child abuse

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Definition

Child abuse is the blanket term for four types of child mistreatment: physical abuse, sexual abuse, emotional abuse, and neglect. In many cases children are the victims of more than one type of abuse. The abusers can be parents or other family members, caretakers such as teachers and babysitters, acquaintances (including other children), and (in rare instances) strangers.

Description

Prevalence of abuse

Child abuse was once viewed as a minor social problem affecting only a handful of United States children. However, in recent years it has received close attention from the media, law enforcement, and the helping professions, and with increased public and professional awareness has come a sharp rise in the number of reported cases. But because abuse is often hidden from view and its victims too young or fearful to speak out, experts suggest that its true prevalence is possibly much greater than the official data indicate. In 1996, more than three million victims of alleged abuse were reported to child protective services (CPS) agencies in the United States, and the reports were substantiated in more than one million cases. Put another way, 1.5% of the country's children were confirmed victims of abuse in 1996. Parents were the abusers in 77% of the confirmed cases, other relatives in 11%. Sexual abuse was more likely to be committed by males, whereas females were responsible for the majority of neglect cases. More than 1,000 United States children died from abuse in 1996.

Although experts are quick to point out that abuse occurs among all social, ethnic, and income groups, reported cases usually involve poor families with little education. Young mothers, single-parent families, and parental alcohol or drug abuse are also common in reported cases. Charles F. Johnson remarks, "More than 90% of abusing parents have neither psychotic nor criminal personalities. Rather they tend to be lonely, unhappy, angry, young, and single parents who do not plan their pregnancies, have little or no knowledge of child development, and have unrealistic expectations for child behavior." About 10%, or perhaps as many as 40%, of abusive parents were themselves physically abused as children, but most abused children do not grow up to be abusive parents.

Types of abuse

PHYSICAL ABUSE. Physical abuse is the nonaccidental infliction of physical injury to a child. The abuser is usually a family member or other caretaker, and is more likely to be male. In 1996, 24% of the confirmed cases of United States child abuse involved physical abuse.

A rare form of physical abuse is Munchausen syndrome by proxy, in which a caretaker (most often the mother) seeks attention by making the child sick or appear to be sick.

SEXUAL ABUSE. Charles F. Johnson defines child sexual abuse as "any activity with a child, before the age of legal consent, that is for the sexual gratification of an adult or a significantly older child." It includes, among other things, sexual touching and penetration, persuading a child to expose his or her sexual organs, and allowing a child to view pornography. In most cases the child is related to or knows the abuser, and about one in five abusers are themselves underage. Sexual abuse was present in 12% of the confirmed 1996 abuse cases. An estimated 20–25% of females and 10–15% of males report that they were sexually abused by age 18.

EMOTIONAL ABUSE. Emotional abuse, according to Richard D. Krugman, "has been defined as the rejection, ignoring, criticizing, isolation, or terrorizing of children, all of which have the effect of eroding their self-esteem." Emotional abuse usually expresses itself in verbal attacks involving rejection, scapegoating, belittlement, and so forth. Because it often accompanies other types of abuse and is difficult to prove, it is rarely reported, and accounted for only 6% of the confirmed 1996 cases.

NEGLECT. Neglect—failure to satisfy a child's basic needs—can assume many forms. Physical neglect is the failure (beyond the constraints imposed by poverty) to provide adequate food, clothing, shelter, or supervision. Emotional neglect is the failure to satisfy a child's normal emotional needs, or behavior that damages a child's normal emotional and psychological development (such as permitting drug abuse in the home). Failing to see that a child receives proper schooling or medical care is also considered neglect. In 1996 neglect was the finding in 52% of the confirmed abuse cases.

— Howard Baker

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n

The physical, sexual, or emotional maltreatment of a person under 18 years of age. Child abuse occurs predominantly with children under 3 years of age. Symptoms include bruises and contusions, medical record of repeated trauma, radiographic evidence of fractures, emotional distress, and failure to thrive.

Definition

Child abuse is the blanket term for four types of child mistreatment: physical abuse, sexual abuse, emotional abuse, and neglect.

Description

Prevalence of Abuse

Child abuse was once viewed as a minor social problem affecting only a handful of U.S. children. However, in the late 1990s and early 2000s it has received close attention from the media, law enforcement, and the helping professions, and with increased public and professional awareness has come a sharp rise in the number of reported cases. Because abuse is often hidden from view and its victims too young or fearful to speak out, however, experts suggest that its true prevalence is possibly much greater than the official data indicate. An estimated 896,000 children across the country were victims of abuse or neglect in 2002, according to national data released by the U.S. Department of Health and Human Services (HHS) in April 2004. Parents were the abusers in 77 percent of the confirmed cases, other relatives in 11 percent. Sexual abuse was more likely to be committed by males, whereas females were responsible for the majority of neglect cases. The data show that child protective service agencies received about 2,600,000 reports of possible maltreatment in 2002. About 1,400 children died of abuse or neglect, a rate of 1.98 children per 100,000 children in the population. In many cases children are the victims of more than one type of abuse. The abusers can be parents or other family members, caretakers such as teachers and babysitters, acquaintances (including other children), and (in rare instances) strangers.

Although experts are quick to point out that abuse occurs among all social, ethnic, and income groups, reported cases usually involve poor families with little education. Young mothers, single-parent families, and parental alcohol or drug abuse are also common in reported cases. Statistics show that more than 90 percent of abusing parents have neither psychotic nor criminal personalities. Rather they tend to be lonely, unhappy, angry, young, and single parents who do not plan their pregnancies, have little or no knowledge of child development, and have unrealistic expectations for child behavior. From 10 percent to perhaps as many as 40 percent of abusive parents were themselves physically abused as children, but most abused children do not grow up to be abusive parents.

Types of Abuse

PHYSICAL ABUSE. Physical abuse is the non-accidental infliction of physical injury to a child. The abuser is usually a family member or other caretaker and is more likely to be male. One fourth of the confirmed cases of child abuse in the United States involve physical abuse. A rare form of physical abuse is Munchausen syndrome by proxy, in which a caretaker (most often the mother) seeks attention by making the child sick or appear to be sick.

EMOTIONAL ABUSE. Emotional abuse is the rejecting, ignoring, criticizing, isolating, or terrorizing of children, all of which have the effect of eroding their self-esteem. Emotional abuse usually expresses itself in verbal attacks involving rejection, scapegoating, belittlement, and so forth. Because it often accompanies other types of abuse and is difficult to prove, it is rarely reported and accounts for only about 6 percent of the confirmed cases.

SEXUAL ABUSE. Psychologists define child sexual abuse as any activity with a child, before the age of legal consent, that is for the sexual gratification of an adult or a significantly older child. It includes, among other things, sexual touching and penetration, persuading a child to expose his or her sexual organs, and allowing a child to view pornography. In most cases the child is related to or knows the abuser, and about one in five abusers are themselves underage. Sexual abuse accounts for 12 to 15 percent of confirmed abuse cases. In multiple surveys, 20 to 25 percent of females and 10 to 15 percent of males report that they were sexually abused by age 18.

NEGLECT. Neglect, the failure to satisfy a child's basic needs, can assume many forms. Physical neglect is the failure (beyond the constraints imposed by poverty) to provide adequate food, clothing, shelter, or supervision. Emotional neglect is the failure to satisfy a child's normal emotional needs, or behavior that damages a child's normal emotional and psychological development (such as permitting drug abuse in the home). Failing to see that a child receives proper schooling or medical care is also considered neglect. Slightly more than half of all reported abuse cases involve neglect.

Infancy and Toddlerhood

Infants who are premature, mentally retarded, or have physical handicaps are more likely to provoke abuse from their caregiver than are infants without such problems. Similarly, nonhandicapped infants who are nonrhythmic (that is, have uneven sleep and eating patterns) are more likely to be abused. It appears that the child's tendency to learn slowly, to be less coordinated, or less affectionate—rather than any physical problem—that promotes abuse. Infants, because of their fragility, are more susceptible to injury from physical discipline than older children. Infants are especially susceptible to head injury from shaking or being thrown. A baby can be fatally injured by being thrown even onto a soft mattress. The baby's brain hits the back of the skull if the child is thrown with even mild force and intracranial bleeding can result.

Shaken baby syndrome (SBS) is the leading cause of death in child abuse cases in the United States. The syndrome results from injuries caused by someone vigorously shaking an infant, usually for five to 20 seconds, which causes brain damage. In some cases, the shaking is accompanied by a final impact to the baby's head against a bed, chair, or other surface. Although SBS is occasionally seen in children up to four years of age, the vast majority of incidents occur in infants who are younger than one year; the average age of victims is between three and eight months. Approximately 60 percent of shaken babies are male, and children of families who live at or below the poverty level are at an increased risk for SBS (and any other type of child abuse).

Preschool

Typically, abused children show developmental delays by preschool age. It is unclear whether these delays occur due to cumulative neurological damage or due to inadequate stimulation and uncertainty in the child about the learning environment and the absence of positive parental interactions that would stimulate language and motor processes. These delays, in concert with their parents' higher-than-normal expectations for their children's self-care and self-control abilities, may provoke additional abuse. Abused preschoolers respond to peers and other adults with more aggression and anger than do non-abused children. A coercive cycle frequently develops in which parents and children mutually control one another with threats of negative behavior.

School Age

School-aged children who are abused typically have problems academically and have poorer grades and performance on standardized achievement tests. Studies of abused children's intellectual performance find lower scores in both verbal and math and visual-spatial areas. Abused children also tend to be distracted and overactive, making school a very difficult environment for them. With their peers, abused children are often more aggressive and more likely to be socially rejected than nonabused children. Less mature socially, abused children show difficulty in developing trusting relationships with others. The anger that is often instilled in such children is likely to be incorporated into their personality structures. Carrying an extra load of anger makes it difficult for them to control their behavior and increases their risk for resorting to violent action. To control their fears, children who live with violence may repress feelings. This defensive maneuver takes its toll in their immediate lives and can lead to further pathological development. It can interfere with their ability to relate to others in meaningful ways and to feel empathy. Individuals who cannot empathize with others' feelings are less likely to curb their own aggression and more likely to become insensitive to brutality in general.

As adolescents, abused children are more likely to be in contact with the juvenile justice system than nonabused children of comparable family constellation and income level. Many of these children are labeled "ungovernable" for committing offenses such as running away and truancy. A higher proportion of abused than nonabused delinquent youth are also involved in crimes of assault. Follow-up studies on abused children in later adolescence show that in addition to having problems with the law, they are also more likely to be substance abusers or to have emotional disturbances such as depression.

Common Problems

Physical Abuse

The usual physical abuse scenario involves a parent who loses control and lashes out at a child. The trigger may be normal child behavior such as crying or dirtying a diaper. Unlike nonabusive parents, who may become angry at or upset with their children from time to time but are genuinely loving, abusive parents tend to harbor deep-rooted negative feelings toward their children. Unexplained or suspicious bruises or other marks on the skin are typical signs of physical abuse, as are burns. Skull and other bone fractures are often seen in young abused children, and in fact, head injuries are the leading cause of death from abuse. Children less than one year old are particularly vulnerable to injury from shaken baby syndrome. Physical abuse also causes a wide variety of behavioral changes in children.

Emotional Abuse

Emotional abuse can happen in many settings: at home, at school, on sports teams, and so on. Some of the possible symptoms include loss of self-esteem, sleep disturbances, headaches or stomach aches, school avoidance, and running away from home.

Sexual Abuse

The two prerequisites for this form of maltreatment are sexual arousal towards children and the willingness to act on this arousal. Factors that may contribute to this willingness include alcohol or drug abuse, poor impulse control, and a belief that the sexual behaviors are acceptable and not harmful to the child. The chances of abuse are higher if the child is developmentally handicapped or vulnerable in some other way. Genital or anal injuries or abnormalities (including the presence of sexuallytransmitted diseases) can be signs of sexual abuse, but often there is no physical evidence for a doctor to find. In fact, physical examinations of children in cases of suspected sexual abuse supply grounds for further suspicion only 15 to 20 percent of the time. Anxiety, poor academic performance, and suicidal conduct are some of the behavioral signs of sexual abuse but are also found in children suffering other kinds of stress. Excessive masturbation and other unusually sexualized kinds of behavior are more closely associated with sexual abuse itself.

Neglect

Many cases of neglect occur because the parent experiences strong negative feelings toward the child. At other times, the parent may truly care about the child but lacks the ability or strength to adequately provide for the child's needs because handicapped by depression, drug abuse, mental retardation, or some other problem. Neglected children often do not receive adequate nourishment or emotional and mental stimulation. As a result, their physical, social, emotional, and mental development is hindered. They may, for instance, be underweight, develop language skills less quickly than other children, and seem emotionally needy.

Parental Concerns

When children reach age three, parents should begin teaching them about "bad touches" and about confiding in a suitable adult if they are touched or treated in a way that makes them uneasy. Parents also need to exercise caution in hiring babysitters and other caretakers. Anyone who suspects abuse should immediately report those suspicions to the police or their local child protection services agency, which is usually listed in the blue pages of the telephone book under Rehabilitative Services or Child and Family Services, or in the yellow pages. Round-the-clock crisis counseling for children and adults is offered by the Childhelp USA/IOF Foresters National Child Abuse Hotline. The National Committee to Prevent Child Abuse is an excellent source of information on the many support groups and other organizations that help abused and at-risk children and their families. One of these organizations, National Parents Anonymous, sponsors 2,100 local self-help groups throughout the United States, Canada, and Europe. Telephone numbers for its local groups are listed in the white pages of the telephone book under Parents Anonymous or can be obtained by calling the national headquarters.

When to Call the Doctor

Physical signs of abuse may include bruises, especially those in different stages of healing, bruises in the shape of an object, such as fingers, a ring, or a belt buckle; unexplained burns, black eyes, or broken bones; vaginal or rectal bleeding, pain, itching, swelling or discharge; a vacant stare or dazed appearance; frequent attempts to run away; and sexual promiscuity.

Behavioral signs of child abuse include: low self esteem; flinching or ducking from motion or people moving towards them; eating disorders or loss of appetite; self mutilation such as "cutting," biting oneself or pulling out hair; unusual habits like rocking, sucking cloth; extreme changes in behavioral patterns; poor interpersonal relationships or a lack of self-confidence; clinginess, withdrawal or aggressiveness; regressing to infantile behavior such as bedwetting, thumb sucking or excessive crying; recurrent nightmares, disturbed sleep patterns, or a sudden fear of the dark; unexplained fear of a particular person; unusual knowledge of sexual matters; acting much younger or older than chronological age; frequent lying, or a fall in grades at school; and depression.

It is important to remember that some of these symptoms of child abuse can be normal manifestations of play and activity. Other symptoms could be the result of a traumatic event that is not necessarily abuse, such as divorce. Still, others are definitely "red flag" symptoms of abuse. If any physical signs of abuse appear, get medical help immediately. Talk frankly with the doctor and share any concerns about possible abuse. If there is physical proof of abuse, get a doctor's report in writing. Any behavioral signs of abuse are cause for concern to a good parent, teacher, or caregiver. A good first move is to open and nurture trusting lines of communication. The parent should increase the time spent with the child and increase the attention given to the child. The parent should show more interest in the child's life and ask more questions. The parent needs to assure the child of the parent's unqualified love and support, and make sure the children know that the parent wants them to feel happy and confident. Children need to know that no matter what has happened, their parents will always love them.

Resources

Books

Browne, Kevin, et al. Early Prediction and Prevention of Child Abuse: A Handbook. Hoboken, NJ: John Wiley & Sons, 2002.

Crosson-Tower, Cynthia. Understanding Child Abuse and Neglect, 6th ed. Upper Saddle River, NJ: Allyn & Bacon, 2004.

Richardson, Sue, and Heather Bacon. Creative Response to Child Sexual Abuse: Challenges and Dilemmas. London: Jessica Kingsley Publishers, 2003.

Periodicals

Bechtel, Kirsten, et al. "Characteristics that Distinguish Accidental from Abusive Injury in Hospitalized Young Children with Head Trauma." Pediatrics 114 (July 2004): 165–69.

Bensley, Lillian, et al. "Community Responses and Perceived Barriers to Responding to Child Maltreatment." Journal of Community Health 29 (April 2004): 141–53.

Brunk, Doug. "Complete Physical Key When Abuse Suspected: History May Be Unreliable." Family Practice News (April 1, 2004): 82.

——. "The True Incidence of U.S. Child Abuse Deaths Unknown: Fragmented Surveillance System Blamed." Family Practice News (April 1, 2004): 82.

Fritz, Gregory K. "A Child Psychiatrist's Dream: Ending Child Abuse." The Brown University Child and Adolescent Behavior Letter 20 (September 2004): 8.

Organizations

Child Welfare Information Gateway. 1250 Maryland Avenue, SW, Eighth Floor, Washington, DC 20024. Web site: www.childwelfare.gov.

National Council on Child Abuse and Family Violence. 1025 Connecticut Ave. NW, Suite 1012, Washington, DC 20036. Web site: www.nccafv.org.

Web Sites

"Child Maltreatment 2002: Summary of Key Findings." National Clearinghouse on Child Abuse and Neglect Information, April 2004. Available online at (accessed November 9, 2004).

"Recognizing Child Abuse: What Parents Should Know." Prevent Child Abuse America, 2004. Available online at www.preventchildabuse.org/learn_more/parents/recognizing_abuse.pdf (accessed November 9, 2004).

[Article by: Howard Baker, RN; Ken R. Wells]

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For more information on child abuse, visit Britannica.com.

Child Abuse refers to intentional or unintentional physical, mental, or sexual harm done to a child. Child abuse is much more likely to take place in homes in which other forms of domestic violence occur as well. Despite a close statistical link between domestic violence and child abuse, the American legal system tends to treat the two categories separately, often adjudicating cases from the same household in separate courts. Some think this practice has led to an inadequate understanding of the overall causes and dynamics of child abuse, and interfered with its amelioration.

The treatment of child abuse in law has its origins in Anglo-American common law. Common law tradition held that the male was head of the household and possessed the authority to act as both disciplinarian and protector of those dependent on him. This would include his wife and children as well as extended kin, servants, apprentices, and slaves. While common law obligated the male to feed, clothe, and shelter his dependents, it also allowed him considerable discretion in controlling their behavior. In the American colonies, the law did define extreme acts of violence or cruelty as crimes, but local community standards were the most important yardstick by which domestic violence was dealt with. Puritan parents in New England, for example, felt a strong sense of duty to discipline their children, whom they believed to be born naturally depraved, in order to save them from eternal damnation. Although Puritan society tolerated a high degree of physicality in parental discipline, the community did draw a line at which it regarded parental behavior as abusive. Those who crossed the line would be brought before the courts.

In the nineteenth century the forces of industrialization and urbanization loosened the community ties that had traditionally served as important regulators of child abuse and neglect. The instability of market capitalism and the dangers posed by accidents and disease in American cities meant that many poor and working-class families raised their children under extremely difficult circumstances. At the same time, larger numbers of child victims now concentrated in cities rendered the problems of child abuse and neglect more visible to the public eye. Many of these children ended up in public almshouses, where living and working conditions were deplorable.

An expanding middle class viewed children less as productive members of the household and more as the objects of their parents' love and affection. While child abuse did occur in middle-class households, reformers working in private charitable organizations began efforts toward ameliorating the problem as they observed it in poor and working-class families. Although the majority of cases brought to their attention constituted child neglect rather than physical abuse, reformers remained remarkably unsympathetic to the social and economic conditions under which these parents labored. Disadvantaged parents commonly lost parental rights when found guilty of neglecting their children. The parents of many institutionalized children labeled as "orphans" were actually alive but unable to provide adequate care for them.

In 1853 the Reverend Charles Loring Brace founded the New York Children's Aid Society. Convinced that the unhealthy moral environment of the city irreparably damaged children and led them to engage in vice and crime, Brace established evening schools, lodging houses, occupational training, and supervised country outings for poor urban children. In 1854 the Children's Aid Society began sending children it deemed to be suffering from neglect and abuse to western states to be placed with farm families. Over the next twenty-five years, more than 50,000 children were sent to the West. Unfortunately, the society did not follow up on the children's care and many encountered additional neglect and abuse in their new households.

Reformers of the Progressive Era (circa 1880–1920) worked to rationalize the provision of social welfare services and sought an increased role for the state in addressing the abuse and neglect of dependent individuals under the doctrine of parens patriae (the state as parent). In 1912 the White House sponsored the first Conference on Dependent Children, and later that year the U.S. Children's Bureau was established as the first federal child welfare agency. Child welfare advocates in the Progressive Era viewed the employment of children in dangerous or unsupervised occupations, such as coal mining and hawking newspapers, as a particular kind of mistreatment and worked for state laws to prohibit it.

The increasing social recognition of adolescence as a distinct stage of human development became an important dimension of efforts to address child abuse. Largely influenced by the work of psychologist G. Stanley Hall, reformers extended the chronological boundaries of childhood into the mid-teens and sought laws mandating that children stay in school and out of the workforce. Reformers also worked for the establishment of a juvenile justice system that would allow judges to consider the special psychological needs of adolescents and keep them separated from adult criminals. In 1899, Cook County, Illinois, established the nation's first court expressly dealing with minors. Juvenile courts began to play a central role in adjudicating cases of child abuse and neglect. Over the following decades the number of children removed from their homes and placed into foster care burgeoned. The Great Depression magnified these problems, and in 1934 the U.S. Children's Bureau modified its mission to concentrate more fully on aiding dependents of abusive or inadequate parents.

By the mid-twentieth century, the medical profession began to take a more prominent role in policing child abuse. In 1961, the American Academy of Pediatrics held a conference on "battered child syndrome," and a sub-sequent issue of the Journal of the American Medical Association published guidelines for identifying physical and emotional signs of abuse in patients. States passed new laws requiring health care practitioners to report suspected cases of child abuse to the appropriate authorities. The Child Abuse Prevention and Treatment Act of 1974 gave federal funds to state-level programs and the Victims of Child Abuse Act of 1990 provided federal assistance in the investigation and prosecution of child abuse cases.

Despite the erection of a more elaborate govern-mental infrastructure for addressing the problem of child abuse, the courts remained reluctant to allow the state to intrude too far into the private relations between parents and children. In 1989, the Supreme Court heard the landmark case DeShaney v. Winnebago County Department of Social Services. The case originated in an incident in which a custodial father had beaten his four-year old son so badly the child's brain became severely damaged. Emergency surgery revealed several previous injuries to the child's brain. Wisconsin law defined the father's actions as a crime and he was sentenced to two years in prison. But the boy's noncustodial mother sued the Winnebago County Department of Social Services, arguing that caseworkers had been negligent in failing to intervene to help the child despite repeated reports by hospital staff of suspected abuse. Her claim rested in the Fourteenth Amendment, which holds that no state (or agents of the state) shall "deprive any person of life, liberty, or property, without due process of law; nor deny to any person within its jurisdiction the equal protection of the laws." The Court, however, ruled that the Fourteenth Amendment protects citizens' rights from violations arising from actions taken by the state—not from actions it may fail to take. The boy had not been in the custody of the state, such as in a state juvenile detention center or foster home, when the violence occurred, and therefore, the Court said, no special relationship existed between the child and the state. In other words, children did not enjoy an affirmative right to be protected by the state from violence committed by their custodial parents in the privacy of the home.

Many advocates for victims of domestic violence criticized the ruling, arguing that it privileged the rights of abusive parents over the best interests of children, and worked toward reforming the law. The federal Adoption and Safe Families Act (ASFA) of 1997 established new guidelines for the states that included mandatory termination of a parent's rights to all of his or her children when the parent had murdered, committed a felony assault on, or conspired, aided, or abetted the abuse of any of his or her children. Laws in all fifty states require parents to protect their children from being murdered by another member of the household; failure to do so may result in criminal liability and loss of rights to other of their children. AFSA extended these liabilities to include a parent's failure to protect a child from felony assault. While the act's intent was to promote the best interests of children, critics have noted that this has not necessarily been the result. Prosecutors, for example, have been able to convict mothers who failed to protect their children from violence in the home even though they were also victims of the abuser. Thus, children have been taken from the custody of a parent who did not commit abuse and who could conceivably provide appropriate care after the actual perpetrator was removed from the home.

Bibliography

Costin, Lela B., Howard Jacob Krager, and David Stoesz. The Politics of Child Abuse in America. New York: Oxford University Press, 1996.

Gordon, Linda. Heroes of Their Own Lives: The Politics and History of Family Violence, Boston, 1880–1960. New York: Viking, 1988.

Rothman, David J. The Discovery of the Asylum: Social Order and Disorder in the New Republic. 2d ed. Boston: Little, Brown, 1990.

—Lynne Curry

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This entry contains information applicable to United States law only.

Physical, sexual, or emotional mistreatment or neglect of a child.

Child abuse has been defined as an act or failure to act on the part of a parent or caretaker that results in the death, serious physical or emotional harm, sexual abuse, or exploitation of a child, or which places the child in an imminent risk of serious harm (42 U.S.C.A. § 5106g). Child abuse laws raise difficult legal and political issues, pitting the right of children to be free from harm against the right of families to privacy and the rights of parents to raise and discipline their children without government interference.

The mistreatment of children at the hands of parents or caretakers has a long history. For centuries, this behavior was shielded by a system of laws that gave children few if any rights. Under English common law, children were treated as property owned by the parents and parents, particularly fathers, had great latitude over the treatment and discipline of children. This outlook was carried to the American colonies and incorporated into early laws in the United States.

One of the first cases to bring national attention to child abuse arose in the early 1870s. An eight-year-old New York orphan named Mary Ellen Wilson complained of being whipped and beaten nearly every day by her foster family. Her case captured the attention of the American Society for the Prevention of Cruelty to Animals (ASPCA). An attorney for the ASPCA took Wilson's case, arguing that as members of the animal kingdom, children are entitled to the same legal protections from cruelty as are animals. A judge heard evidence that Wilson's foster family, the Connollys, routinely beat her, locked her in a bedroom, and made her sleep on the floor. Charged with assault and battery, Wilson's foster mother was convicted and sentenced to one year of hard labor. Even more significantly, publicity surrounding Wilson's case led to the establishment, in 1874, of the New York Society for the Prevention of Cruelty to Children. The following year the New York Legislature passed a statute that authorized such societies to file complaints of child abuse with law enforcement agencies.

In 1962 an article in a major medical journal again brought national attention to the issue by identifying the symptoms that can indicate child abuse. The article, by Dr. Henry Kempe, appeared in the Journal of the American Medical Association and discussed a diagnosis for child abuse. The article resulted in widespread awareness of child abuse and prompted further public discussion on how to address the problem. By 1970, every state had enacted laws requiring certain professionals, such as teachers and doctors, to report incidents of suspected child abuse to law enforcement agencies. In 1974 the Federal Child Abuse Prevention and Treatment Act (42 U.S.C.A. §§ 5105-5106) became law, authorizing federal funding for states to identify child abuse and offer protective services for abused children.

Statutes make up one component of a state's child protective services; another component, the child protective services agency, implements the statutes. Reporting statutes, which vary from state to state, require that certain professionals report suspected child abuse, whereas others, such as neighbors, are entitled but not required to. Other statutes define child abuse. For example, in some states, physical abuse occurs only when a child suffers a specified type of injury, whereas in other states, any serious injury that is not accidental in nature is considered abuse. Sexual abuse of children generally need not cause injury; any sexual act performed on a child can be considered abuse. Similarly, state statutes categorize as child abuse any neglect of a child that places the child at risk, regardless of whether the child is actually injured. Before substantiating a report of emotional abuse of a child, state statutes generally require a finding of actual harm. Still other statutes specify procedures for investigating child abuse, determining whether a report of abuse is substantiated, intervening to protect an abused child from further harm, and maintaining records of child abuse reports.

When allegations of abuse meet the statutory definitions, the state child protective services agency or a law enforcement agency steps in to investigate. Child protective services agencies generally investigate allegations only when the child's parent or guardian is suspected of causing the abuse or allowing it to occur. There is a presumption that the parent or guardian will protect the child from abuse by other parties and will contact law enforcement agencies to investigate incidents of abuse by other parties when the parent is not causing or allowing the abuse.

Caseworkers for child protective services investigate abuse allegations most commonly by interviewing or visiting with the child, the child's parents or guardians, and other sources such as physicians and teachers. If an agent finds evidence that supports a conclusion that the child was abused, the agency deems the allegations substantiated. The next step is intervention.

Intervention can mean many different things. Frequently, when the risk of further abuse is immediate and significant, child protective services agents will place the child temporarily in a foster home. Alternatively, agents may monitor the family or provide counseling to curb the threat of abuse. If a family does not cooperate with the intervention efforts of child protective services, the agency may take the case before a judge, who may determine that abuse or neglect has occurred and issue a court order mandating the agency's intervention. In extreme cases, agents may remove the child from the home permanently; following a judicial termination of parental rights, the child is then placed for adoption.

Another function of state child protective services is record keeping, which is accomplished through a system known as the central registry. The central registry contains information about child abuse reports — both substantiated and unsubstantiated — such as the names of the child and of the suspected abuser and the final determination made by the child protective services worker. This system helps agents investigating current reports of abuse because it allows them to compare any previous accusations, particularly within the same family. The registry also supplies statistics about child abuse, which help the agency and the state legislature enact appropriate laws and policies and provide adequate funding for child protective services. Also, in some states, other parties may have access to the registry. For example, a day care center may check the registry before hiring child care employees, or an adoption agency may check the registry before placing an infant with a family.

There is little argument that state child protective services agencies provide a valuable service by responding to allegations of child abuse. But such agencies also have their critics. Many people accused of child abuse, particularly parents, object to the way these agencies routinely remove children from their homes when child abuse is suspected. Children are traumatized by being taken from their parents, and allegations of abuse are frequently unfounded, these critics claim. Contentious child custody battles sometimes prompt false accusations of physical or sexual abuse, costing the accused time and money in the fight to reclaim their children and their reputations. Others object to the names of the accused being included on the central registry even when the accusations are unsubstantiated. The backlash against child protective services spurred the establishment, in 1984, of an information and support group known as Victims of Child Abuse Laws (VOCAL). VOCAL claims to have thousands of members nationwide and members lobby for new laws that protect not only children but also parents who are falsely accused of being abusive or negligent.

Despite increased legislation and penalties for child abuse, extreme cases continue to appear and to sustain the debates over child abuse laws. Such cases include the Schoo case in suburban Chicago, which received widespread media coverage. In December 1992, David Schoo, a forty-five-year-old electrical engineer, and his thirty-five-year-old wife, Sharon Schoo, a homemaker, flew to Acapulco for a Christmas vacation, leaving their daughters, nine-year-old Nicole Schoo and four-year-old Diana Schoo, home alone. The Schoos provided their daughters only cereal and frozen dinners to eat and a note telling them when to go to bed. One day during their parents' absence, the girls left the house when a smoke alarm sounded. As they stood barefoot in the snow, a neighbor found them, learned of their plight, and called the police.

The Schoos were arrested while still on the plane that returned them from Mexico nine days after they left their children. Following their indictment on various state charges of child endangerment and cruelty, a grand jury also found evidence that the Schoos had beaten, kicked, and choked their children to discipline them. In April 1993, the Schoos plea bargained, agreeing to serve two years of probation and thirty days of house arrest while the girls remained in foster care. In August 1993, the Schoos agreed to give up their parental rights and placed their daughters for permanent adoption.

Another nationally publicized case raised questions regarding the effectiveness of child protective services and implicated social workers charged with protecting the victim. Two-year-old Bradley McGee, of Lakeland, Florida, died in July 1989 from massive head injuries after his stepfather, twenty-three-year-old Thomas E. Coe, repeatedly plunged him headfirst into a toilet. Coe later testified that he had become angry when the child soiled his pants. McGee's twenty-one-year-old mother, Sheryl McGee Coe, pleaded no contest to second-degree murder and aggravated child abuse for allowing her husband to abuse McGee, and received a thirty-year prison sentence. Thomas Coe, convicted of first-degree murder and aggravated child abuse, received a sentence of life in prison.

The McGee case alarmed the public not only because of the harsh physical abuse that caused the toddler's death but also because of what many perceived to be a failure in the system designed to protect children like McGee. Two months before his death, McGee had been living with foster parents owing to allegations of abuse at the hands of the Coes. Despite strong objections by the foster parents, caseworkers for Florida's Health and Rehabilitative Services returned McGee to his mother and stepfather, determining them to be fit parents.

Public reaction was strong following the news of McGee's death. Four social workers were prosecuted for negligently handling the case but only the main caseworker, Margaret Barber, was convicted, for disregarding a report from a psychologist who warned that the Coes were unfit parents. The publicity shed light on problems within Florida's child protective services agency, including severe understaffing, and led to new laws emphasizing keeping children safe over keeping families together and increasing funding for more social workers. A Florida appellate court later overturned Barber's felony conviction but left standing a misdemeanor conviction for failing to report child abuse.

Legislation at the state and federal levels continues to change to meet the goal of protecting children from abuse and neglect while protecting families from the damage of false accusations.

See: family law; parent and child.

Human beings can go to great lengths to care for and to protect children; yet since history began children have been abused. It was not, however, until the 19th century that social reformers in Europe and North America influenced legislation by showing that children employed under conditions accepted as normal were in fact being seriously abused.

Awareness that the two contradictory states, caring for children yet abusing them, could exist side by side was not evident among members of the medical profession and many others caring for children until very recently. Despite a description in 1888 of the signs of child abuse, it was not until Henry Kempe and his associates published in 1962 the now classic paper, emotively entitled 'The Battered Child Syndrome', that professional eyes opened. Shock and initial disbelief were followed by a growing acceptance of Kempe's findings, leading to an extensive literature and registers of children at risk. This sharpening of awareness is illustrated by the paediatrician who, in a recent presidential address, while pointing out clear-cut and unequivocal signs of physical abuse in infants and young children, stated that over a period of seven years of general paediatric practice he had never seen a case of child abuse because he had not been looking for it.

The term 'child abuse' refers to a number of areas and is usefully considered under three headings. These cover:

(i) general neglect, systematic poisoning, and physical violence — which in recent years has been euphemistically relabelled non-accidental injury;
(ii) sexual abuse, which since the late 1970s has become increasingly recognized and found to be widespread; and
(iii) psychological abuse, a concept that is gaining ground.

It is safe to work on the assumption that children subjected to any form of general physical or sexual abuse will also suffer psychological abuse. Moreover, many children who are not physically abused are deliberately made to suffer painful psychological states such as fear, rejection, and loneliness which constitute abuse. The statements that follow refer to findings on non-sexual physical abuse.

All figures on the extent of child abuse are at best imprecise estimates. Furthermore, findings from different studies are not easily compared because workers tend to focus upon different aspects of the subject and to express their findings in different ways. It can however be estimated that in the USA approximately one in every 100 children under 18 is physically abused, sexually molested, or severely neglected; the figure is probably about the same for England and Wales. It is a conservative estimate that up to 10 per cent of abused children die, and that at least 25 per cent suffer serious neurological damage with impairment of intelligence. The epidemiology of child abuse has been reviewed by Jack Oliver (in Smith 1978). Since about 1960 the figures have tended to increase, but it is an unanswerable question whether this reflects greater recognition of the condition or an actual increase in its extent.

Child abuse is not a haphazard occurrence, despite evidence that anyone sufficiently stressed by adversity is liable to abuse a child judged uncooperative. As a group, abusers show certain characteristics, although many people with the same characteristics do not abuse children. For instance, abusers are most frequently parents, step-parents, or others in charge of the child. Parents who abuse tend to be young, unskilled, and often from lower social classes. Criminality, recidivism, and low intelligence are common, whereas mental illness, severe alcoholism, and drug addiction are less frequently found. There is evidence that many abusers show disorders of personality, or neuroses coupled with a sense of low self-esteem, but there is no homogeneous personality profile. They tend to have difficult relationships with their spouses or partners, family, and friends, and consequently have little support or help despite, frequently, suffering hardships such as poor housing and unemployment.

Abusing parents have themselves usually been abused as children. They frequently function at the emotional level of a young child, and the abuse occurs during outbursts of uncontrolled anger. They have, almost always, unrealistic expectations of the abused child, who is expected to be obedient and empathic to the parent's needs, and to have a degree of control over natural functions and behaviour appropriate to a much older child or to an adult. This feature is frequently so marked as to constitute a role reversal: it is as if the child is expected to be the parent of the parent.

There is no one set of characteristics that distinguishes children who are abused, although there is evidence that some groups are especially vulnerable: for instance, the youngest child, any under two years, the premature, and children with congenital deformities. Commonly one child in a family is abused more than the others.

There is now evidence that it is a common human characteristic for parents not to feel love immediately for their newly born offspring and that a loving, protective attitude becomes established as a result of social interaction between infant and parents, in which each plays a part — a process often referred to as 'bonding' (see attachment). In many instances of abuse associated with difficult family relationships, the ability of parents to develop their capacities to protect and to care consistently for an infant appears to be limited. In such families particular dynamic patterns can be identified. For example, so long as the infant is an 'easy baby', rewarding to handle and healthy, all may be well, and while this state continues the infant may be protected and loved. Intense anger, associated with irresistible impulses to force the child to comply with the parent's wishes, is, however, aroused whenever the infant's behaviour leads one, or both, parents to feel inadequate (the irritable or sickly baby, the baby who is difficult to feed or to pacify), or to feel rejected by the baby (the unresponsive baby who seldom smiles). In other instances, anger is directed towards the baby because the relationship cannot be isolated from the relationships the parents have with each other or with other members of the family.

Some common examples of family dynamics associated with abuse are:

(i) the parents feel they are in some way to blame, because the child is malformed, or because the child's physical attributes or sex do not meet with family or cultural expectations.
(ii) One parent, usually the father, or a sibling, feels unloved and jealous because of the attention given to the baby by the other parent.
(iii) Anger aroused by someone towards whom a parent cannot show anger is redirected towards the baby, who cannot retaliate.
(iv) Abuse is a Medea-like attempt on the part of one spouse to take revenge on the other. The assumption is that it will hurt that spouse if the baby is hurt.
(v) A love-hungry parent may demand an unrealistic degree of altruistic devotion, companionship, and love from a child — who is attacked because he or she cannot meet these expectations. An overview of the subject of child abuse has been edited by Ellerstein (1981).

We are still far from constructing a comprehensive theoretical model to explain social behaviour in man, and it may never be possible to explain all instances of child abuse by a single model. For example, abuse by parents who suffer recognizable mental illness — when the abuse is often bizarre — may have a distinctive origin. Nevertheless, many of the characteristics described above are seen frequently enough to suggest that it may be possible to find a theory that will allow useful predictions to be made in many instances of child abuse. The model would have to explain why intensely angry impulses towards a child are regularly aroused whenever the behaviour of the child results in a parent feeling inadequate, lonely, or rejected. Ethologists such as Konrad Lorenz have suggested that harmful behaviour to babies and young animals is inhibited by an innate releasing mechanism which responds to the total configuration characterizing 'babyishness'. For some unknown reason those who abuse their children are apparently not endowed with this innate response to their offspring's behaviour and morphological features. The most comprehensive theory available today postulates that anger as described above is an emotional response to rejection and to a sense of inadequacy. This is attachment theory, formulated by John Bowlby and elaborated by Mary Ainsworth.

Attachment theory has been described as 'programmatic', in that it acts as a guide to understanding data and to further research. It can be seen as a new paradigm for understanding social development. The theory has integrated several major trends in biological and social science. It is based on the assumptions

(i) that behaviour is organized around plans to reach set goals,
(ii) that in order to reach goals one has to have internal representations, or working models, of the world in which one acts, and of one's self in action in that world, and
(iii) that behaviour is governed by control systems — kinds of mechanisms such that certain behaviour is evoked by specific circumstances and terminated by others.

Using these basic assumptions, attachment theory postulates that the infant is born with the potential to develop an internal behavioural system mediating attachment behaviour. The goal of attachment behaviour is to attain physical closeness to and interaction with familiar, more experienced people (attachment figures). Attachment behaviour can be activated at any age, and is aroused whenever strangeness, fear, or physical states such as hunger, fatigue, or malaise are experienced. There is also a complementary inbuilt system, usually fully functional in adults, which mediates parental caregiving. Caregiving behaviour, when effective, terminates attachment behaviour in another person, and restores a child (or indeed another adult) to a state in which he or she is able to explore and to enjoy the surrounding world and relate to others in a caregiving way. Without such experience of caregiving the child, or adult, feels angry and rejected; angry protests then alternate with states of despair.

Child abuse is difficult to treat; but in many instances it is possible, after the first discovery of abuse, to promote the development of effective parental caregiving behaviour, by providing understanding helpers who act, as it were, as surrogate grandparents, taking an active part in supporting and educating parents so that they can achieve a sense of attainment about their lives and parental responsibilities.

Punishment of abusing parents is singularly ineffective. A reason for this can be predicted from attachment theory. Punishment, insofar as it evokes fear and feelings of rejection, arouses the parents' own attachment behaviour and leaves them unassuaged. Moreover, the parents are not helped to develop effective parental behaviour.

It is an important preventive measure to take steps to promote the development of affectionate parent–child relationships, by ensuring that the child and parents have the opportunity to interact right from birth onward, and so build up the new relationships. There is now growing evidence (Bretherton and Waters 1985) that development of harmonious relationships between parents and child is facilitated first by close physical contact between them in a supportive, comforting environment immediately after birth followed by responsive, supportive, and companionable interaction thereafter.

Nevertheless, in some instances it is found that, even with help, a parent's capacity to care for a child reliably and consistently cannot be sufficiently developed. Then a second home, with consistent and loving surrogate parents, has to be found for the child, in order to ensure not only that he survives but that his development in all its aspects proceeds as well as possible. Without such measures an abused child is unlikely to become an effective parent when he grows up, and is liable to continue the tragic tradition of abuse into which he was born.

(Published 1987)

— Dorothy H. Heard

Bibliography
• Bretherton, I., and Waters, E. (eds.) (1985). Growing Points of Attachment Theory and Research.
• Ellerstein, N. S. (ed.) (1981). Child Abuse and Neglect: A Medical Reference.
• Oates, K. (1996). The Spectrum of Child Abuse: Assessment, Treatment and Prevention.
• Smith, S. M. (ed.) (1978). The Maltreatment of Children.

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