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.

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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.

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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

Sexual abuse is the third most frequently reported form of child mistreatment (10% of all cases). Experts believe that sexual abuse may be the most underreported type of abuse because of the secrecy or "conspiracy of silence" that so often characterizes these cases. A generally accepted definition of sexual abuse is that of a child involved in sexual activity for which consent cannot be given, is outside of the victim's developmental age, is unable to comprehend, and/or "violates the law or social taboos of society." Examples include fondling and any form of genital, anal, or oral-genital contact with a child that are unwarranted. These acts may occur whether the child is clothed or unclothed. Non-touching child sexual abuse would include exhibitionism, voyeurism, and the involvement of a child in prostitution or pornography.

The most lethal form of child abuse is neglect. Deaths from neglect can, for example, be caused by accidents due to lack of supervision or abandonment or from the failure to seek medical attention for an injury, illness, or condition.

Fatal injuries from mistreatment can and do result from many different acts. Children may die from severe head trauma (injury), shaken baby syndrome, trauma to the abdomen or chest, scalding, burns, drowning, suffocation, poisoning, starvation, etc.

Specialists evaluating an abused child's environment and family background have noted several risk factors for potential abuse:

1. The abuser's childhood: Approximately 20% of offenders were themselves abused as children.



2. The abuser's substance abuse: Children in alcohol-abusing families are nearly four times more likely to be mistreated, almost five times more likely to be physically neglected, and 10 times more likely to be emotionally neglected than children in non-alcohol-abusing families. Of all child-abuse cases, 50%-80% involve some degree of substance abuse by the child's parents.



3. Family stress: The disintegration of the nuclear family and its inherent support systems have been held to be associated with child abuse.



4. Social forces: Experts debate whether a presumed reduction in religious/moral values coupled with an increase in the depiction of violence by the entertainment and informational media may increase child abuse.



5. The child: Children at higher risk for abuse include infants who are felt to be "overly fussy," handicapped children, and children with chronic diseases.

Specific "trigger" events that occur just before many fatal parental assaults on infants and young children include an infant's inconsolable crying, feeding difficulties, a toddler's failed toilet training, and exaggerated parental perceptions of acts of "disobedience" by the child.