The purpose of this paper is to research the subject of childhood abuse in view of what is suffered both immediately and on the long-term basis in relation to the child's psychological, biological and social development.
Child abuse is all too common in today's world and is a subject that is almost daily splashed across the news. Physical abuse is by Merck Manual as being "battery'. Battery has the same meaning as physical violence to the body. Further the manual reveals that it is an element in every race and throughout every layer of societal structure leaving no one race, sex, group, or religion unscathed by its' effects. Two million children are abused in the United States each year; the numbers are likely much higher with 2000 to 5000 children dying each year as a result of abuse or neglect.
Indeed, child abuse may occur in the most unlikely of families leaving scars for the duration of the life of the individual who was abused.
I .Statistical Information:
Although every representative individual sector and subset group in society has to death with this issue sooner or later, statistical information reveals that of all children the children of poor families are twelve times more likely to be a victim of abuse. One-fourth of children that are abused are older than two years of age. In a survey performed by the United States in 2002 revealed that 53% of the cases involved neglect, physical abuse was present in 26% of confirmed cases, 14% was sexual abuse cases and 5% emotional abuse. The male and female children were equally effected and 20% of the children were permanently injured. In fact, the report stated that each year somewhere between the number of one-thousand and twelve-hundred children die from abuse.
II. The Pediatric Doctor: Responsibility to Report to Authorities:
The attending physician of a child is generally required to report suspected abuse to the authorities. Child abuse is not always easy to detect. According to the Merck Manual:
'Abuse: Generally abuse is caused by the breakdown of impulse control in the parent or guardian." (Merck Manual)
Four contributing factors are stated by Merck Manual as being that of:
1. Parental Personality Features:
Parental personality features is that in which the parent is cold or non-caring leaving the child feeling abandoned. Due to the lack in early bond-forming relationships the child will not mature mentally and emotionally in a normal pace or in a normal capacity.
2. A "difficult" child:
Irritability is something the child is likely develops if left at an early age with caretakers.
3. Inadequate support.
Every parent needs a network of people that they can talk to and rely on for wise advice.
4. A crisis:
Stress that is due to a situation or situational stress and is common when the parent has no support network
III. Background and History of Child Abuse:
The following are inclusive in Merck's attributed 'manifestations of abuse':
1. Parents reluctance in providing history of injury
2. A background that is incompatible with historically with the "apparent state of resolution."
3. History of injury seen as incompatible in relation to the developmental capacity of the child.
4. Inappropriate response by the parents as to the level of severity.
Children that are neglected or abuse have tendency for lower IQs as well as a tendency to suffer from depression. Approximately seventy percent the abusers are family members. Forty percent of female children and thirty percent of male children are molested.
Common physical signs were listed as to be those such as skin lesions: ecchymoses, hematomas, burns, welts, abrasions. The diagnostic considerations the physician must focus toward during examining the patient are:
1. Multiple injuries at different stages of resolution or development.
2. Cutaneous lesions specific for particular sources of injury; and
3. Repeated injury which is suggestive of abuse or inadequate supervision.
The signs of 'sexual abuse' are listed as difficulty in walking, sitting as well as genital trauma, vaginal discharge or pruritus, recurrent UTIs or a sexually transmitted disease infection.
According to the Merck Manual, 'emotional abuse symptoms' are not so easily recognizable. In children still at the age of an infant "failure to thrive" is listed as Merck's definitive of noting that abuse is occurring. Neglect manifests in the demonstration of malnutrition, fatigue, lack of hygiene care and appropriate clothing, food shelter in spite of available support in the community. Blunting may occur leaving the child unable to cope with other individuals and lacking in social skills.
IV. Fatalities Resulting from Abuse & Neglect:
According to the report of the National Child Abuse and Neglect Data System (NCANDS) there are an estimated 100,000 children die each year as a result of neglect or abuse.
There are also those that believe that the abuse of children as well as fatalities which occur are not reported by many. Studies performed in Colorado and North Carolina has revealed that as many as 50 to 60% of deaths that was result of abuse of neglect are not recorded. (Crume, Diguiseppi, Byers, Sorotnak, Garrett, 2002; Herman-Giddens, Brown, Verbiest, Carlson, Hooten et al. 1999)
The following chart shows the children most vulnerable by age groups and risk.
According to the NCANDS report during the year 2002 more than 38% of fatalities of children were cases attributed to neglect only. Physical abuse was present in more than 30% of the fatalities that were reported. Those cases that resulted from multiple-maltreatment were 29%.
V. The Psychological Effects of Abuse in Children:
Children who are survivors of abuse are likely to suffer from Post Traumatic Stress Disorder (PTSD). The following are symptoms noted by the medical professionals as likely to surface in cases of child PTSD:
Recurrent and intrusive recall of the event inclusive of images, thoughts, or perceptions. Young child may have repetitive replay in which the themes or aspects of the trauma are expressed.
Recurrent dreams or nightmares of the event including a feeling of reliving the experience.
Acting or feeling as it the event is of the nature of reoccurring
Intense psychological distresses at exposure to the internal or external clues that symbolize of resemble an aspect of the traumatic event.
Symptoms of increased arousal include difficulty falling asleep or staying awake as well as irritability and anger outbursts. Further there is difficulty concentrating, hyper vigilance and exaggerated startle response. According to the American Psychiatric Association these symptom will last up to a month and many time much longer.
According to the article "The Facts of Life: Issues Briefing for Health Reporters Publication Volume 4, Issue Number 2, 1999:
"Adults survivors of childhood physical, emotional, or sexual abuse are not only at increased risk for depression and other mental health disorders." However, recently released information makes as a suggestion the possibility that they are also more likely to suffer form heart-disease, obesity and other fatal physical conditions."
In a study performed at Columbia University it was found that, "women who were physically, sexually, or emotionally abused as children are significantly more likely to be hospitalized and to have a host of physical and mental health problems. Dr. James R. Moeller, Ph.D along with colleagues at Columbia University College of Physicians and Surgeons, after having studied 660 individuals stated that:
'It appears that abusive acts perpetrated towards children continue to carry detrimental psychological and physical consequences into the adult years for many women." (Meoller, 1999)
Yale University School of Medicine's J. Douglas Brenner, MD performed a study using the method of magnetic resonance imaging (MRI) in the exploration of the effects on the brain of having experienced abuse. Brenner's findings were that there existed 12% less, in terms of size, of the brain in those that are known to have survived childhood abuse. According to Rockerfeller University Researcher, Bruce McEwen, Ph.D:
"Apparently the brain plays an important price as a result of that trauma, believe me, there are other things going on in the brain besides damage to the hippocampus. This is just what we can put our finger on this time."
VI. Sexual Abuse Symptoms:
Instances of sexual abuse are on the rise according to Barbara E. Bogorad, Psy.D.A.B.P.P. In the work "Sexual Abuse Surviving the Pain." Estimates are that currently 1/3 of all children are sexually abused before the age of 11 years old. Children that have been abused are 53% more likely to become arrested as juveniles.
Symptoms of sexual abuse are inclusive of the development of low self-esteem as follows:
"Withdrawal and mistrust of adults, suicidal thoughts, difficulty in relating to others other than in a sexual manner, Sleep problems, nightmares, fear of going to bed, frequent accidents or self-injurious behaviors, refusal to go back to school or work or the doctor or home, secretiveness or unusual aggressiveness, sexual components to drawings and games, neurotic reactions (obsessions, compulsiveness, phobias, habit disorders (such as rocking or biting), always wears long sleeves (attempt to cover bruises), unusual…