American Medical Association Family Medical Guide - American Medical Association [70]
Child Abuse
Because they are young and dependent on adults for care and guidance, children are vulnerable to abuse. Child protective services agencies across the United States receive nearly 3 million reports of child abuse every year, but because many more cases go unreported, the actual incidence of child abuse is thought to be much higher. About three American children die each day from abuse or neglect. Child abuse or neglect is the No. 1 cause of death in children under age 5.
The abuser usually is a child’s parent or caregiver, and the problem occurs in all racial, ethnic, and socioeconomic groups. Child abuse is a repeated pattern of any of the following types of abusive behavior:
• Physical neglect Failure to meet a child’s physical needs, including lack of supervision; inadequate food, shelter, or clothing; abandonment; denial of medical care; or poor hygiene. Physical neglect is the most common form of child abuse.
• Emotional neglect Failure to give a child affection and the guidance needed to develop emotionally by ignoring him or her, withholding affection or attention, or withholding praise.
• Educational neglect Failure to enroll a child in school, or overlooking or encouraging truancy.
• Emotional abuse Impairing a child’s emotional development by screaming, name-calling, shaming, belittling, or telling the child that he or she is bad or worthless.
• Sexual abuse Sexual exploitation of a child, including sexual contact between an adult and a child, child pornography, child prostitution, or on-line solicitation of a child for sexual purposes.
• Physical abuse Slapping, punching, shaking, burning, biting, choking, throwing, whipping, or paddling a child, whether or not an injury results. Any intentional injury to a child.
The incidence of all types of child abuse is roughly equal among boys and girls, with the exception of sexual abuse, which occurs more frequently to girls than to boys.
Various factors contribute to child abuse, including parental use of alcohol or other drugs, poverty, inadequate parenting skills, and violence within the family. (Some experts also consider witnessing violence in the home to be a form of child abuse.) Children with special needs are especially vulnerable to abuse because their caregivers may be unprepared to provide adequate care or consider them less valuable than other children.
Corporal punishment (such as spanking) has the same effect on children as child abuse. Younger children, especially, cannot distinguish between being spanked as punishment and being spanked in anger. Although spanking a child may make him or her obey immediately, it will not affect a child’s behavior over the long term, teach him or her right from wrong, or prevent future misbehavior. Being disciplined with violence teaches children to resolve problems with violence. For these reasons, you should never use corporal punishment to discipline a child. Instead, give your child a time-out or take away a privilege. Some states allow corporal punishment in schools; if your child’s school allows corporal punishment, protect him or her by working with the school to eliminate this practice.
Child abuse can have serious, long-lasting consequences for a child and can lead to a psychological disorder called posttraumatic stress disorder (see page 720). Girls who are sexually abused are at especially high risk of smoking, abusing drugs, dropping out of school, stealing, engaging in sexual activity at a young age, or having multiple sexual partners. Many children who were abused have difficulty forming and maintaining healthy relationships in adulthood.
If you know a child who you think may be a victim of abuse or if you think you may be at risk of abusing a child yourself, get help. Call your local child protective services agency or the national child abuse hot line at 1-800-4-A-CHILD (1-800-422-4453).
Teaching Your Child Nonviolent Problem-Solving
Young children