Child Abuse (cont.)

Medical Author:

John Mersch, MD, FAAP

John Mersch, MD, FAAP

Dr. Mersch received his Bachelor of Arts degree from the University of California, San Diego, and prior to entering the University Of Southern California School Of Medicine, was a graduate student (attaining PhD candidate status) in Experimental Pathology at USC. He attended internship and residency at Children's Hospital Los Angeles.

View Full Profile

Medical Editor:

William C. Shiel Jr., MD, FACP, FACR

William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

View Full Profile

In this Article

• What is the scope of the child abuse problem?
• What age child is abused?
• Are girls more often abused than boys?
• Is the pattern of abuse different for girls and boys?
• What is known about the perpetrators of child abuse?
• Is there an association between poverty and child abuse?
• Who abuses children?
• What is child abuse?
• What does the term child neglect include?
• What actions are viewed as physical child abuse?
• What constitutes emotional child abuse?
• What is sexual child abuse?
• What causes child abuse deaths?
• What factors predispose a person to child abuse?
• How is alleged child abuse evaluated?
• How is child abuse treated?
• How can child abuse be prevented?
• What more can be done to prevent child neglect?
• Are people who were abused as children more likely to become criminals later in life?
• Child Abuse At A Glance
• Patient Comments: Child Abuse - Experience
• Child Abuse Index

Physical abuse is the second most frequently reported form of child abuse (16% of all cases).

This form of mistreatment is defined as willful (as opposed to accidental) physical injury inflicted upon the child. Physical abuse can be the result of punching, beating, kicking, biting, burning, shaking, or otherwise harming the child's body. The parent or caretaker may not have intended to hurt the child; rather, the injury may have resulted from excessive disciplinary efforts or physical punishment.

There exists a significant controversy regarding physical methods of discipline (for example, spanking) and their relationship to more orthodox forms of physical abuse. A unique form of physical child abuse is Munchausen syndrome by proxy. In this situation, a parent will purposely either invent symptoms and falsify records (for example, fever) resulting in unnecessary tests, hospitalizations, and even surgical procedures. This psychiatric illness of the parent(s) requires a high index of suspicion, and its consideration is part of the investigation of any child with recurrent complaints that are not supported by physical or laboratory findings.

Isolated emotional abuse is the least frequently reported form of child abuse (7% of all cases). This form is felt to be markedly underreported since it can be difficult to detect and document.

However, since it is a component of all forms of child abuse, it is the most pervasive of all the previously listed forms of child abuse. There are several categories of emotional abuse and they may occur as unique experiences or together in the same child. They include

1. rejecting (for example, refusing to acknowledge the child's worth and emotional needs),



2. isolation (denying the child social experiences: locking child in the closet is an extreme example),



3. terrorizing (verbal assault with or without weapons),



4. ignoring (refusing to show affection),



5. corrupting (reinforcing destructive, antisocial, or sexually exploitative behaviors),



6. verbal assault (extreme sarcasm, name calling, public humiliation), and



7. over-pressuring (criticism of age-appropriate behaviors/skills as inadequate).

Emotional child abuse is also sometimes termed psychological child abuse, verbal child abuse, or mental injury of a child.