child abuse

The deliberate injury of a child. Child abuse can take several forms: neglect (including failure to provide adequate shelter, food, or medical treatment), physical abuse (including beating and poisoning), emotional abuse (including verbal abuse), and sexual abuse. In practice, a child is often subject to more than one form of abuse. In 1994, 1,271 children died from child abuse in the UK; over 80% were under five and nearly 50% under one. Child abuse has only been recognized as a serious problem since the 1960s but is now a major area of health, welfare, and legal practice. The protection of children from abuse ranks as a top priority in social work.

Neglect accounts for nearly half of the reported cases of abuse; physical abuse 25%; emotional abuse 3%. While the sexual abuse of children by adults accounts for only about 10% of cases, it receives the most attention. Child sexual abuse may take many forms: exposure (viewing of sexual acts, pornography, and exhibitionism), molestation (fondling of either the child's or the adult's genitals), sexual intercourse, and rape. Sexual abuse takes place most commonly within the family although it also occurs with neighbours and acquaintances of the child, as well as with complete strangers. An increasing number of cases are being investigated, and an increasing number of adults are now reporting that they were abused in childhood.

In 1994, over 3 million children were reported as victims of child abuse and neglect in the USA. Reporting levels in the USA increased 63% between 1985 and 1994. In 1996 California passed a law requiring child sexual-abuse offenders to be chemically castrated.

History Children have been exploited and abused for centuries. The importance placed on blood ties, the special nature of the parent–child relationship as the cornerstone of society, the family's right to privacy, and, until recently, the notion that children were the property of their parents, masked the extent of child abuse. Public awareness of its nature and frequency grew during the 1960s after the publication of ‘Battered Baby Syndrome’ (1962) by Henry Kempe, which focused attention on physical abuse. In the 1970s the more broadly defined term ‘child abuse’, which encompasses not only physical abuse but also neglect and emotional abuse, came to be used. It was not until the 1980s that the sexual abuse of children began to be recognized. In December 2000, a US study reported that child abuse can lead to aggression, personality disorders, poor emotional control, and impairment of memory and attention throughout adulthood.

Nature of abuse The majority of sexually abused children, about 75%, are girls, although a significant number of boys are also abused. Boys tend to be younger and more severely abused and for longer periods of time. Most of the perpetrators are men. Abuse may be one incident, occasional incidents, or a gradually escalating level of abuse. At the time, it may not be experienced as distasteful by the child, becoming a way of life that is only recognized as sexual abuse in adolescence. For others, it may be coercive and frequent from the beginning. Children of any age are at risk, and there may be more than one victim in the family. Many sexually abused children are under pressure by the perpetrator not to tell. There may be threats that the perpetrator will commit suicide, threats of violence, or threats that the child will be taken away from the home and put into care.

Contributing factors Child sexual abuse cannot be attributed to a single cause, as many factors, such as social circumstances and individual psychology, are involved. Alcohol, drugs, marital or sexual difficulties, absence of one of the parents, or a chaotic family life may all be contributing factors. Potential abusers often have a history of unstable, damaging, or violent adult relationships in which other forms of sexual and emotional gratification are obstructed. They frequently have a history of abusing children.

Consequences For the child, abuse often results in feelings of guilt, self-reproach, and humiliation as well as changes in behaviour, including withdrawal, inability to concentrate, lack of sleep, emotional outbursts, and weight loss. Abused children may experience delays in physical growth, impaired language and learning abilities, problems in personality development, and behavioural disorders. Emotional development may be delayed, preventing them from establishing normal personal and sexual relationships. Those who have been abused in childhood are at a high risk of abusing their own children. Abused children are often taken away from home and placed in a hospital or in foster care.

Prevention Preventative methods include imprisonment of offenders, screening of persons employed in child care, removal of the child from the custody of the offenders, and caution by parents about whom they allow to come into contact with their children. Because of the numerous problems involved in proving guilt, however, the emphasis has been on child education. Preventative educational programmes teach children about their bodies and the nature and appropriateness of different relationships, inform them of their rights and self-worth, and provide them with the skills to avoid sexual abuse and to report actual or potential abuse.