffer from some type of chronic head, abdominal, pelvic,
or muscular pain with no identifiable reason. Even though the majority of childhood abuse
victims know or believe that their abuse is, or can be, the cause of different health problems in
their adult life, for the great majority their abuse was not directly associated with those problems,
indicating that sufferers were most likely diagnosed with other possible causes for their health
problems, instead of their childhood abuse.

The effects of child abuse vary, depending on its type. A 2006 study found that childhood
emotional and sexual abuse were strongly related to adult depressive symptoms, while exposure
to verbal abuse and witnessing of domestic violence had a moderately strong association, and
physical abuse a moderate one. For depression, experiencing more than two kinds of abuse
exerted synergetically stronger symptoms. Sexual abuse was particularly deleterious in its
intrafamilial form, for symptoms of depression, anxiety, dissociation, and limbic irritability.
Childhood verbal abuse had a stronger association with anger-hostility than any other type of
abuse studied, and was second only to emotional abuse in its relationship with dissociative
symptoms. More generally, in the case of 23 of the 27 illnesses listed in the questionnaire of a
French INSEE survey, some statistically significant correlations were found between repeated
illness and family traumas encountered by the child before the age of 18 years. These
relationships show that inequality in terms of illness and suffering is not only social. It has also
its origins in the family, where it is associated with the degrees of lasting affective problems
(lack of affection, parental discord, the prolonged absence of a parent, or a serious illness
affecting either the mother or father) that individuals report having experienced in childhood.

New research illustrates that there are strong associations between exposure to child abuse in all
its forms and higher rates of many chronic conditions. The strongest evidence comes from the
Adverse Childhood Experiences (ACE's) series of studies which show correlations between
exposure to abuse or neglect and higher rates in adulthood of chronic conditions, high risk health
behaviors and shortened live span. A recent publication entitled Hidden Costs in Health Care:
The Economic Impact of Violence and Abuse makes the case that such exposure represents a
serious and costly public health issue that should be addressed by the health care system.
Consequences of physical abuse

Children who are physically abused are likely to receive bone fractures, particularly rib fractures,
and may have a higher risk of developing cancer.

Prevention

April has been designated as Child Abuse Prevention Month in the United States since 1983.
U.S. President Barack Obama continued that tradition by declaring April 2009 as Child Abuse
Prevention Month. One way the Federal government of the United States provides funding for
child abuse prevention is through Community-Based Grants for the Prevention of Child Abuse
and Neglect (CBCAP).

Resources for child protection services are sometimes limited. According to Hosin (2007), "a
considerable number of traumatized abused children do not gain access to protective child
protection strategies."Briere (1992) argues that only when "lower-level violence" of children
ceases to be culturally tolerated will there be changes in the victimization and police protection
of children.

Treatment

A number of treatments are available to victims of child abuse. Trauma-focused cognitive

behavioral therapy, while developed to treat sexually abused children, is now used for victims of
any kind of trauma. It targets trauma-related symptoms in children including posttraumatic stress
disorder (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 only non-sexual abuse was not available as of 2006.

Abuse-focused cognitive behavioral therapy was designed for children who have experienced
physical abuse. It targets externalizing behaviors and strengthens prosocial behaviors. Offending
parents are included in treatment, to improve parenting skills/practices. It is supported by one
randomized study.

Child-parent psychotherapy 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.

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've
experienced. Play therapy and art therapy are ways to get children more comfortable with
therapy by working on something that they enjoy (like 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.
Ethics

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. 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 aparent interests of his child. 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.

Organizations

There are organizations at the national, state, and county levels in the United States that provide
community leadership in preventing child abuse and neglect. The National Alliance of Children's
Trust Funds and Prevent Child Abuse America are two national organizations with member
organizations at the state level.

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. Mandated reporter training is a program used to prevent ongoing child
abuse.