TREATING CHILD ABUSE

 

To many, child abuse is narrowly defined as having only physical implications. In reality, child abuse is any act of omission or commission that endangers or impairs a child’s physical or emotional health and development.

Examples of Child Abuse

• Physical abuse and corporal punishment
• Emotional abuse
• Emotional deprivation
• Physical neglect and/or inadequate supervision
• Sexual abuse and exploitation

The act of enticing injury or allowing injury to result, rather than the degree of injury, is the determinant for intervention. A parent or caretaker may begin by inflicting minor injuries, then may increasingly cause more serious harm over a period of time. Therefore, detecting the initial, small injuries and intervening with preventive action may save a child from future permanent injury or death.

Of course, physical injuries, physical neglect and malnutrition are more readily detectable than the subtle and intangible injuries that result from emotional maltreatment or deprivation. However, all kinds of abuse create serious problems and demand attention.

A critical aspect of child abuse reporting involves assessment of a family’s emotional relationships. When observing a family, it is important that the therapist’s personal biases and preconceptions be controlled. Differentiation is to be made between child-rearing practices which are truly harmful to children and those practices that merely reflect differences in lifestyles.

Family stress, created by difficulties in obtaining the basic necessities of life, including food, shelter, clothing, medical care and education, may cause parents to be less capable of providing adequately for the emotional needs of their children. In struggling for survival, such a parent may be incapable of resolving difficult situations rationally and abuse of children may occur. Such situational stress does not constitute justification or legal defense for child abuse, but must be taken into consideration by agencies that become involved in determining appropriate, protective measures against future harm of the child and/or treatment and proper punishment for the child abuser. Although many people assume that parents are the only culprits, it is important to remember that children can become victims of abuse by persons in non-parental relationships, such as foster parents, babysitters, day care workers, etc. The guidelines which are delineated as “reasons for suspicion” are applicable to all situations or relationships involving the care and well-being of children.

Physical Abuse and Corporal Punishment

Inflicted physical injury most often represents unreasonably severe corporal punishment. This usually happens when the parent is frustrated or angry and shakes or throws the child or strikes the child out of anger. Other forms of punishment may also place a child in a situation where injury occurs or the child’s health or person is endangered.

Intentional, deliberate assault, such as burning, biting, cutting, poking, twisting limbs or otherwise torturing a child, is also included in this category of child abuse.

The combination of physical punishment and rage is ineffective as a disciplinary tool and can be deadly. Many experts agree that while physical punishment and rage have the immediate effect of interrupting the child’s behavior, the deterrent effect is not long-term. In addition, the use of excessive corporal punishment may teach a child to resolve conflicts violently and to use physical power rather than reason to obtain results or to express anger. Physical punishment is more effective for relieving parental tension than for disciplining the child. Moreover, it frequently leaves the parent with feelings of guilt and remorse.

While there are many who believe that all corporal punishment is abusive, there are others who believe it is a useful method of discipline under restrained conditions. Discipline and punishment are not the same. Parents and children need to establish mutual respect and rules of behavior.

Some techniques suggested for maintaining good discipline are: the giving of choices, suggesting substitutes, giving face-saving commands, removing tempting objects, setting up rituals and cooperative activates, being sensitive to a child’s needs and values and keeping a sense of fair play. There are numerous books and articles which expound on these issues and are instructive and helpful for parents. Local Child Abuse Councils may have a listing of these books.

Signs of Physical Abuse

The general clinical signs of abuse (in the absence of a reasonable explanation for the injury) include:

• Damage to the skin and surface tissues, such as bruises, bums, abrasions, lacerations or swelling.
• Damage to the brain, as evidenced by convulsions, altered mental status, such as coma or irritability, retardation of developmental progress or change in the rate of head growth.
• Damage to other internal organs, as suggested by shock, abdominal pain or distention or bleeding within the organs.
• Damage to the skeleton, as evidenced by swelling, pain on movement or deformity.

Indicators of reportable suspected child abuse would generally fall into the following categories (see “Reporting child abuse”) (is this from a book? Does a reference need to be included or do you want to remove it? There are more of these in the document, which I’m going to highlight in red for your review.):

• Child states that injury was caused by abuse.
• Any injury unusual for a specific age group (e.g., any fracture in an infant).
• A history of previous or recurrent injuries.
• Unexplained injury (e.g., parent unable to explain reason for injury; discrepancies in given explanations; blame placed on a third party; explanations inconsistent with medical diagnosis).
• Bruising in an unusual area, other than on shins, elbows, knees, for example. Certain specific bruising patterns also indicate child abuse, such as belt buckle marks, handprints, bite marks and pinches.
• Evidence of poor supervision (repeated falls down stairs; repeated ingestion of harmful substances; a child cared for by another child).
  • Evidence of neglect. (See “Physical neglect”)
  • Any indication of sexual abuse. (See “Sexual abuse and exploitation”)
  • Verbal threats against the life of a child made by a parent or caretaker.

Types of Injuries Warranting Suspicion of Physical Abuse

Burns

Burns are often difficult to evaluate. However, the location of the burn and its characteristics (shape, depth, margins, etc.) may indicate abuse. It is important to keep in mind that children instinctively withdraw from pain. Burns without some evidence of withdrawal are highly suspect. One burn characteristic of abuse is that which the shape of a recognizable object has evenly burned into the victim’s skin. Such burns indicate forced contact or “branding” with, for example, the grill of an electric heater, the element of an electric stove or an iron.

Another burn that does not appear to be accidental is a scald burn between the shoulder blades. Such burns can result from immersion of a child’s upper back in hot water. “Zebra” burns also indicate abuse. Such burns result when a child is
held by his or her hands and legs under a running hot faucet. The tissue on the child’s abdomen and upper legs folds up, preventing burning in the creases. The resulting “zebra stripes” from scalding of exposed tissue are clearly evident.

A child’s natural response when stepping into a tub of water is to sit down in it. This may result in burns of the feet and the entire surfaces of the buttocks if the water is hot. The child will then usually try to escape; which will result in splashes, uneven burns and sometimes burns on the hands.

In contrast, when children are forcibly held in hot water, there are often sharply demarcated burns. If held in water in a “jackknife” position, only the buttocks and genitalia may be burned. If held down forcibly in a sitting position, the center parts of the buttocks (if pressed tightly against the tub) are spared from burning, thus resulting in a “doughnut-shaped” burn. If the extremities are forcibly immersed in hot water, “glove” or “sock” burns to the hands or feet may result. The burns are often symmetric and an immersion line is readily evident.

Abuse should also be suspected when burns are pointed or deeper in the middle. This indicates that hot liquid was poured on, or a hot object (poker, utensil) pressed into the skin. Cigarette burns are difficult to diagnose, but when inflicted they are usually multiple and are often found on the palms or soles. There is a searing effect with charring around the wound.

Rope burns appear around wrists or ankles when children are tied to beds or other structures.

Bruises

Inflicted abuse should be suspected when:

• Bruises are both multiple and all of the same color or multiple and of different colors (differences in coloration reflect various stages of healing and indicate that the injuries were sustained at different times); the child is less than 12-months-old (children this age would be unlikely candidates for multiple bruises).
• Bruises are found on multiple surfaces of the body, particularly on the back, genitals or mouth.
• Bruises have a characteristic pattern (outline of hand, paired bruises from pinching, loop from a cord, etc.) or clearly resemble an impression of an item of jewelry, such as a ring.
• Bruises are on both sides of the face (two black eyes would be highly suspect, unless in the case of a proven accidental broken nose).

Timing or age dating (ecchymosis) of bruises can be an important factor. While the following colorations are only approximations, they can serve as a rough guide to determine when the injury occurred:

• Immediate – within a few hours: red
• Soon – from 6 to 12 hours prior: blue
• Later – from 12 to 24 hours prior: black-purple
• 4 to 6 days prior: green tint, dark
• 5 to 10 days prior: pale green to yellow

Abrasions, Lacerations and Scars

Again, the multiplicity and location of wounds, as with bruises, should be considered. For example, lacerations under the tongue or those of a torn frenulum (the small piece of skin connecting the gum to the lip) could be caused by falling with an object in the mouth or by excessive force during beatings. Both are suspicious injuries, particularly before an infant can stand.

Whipping

Linear marks or strap marks, sometimes covering a curved body surface (wraparound), are evidence of intentional abuse. Belt buckles cause a “C”- or “U”-shaped, dark wound called a “gull wing” laceration. Belt buckles can cause other wounds with distinctive shapes as well. Loop marks on the skin may be caused by a doubled-over electrical cord or rope.

Head Injuries

Whenever abuse or neglect is suspected, a careful examination of the child’s eyes and nervous system should be performed, looking for signs of intracranial injury. Serious intracranial injury may occur without visible evidence of trauma on the face or scalp. One such injury is a subdural hematoma (blood trapped in a space around the brain), which, if left untreated, may cause brain damage or death. Skull x-rays should be performed in all abused children with evidence of trauma to the head, as well as in all small infants in whom abuse is suspected. All types of skull fractures should be carefully evaluated, especially when the explanation of the injury is not consistent with the presented trauma.

Head injuries are the most common cause of child abuse-related deaths.

Whiplash Shaken Infant Syndrome

The essential elements in this syndrome present an apparent diagnostic contradiction, in that intracranial and intraocular hemorrhage occur in the absence of signs of external injury to the head. Shaking, using excessive force, may produce not only these injuries, but also lesions of the long bones.

The injury may go undiagnosed for years and perhaps first be manifest at school age as minor neurological deficits or learning problems. More severe deficits, such as blindness, deafness, or
paralysis, generally appear sooner. Even death can be caused by this type of abuse. A careful post-mortem examination of every child who dies in infancy is required to detect the real cause of death and to avoid erroneous diagnoses.

Pummeling

Blows from a heavy blunt object, such as a baseball bat or fist, on soft tissue, result in deep muscular bruises or hemorrhage. These are rarely discolored. In time, such a collection of blood may be seen on x-rays. Blunt blows to the body may cause serious internal injuries to the liver, spleen, pancreas, kidneys and other vital organs. Detectable surface evidence of such trauma is present only about half the time.

Fractures

Any fracture in an infant or toddler is suspect. Long-bone (arm and leg) fractures that are the result of twisting are called “spiral” fractures and are almost always due to inflicted trauma.

Other fractures which raise suspicion include:

• “Chip” fractures at the end of long bones, particularly when they occur in an infant
• Fractures resulting from yanking and jerking
• Rib fractures, especially back rib fractures
• Healing or healed fractures revealed by x-rays

Additional Signs of Physical Abuse

Some additional factors that should raise suspicion and trigger further investigation include the following:

• Very young children with injuries on the back surfaces of the body from the neck to the knees. This is the primary target zone for infliction of physical injuries. Such injuries constitute the largest percentage of identified abuse.
• Bruises, scars and wounds on the backs of arms and hands which are called “defense” wounds.
• Excessive layers of clothing, especially in hot weather. (It may be an attempt to hide wounds.)

One of the most important grounds for suspicion is the one that is discussed the least: when a child tells someone. It is essential that the child not be ignored, nor the gravity of the situation minimized. It should be remembered, too, that when a child tells a particular person who is an individual required to report child abuse, the communication is not privileged. That individual, BY LAW, shall report what the child has related to him or her. This requirement applies to any type of communicated abuse, including situations of physical abuse, emotional assault or deprivation, physical neglect or sexual abuse. Individuals who report such suspected child abuse cases in good faith cannot be held liable, either civilly or criminally, for making such reports. (See “Reporting child abuse.”) It is often advisable that the person making the report gain the confidence of the child and try to maintain a close relationship throughout the emotional ordeal likely to occur when the child abuse is reported.

Emotional Abuse

Just as physical injuries can scar and incapacitate a child, emotional cruelty can similarly cripple and handicap a child emotionally, behaviorally and intellectually. Severe psychological disorders have been traced to excessively distorted parental attitudes and actions. Emotional and behavioral problems, in varying degrees, are very common among children whose parents abuse them emotionally and include the following:

• Excessive verbal assaults (belittling, screaming, threats, blaming, sarcasm)
• Unpredictable responses (inconsistency)
• Continual negative moods

Constant family discord and double-message communication are examples of ways parents may subject their children to emotional abuse.

Emotional abuse may be suspected if the child:

• Is withdrawn, depressed and apathetic.
• “Acts out,” and is considered a “behavior problem.”
• Is overly rigid in conforming to instructions of teachers, doctors and other adults.
• Displays other signs of emotional turmoil (repetitive, rhythmic movements; inordinate attention to details; no verbal or physical communication with others).
• Unwittingly makes comments such as, “Daddy always tells me I’m bad.”

The behavior patterns mentioned may, of course, be due to other causes, but the suspicion of abuse should not be precluded.

Emotional distress may result when:

• Demands are made on the child that is based on unreasonable or impossible expectations or without consideration of the child’s developmental capacity.
• The child is used as a “battleground” for marital conflicts.
• The child is used to satisfy the parent’s/caretaker’s own ego needs and the child is neither old enough nor mature enough to understand.
• A person who emotionally abuses a child, as well as one who abuses a child in other ways, may tend to “objectify” the child by referring to him/her as “it” (“it” cried, “it” died, etc.).
• Emotional abuse can be seen as encouraging a self-fulfilling prophecy. If a child is degraded enough, the child will begin to live up to the image communicated by the abusing parent or guardian.
• Emotional abuse cases are not mandated reporting situations (except in extreme cases) and they are difficult to prove. Accumulative documentation by witnesses is imperative. Such cases should be diverted to treatment as soon as possible.

Emotional Deprivation

Emotional deprivation has been defined as “the deprivation suffered by children when their parents do not provide the normal experiences producing feelings of being loved, wanted, secure and worthy.”

When parents ignore their children, whether because of drugs or use of alcohol, psychiatric disturbances, personal problems or other preoccupying situations, such as outside activities, serious consequences may occur.

Emotional deprivation should be suspected if the child:

• Refuses to eat adequate amounts of food and is thus very frail.
• Is not thriving in general (unable to perform normal learned functions for a given age, e.g., walking, talking, etc.).
• Displays antisocial behavior (aggression, disruption) or obvious “delinquent” behavior (drug abuse, vandalism); conversely, the child may be abnormally unresponsive, sad or withdrawn.
• Constantly “seeks out” and “pesters” other adults (such as teachers, neighbors, etc.) for attention and affection.
• Displays exaggerated fears.

Physical Neglect

Physical neglect is essentially the failure of a parent or caretaker to provide a child with adequate food, shelter, clothing, protection, supervision and medical and dental care.

Physical neglect is suspected if the following conditions exist:

• Unsanitary conditions in home (garbage, animal or human excretion).
• Lack of heating or plumbing in home.
• Fire hazards or other unsafe home conditions.
• Sleeping arrangements are cold, dirty or otherwise inadequate.
• Nutritional quality of food in home is poor.
• Meals are not prepared (children snack when hungry).
• Spoiled food in refrigerator or cupboards.
• The child is lacking in medical or dental care.
• The child is always dirty; poor personal hygiene.
• The child is always sleepy or hungry.
• The child’s clothing is always dirty or inadequate for weather conditions.
• A child under 14 is left alone in the home or unsupervised under any circumstances (left in car, street, etc.).

While some of these conditions may exist in any home environment, it is the extreme or persistent presence of these factors that indicate neglect.

Failure to Thrive

Infants or young children who are much smaller than would be expected at a particular age can be a difficult diagnostic problem for physicians. After excluding those infants who are small because they were small at birth, there remains a large group of infants with low weights (and perhaps short length and small head circumferences). Most of these children are small because of a failure to meet their nutritional needs and/or failure to meet their emotional needs. These children may also demonstrate delayed development and abnormal behavior. Some of the small children, however, do have hidden medical problems. Hospitalization may be required to screen for significant medical illness and, more important, to see if the child responds to a nurturing environment and adequate food with a rapid weight gain and more appropriate behavior. If left untreated, emotional disorders, school problems, retardation and other forms of abuse may ensue.

Sexual Abuse and Exploitation

Incestuous/Intra-Familial Sexual Abuse

Sexual abuse of children within the family is the most hidden, least publicized form of child abuse. In spite of its taboo nature and the difficulty of detection, some researchers believe such abuse may be even more common than physical abuse.

In discussing sexual abuse, “incest” means sexual activity between persons who are blood-related; “intra familial” refers to sexual activity between family members not related by blood (stepparents, boyfriends, etc.).

A person with no prior history of sexual problems can be tempted to sexually abuse a child in the intimacy of family life, especially at times of stress or when adult relationships are poor. A person who chooses to involve a child in sexual activity can easily make the child believe that sex is a special game or a normal and necessary part of being loved and accepted. An older child can be convinced that he/she is at fault for seducing the parent/caretaker. The child will then fear disgrace, hatred or blame for breaking up the family if the secret is revealed.

Although some adults may believe their conduct is blameless, the harm done to the child remains the same whenever sexual abuse is committed. The abuser may convince himself that he has a duty to “show the child the facts of life.” He may believe he is more loving and caring than outsiders who might “spoil” or mistreat the child. He may feel so neglected and needy himself that he feels compelled to exploit the only supporting, loving relationship he can find. He may enter the child’s bedroom at night and take down the bed covers to expose the child’s body or to explore it with hands or mouth. Confused and fearful of this strange, recurring behavior, the child usually pretends sleep. Sometimes the abuser’s approach is more direct. The child is courted and seduced into mutual arousal or forced to masturbate or fellate the abuser. Vaginal intercourse also occurs. Full vaginal intercourse occurs even with quite young children, as well as with older children.

Sexual abuse is followed by guilt-provoking demands for secrecy and/or threats of terrible harm if the secret is revealed. Regardless of how gentle or forceful or how trivial or coincidental the first approach may have been, sexual coercion tends to be repeated and escalates over a period of years. Often the child eventually accepts the blame for tempting and provoking the abuser. In most reported cases of sexual abuse, the father or another man acting as the parent is the initiator. While girls are the most frequent victims, boys are victims of abuse much more often than previously believed. The embarrassment and shame used to deter girls from reporting such abuse has an even greater effect on boys since the abuse is most often homosexual. When responding to a case of reported abuse of a female, investigators should not overlook the possibility that male children in the family may also have been molested.

The initial sexual abuse may occur at any age, from infancy through adolescence. However, the largest number of cases involves females under the age of eleven years. The sexual activity is usually repetitive and progressive. There is no escape for the victim until he/she is old enough to realize that incest is not a common occurrence, and/or he/she is strong enough to ask for help outside the family.

The mother, who normally would be expected to protect the child, may purposely try to stay isolated from a problem of sexual abuse. Sometimes she is distant and uncommunicative, or so disapproving of sexual matters that children are afraid to speak up. Sometimes she is insecure and the potential loss of her husband or partner and the fear of scandal are so threatening that she cannot allow herself to believe or even to suspect that her child is or could be at risk. She may have been a victim herself of child abuse and rejection and may not trust her judgment or her right to challenge the male authority. Some mothers actually know of sexual abuse, but, for whatever reason, they “look the other way.”

Sometimes a child who does seek help is accused of making up stories, since many people cannot believe that the apparently well-adjusted person involved could be capable of sexual abuse. When the matter does come to the attention of authorities, the child may give in to pressure from parents/caretakers and deny that any sexual abuse has occurred. Even if protective attention is gained, the child may feel guilty about “turning in” the abuser or breaking up the family and, consequently, withdraw the complaint. This process leads many to be skeptical of the child’s complaint of sexual abuse, and leaves him/her feeling helpless and guilty for causing so much trouble. Everything in the secrecy and circumstances surrounding illicit sexual activity combines to make the victim carry the weight of the problem.

The sad reality is that the child often remains trapped in secrecy by shame, fear and the threats of the abuser.

Careful evaluation is necessary in a sexual abuse situation to determine whether the child should be removed from the home immediately. The mother may assure the officer that the offending male will not be allowed to return to the home. However, in view of the emotional and perhaps economic dependence the mother often has on the offending male, she may allow him back into the house. Thus, the child is again in an unprotected environment.

Even though sexual abuse is often deceptively nonviolent, it is more powerfully compelling and more often disabling than any strong-arm attack from a stranger. Yet the prognosis often can be encouraging. There can be a striking recovery when effective intervention and help are provided. Intervention alone does not interrupt the trap of sexual abuse, for the child remains burdened with guilt and helplessness unless the offending parent is forced to admit and take responsibility for his/her actions. Detection, reporting, investigation, appropriate prosecution, supervision and counseling are frequently essential parts of a family treatment process. When child abuse has been exposed, self-help organizations, such as Children United, Parents United and Parents Anonymous can be very helpful. They provide support and promote the self-esteem and emotional well-being of each family member during the process of discovery, social intervention, adjudication, re-socialization and rebuilding of the family.

Sexual abuse should be suspected if:

• The child reports sexual activities with parents, other relatives, friends of the family or other adults.
• The child shows an early and exaggerated awareness of sex, with either seductive interest or fearful avoidance of close contact with others.
• There is tearing, bruising or specific inflammation of the mouth, anus or genitals, or evidence of semen (oral, rectal, vaginal).
• There is venereal disease of the eyes, mouth, anus or genitals of a child or adolescent.
• A girl is pregnant and appears extremely fearful, distressed or secretive.
• A child with behavioral problems hints at conflicts at home, but seems quite hesitant or fearful to talk about the problem.
• A child is known to be the victim of other forms of abuse.

Exploitation/Child Pornography

Although it is impossible to make an exact assessment of the number of California children who have been the victims of pornographic exploitation, it is clear that by even the most conservative estimate, the number is alarmingly high.

The difficulty in assessing the number of children involved in pornography is compounded by a number of factors. First, the evidence indicates that in the vast majority of cases, this kind of sexual exploitation goes unknown to even the parents of the children. Additionally, the ever-increasing number of juvenile runaways who have migrated to California in recent years, together with the associated and growing problem of juvenile prostitution, contribute to the difficulty in making this assessment. The runaway juvenile, alone and without support in a strange city, is a particularly attractive target as a model for pornography. Finally, some parents use their own children to produce this material. Therefore, the only reasonable conclusion that can be drawn is that the number of children involved is substantial. Moreover, the number appears to be growing.

In recent years, police have been able to increase the number of arrests in California of persons suspected of producing and disseminating child pornography. These arrests have resulted in literally thousands of films, magazines and still photographs being seized which depict children (some as young as four years old) involved in sexual activity. However, the problem still outweighs the arrests by a large margin.

The distribution of pornographic material has been limited, in part, due to amendments to Labor Code Section 1309.5 -1309.6 and Penal Code Section 311.4, which now provide essentially:

• that anyone convicted of promoting, employing, using or coercing a minor to perform a sexual act in a film or photograph is guilty of a felony;
• for a mandatory state prison term of three to five years for a person convicted of involving a minor 13 years of age or younger in a film or photograph depicting sexual conduct; and
• that wholesale distributors of films depicting
  minors engaged in sexual conduct must keep records indicating names and addresses of those from whom the material is obtained (producers). Failure to keep such records for the specified time period is a misdemeanor offense which is punishable by a maximum $5,000 fine for each violation. (For further details on this law, see “The legal aspects.”)

Child Molesters and “Chicken Hawks”

In contrast to what is perceived as forced sexual abuse or exploitation, this section deals with child victims of sexual abuse who are usually consenting partners, or non-complaining victims.

The concept of these children as consenting partners or non-complaining victims does not fit with society’s image of an unsuspecting child being lured into a car with a candy bar. A large proportion of these willing children include runaways, who are reasonably “streetwise,” and emotionally troubled children who trade themselves for money or for what they perceive as attention and affection.

The label “child molester” usually refers to a male or female (but most often, an older adult heterosexual male) who receives sexual gratification from young girls. A male (adult homosexual) or female who receives sexual gratification from young boys is commonly referred to as a “chicken hawk.” The child molesters and chicken hawks usually have a specific age preference.

Chicken hawks and child molesters are “benevolent keepers” of their child victims. Many suspects are, in fact, wealthy and financially secure men or women who can afford to provide elaborate gifts for their victims. For most of their time together, the suspect caters to the child’s wants and needs in an exaggerated caring relationship. In return, the child willingly submits to sexual activity. While this perverse form of attention and affection may be especially appealing to an isolated runaway child, the danger of such sexual exploitation is certainly not limited to runaways. It can and does represent a danger to any child whose parent/caretaker fails to provide necessary attention and affection.

The use of pornographic material by the chicken hawk and child molester is extensive. This is evidenced by the ever-increasing volume of pornographic material seized in investigations of sexual exploitation cases. The statements of victims corroborate this evidence. Pornographic literature is a device by which a suspect can steer a normal conversation with a juvenile toward a sexual theme. It is used to stimulate both suspect and victim and to assist in breaking down inhibitions. The nature of the literature usually will correspond with the suspect’s particular sexual inclinations, and the models used are usually of the age the suspect prefers.

In 1972, a pamphlet entitled “Where the Young Ones Are” sold 70,000 copies in California at $5 each. The names and addresses of almost 400 places across the country where “…the young can be found” were listed. Other pamphlets which have been seized by law enforcement provide suggestions to child molesters and chicken hawks about what to do, where to go and “come-oris (is this the correct term or a typo? Is this supposed to be “come-ons”?).” They include cartoons depicting sexual activity to which a child can relate.

For a solution to be found, there needs to be an increased awareness and understanding of the growing problem of sexual exploitation of children.

More on the Extent of the Problem

Statistical data to describe the magnitude of child abuse and neglect across the nation are, at best, inconsistently used. The probability that child abuse and neglect are leading causes of childhood deaths seems to be generally accepted. However, official state and national statistics identify causes of death from abuse and neglect mainly in medical terms (per “International Classification of Diseases” listings). For instance, a child whose death is officially recorded as pneumonia may, in fact, have contracted the illness as a result of being poorly clothed, fed, bedded or medically neglected. Thus, many child abuse experts feel that abuse or neglect may well be the underlying cause in many cases where the cause is medically described.

On the basis of existing information, national estimates indicate that over one million American children are suffering from abuse and/or neglect at any given time and that approximately one-quarter of these will be injured for life as a result. The number of reported cases of child abuse and neglect has been increasing steadily in the last several years. It is uncertain whether this trend reflects an actual increase in the number of children being mistreated, the increased exposure of abuse, the increase in the number of people willing to report, or a combination of all three.

The gathering of information and statistics is recognized as a problem at most levels of government. Efforts, however, are being made to develop systems which will reflect more accurately the scope and degree of child abuse and neglect.

The Department of Justice statewide child abuse index only represents a portion of all child abuse cases. Generally, those cases, which are referred directly to law enforcement agencies rather than to social services, are represented in this index. Therefore, the statistics reflect only the more violent cases of child abuse. (For example, social services statistics show that “general neglect” cases represent over 50 percent of their total caseload versus 21.7 percent of the Justice Index caseload.) However, reviewing the Justice Index statistics can be revealing, as long as these circumstances are considered.

Of the cases reported to the Department of Justice index for the calendar year 1979, 42.1 percent were physical abuse, 21.7 percent were in the “general neglect” category and 36.2 percent were sexual abuse. The “age distribution” factors from those 1979 cases are also of interest. The figures show that the heaviest incidence of physical abuse takes place between 0-4 years of age, declines in the 5- to 8-year-old range and continues to diminish between the ages of 9-15. After 16-years-of-age, physical abuse percentages drop off sharply. In the category of “general neglect,” the heaviest incidence of neglect is between the ages of 0-4. The percentage pattern is similar to physical abuse and diminishes sharply after the age of 16. In contrast, sexual abuse is heaviest between the ages of 9-12, with the percentage being slightly less in the 5-8 and 13-15 age groups. Sexual abuse is lower in the 0-4 category and in the 16+ years’ age group.

In reviewing available data from a variety of sources, it is generally recognized that a great deal of reported abuse and neglect is committed against children under four-years-of-age. It cannot be stressed strongly enough that we have to rely on third-party reporting of these cases.

The problem of adolescent abuse is often underestimated. For a variety of reasons, adolescents are frequently bypassed in the protective system. First of all, they are considered to be less “at risk” than younger children who can be severely injured by parents or caretakers. Secondly, adolescents are seen as having options increasingly available. They are not considered as helpless as younger children. They are able to leave the house until the parent/caretaker “calms down.” The adolescent can fight back or, in some cases, “take it” with only temporary discomfort. However, many of the child prostitutes who walk
the steets at night or the youngsters involved in alcohol and drug abuse are victims of physical or sexual abuse and neglect at home. Thus, adolescents may have more options, but they are not necessarily positive options. Adolescent abuse remains a serious problem which deserves attention and action.

Who are the Child Abusers?

Child abuse, contrary to popular belief, occurs in all cultural, ethnic, occupational and socio-economic groups.

Studies indicate that a variety of factors are associated with child abuse. Many of these factors apply to and characterize the general population (such as social isolation, transiency and other factors discussed in this section). Data accumulated from the cases reported to the Department of Justice central index indicate that women and men physically abuse children in virtually equal numbers.

Frequently, abusing parents or caretakers themselves have experienced deprived childhoods. Consequently, they often create the same destructive environment for their children that their parents provided for them. Without intervention, these negative life patterns can be transmitted for generations.

Abusing people often reverse roles with their children. That is, they expect and demand love and care from their offspring, but have difficulty in returning these emotional necessities to their children. These people are either crippled from child abuse experiences of their own or simply lack understanding of children’s basic needs and capabilities.

Studies have shown that a mother who has little or no contact with her infant immediately after birth may be more likely to abuse or neglect her child. Children born prematurely, by Caesarean section or with an illness, may run a greater risk of maltreatment because the early “bonding” between mother and child may be disturbed by separation due to prolonged hospitalization of either the mother or the child. Also, a child born with defects or other disfigurements is often
singled out for emotional or physical abuse. A child viewed as different or slow often becomes a scapegoat.

Child abuse has also been related to the decline of the “extended” family. An extended family is best described as that in which a number of immediate relatives reside in the same household or live close by and are readily available in times of need. In contrast, the “nuclear” family, more prevalent in today’s transient society, generally consists of mother, father and child with few relatives close enough to provide immediate support. There are fewer sympathetic ears listening and helping with frustrations and fewer potential babysitters or persons to assist parents with child rearing. Mobility and the degree of transiency characteristic of the nuclear family also mean parents have fewer close friends upon whom to depend. Abusing families have a tendency toward social and emotional isolation.

Child abuse is seldom the result of any single factor. Rather, a combination of circumstances and personality types precipitates acts of abuse. For example, the existence of one or more of the following factors could trigger abusive acts:

• emotional stress, such as marital or employment problems;
• a predisposition toward maltreatment (perhaps having been an abused child);
• a strong belief in corporal punishment;
• or a lack of constructive outlets for tension, anger or aggression. These factors are compounded by any act of the child which, for whatever reason, triggers the contempt or resentment of a parent or caretaker.

The child abuser is typically a recidivist; that is, the abuser tends to repeat the abuse. The abuser is also typically an escalator in that the amount and severity of the abuse tends to increase. Because of these characteristics, early identification, reporting and intervention are essential and vital.