Child Abuse Prevention

Blog contributed by Andrea Burks, DO, Heritage Pediatrics, PinnacleHealth Medical Group



April is child abuse prevention month.  In the United States of America there are approximately 3 million reports of child abuse and neglect each year involving 6 million children. 686,000 children were determined to be victims of abuse and neglect in 2012 and of those 1,640 resulted in death. That is greater than 4 child abuse related deaths per day. There are likely many more cases that are not reported. Child abuse and neglect happens at every socioeconomic level, across ethnic and cultural lines, within all regions and levels of education. Boys and girls are maltreated in equal numbers.  Children less than 4 years old are at greatest risk for severe injury and death from abuse. The most common abusers are parents, other family members, or an unmarried partner of a parent. Children who suffer maltreatment are at higher risk for cognitive delays, emotional difficulties, harm to development of nervous and immune systems, and health problems as adults. It is important to recognize, help prevent and report suspected child abuse and neglect because its lasting effects can impact us all. Small acts from everyone in a community can help save a child from harm.

The first step is to recognize child abuse. Child abuse can be physical, emotional, sexual, or involve neglect of a child by someone who has responsibility for the child. It is common for more than one type of abuse to occur at a time. It is important to note a single sign does not mean maltreatment has occurred but if signs appear repeatedly or in combination a closer look at the situation may be warranted.

• Physical abuse involves non accidental physical injury including but not limited to hitting, kicking, biting, burning, choking, shaking, and throwing. It often leaves bruising at different levels of healing, marks on body consistent with objects or hand prints, or unexplained bruises, black eyes, or broken bones. The physically abused child may wear clothing inappropriate for weather (e.g. long sleeves in hot weather to hide bruising). They may also be reluctant to go home or fearful of parents.
• Emotional abuse involves with holding love, support or guidance from a child. Emotional abuse is as strong a predictor of subsequent impairment in child development as physical abuse. Emotional abuse may include ignoring, rejecting, isolating, verbal assault, threatening, blame, belittling, or shaming the child in a persistent chronic pattern. The caregiver may appear unconcerned about the child. The child may show overly compliant or demanding behavior, be extremely passive or aggressive. They may speak of attempting suicide or they may report lack of attachment to parent.
• Sexual Abuse can involve engaging a child in sexual acts, exposing a child to sexual activities, indecent exposure, or exploitation of a child through pornographic material. Effects of sexual abuse extend beyond childhood. These children often have loss of trust and feelings of guilt. The child may show signs of regression such as bedwetting, rocking, head banging, stranger anxiety, withdrawal from family and friends, suddenly refuse to change clothes in gym, or refusal to participate in physical activities. The adults may appear extremely protective and limit contact of the child with other children.
• Neglect is failing to provide the basic needs for a child including food, clothing, shelter, proper hygiene, education, and medical attention. Neglect can also involve abandoning a child or putting a child in unsupervised or dangerous situations. The child may miss a lot of school, beg or steal from classmates or friends, or lack medical/dental care. They may have dirty clothes or clothing inappropriate for weather.

Prevention of child abuse and neglect is a community effort. Individuals in the community can play a role in helping families find the strength to raise safe, healthy, and productive children.  A majority of parents don't want to harm their children. Abusers are more likely to have been abused themselves and don't know other ways to parent. They may suffer from mental or chronic health problems, struggle with substance abuse, and commonly have high stress and lack of support. Parenting is one of the toughest and most important jobs. We all have a stake in ensuring parents have access to the support they need to be successful parents. You can start by getting to know your neighbors. Help a family under stress by offering to give them a break and babysit for a few hours, help run errands, help a parent with a small child get through checkout line at the grocery store, or reach out to children in the community. If a child discloses they are victims of abuse, first believe them, listen, and don't be critical or negative of child or parent. Assure the child they are not to blame and report the incident.

It is the right and responsibility of everyone in the community to report suspected child abuse or neglect. You can make a report by contacting your local child protective service agency or police department. You do not need to have evidence or actual knowledge of abuse to make a report. You should have reasonable cause, heightened concerns, or belief based on observation. Reporters can be anonymous but giving your name may help the investigation. Good Faith Laws protect the reporters from legal liability. Trust your instincts. Reporting your suspicions may protect the child and get help for a family who needs it.

If you are a parent under stress find ways to regain control. Try counting to 10, take deep breaths, call a friend, put your child in a safe place and take a few minutes to calm down and relax. Never be afraid to apologize to your child if you lose your temper and say something in anger that wasn't meant to be said. Reach out to community centers, church, schools, and physicians for guidance on positive parenting skills. It is often helpful to learn good communication skills, appropriate discipline, and how to respond to children's physical, developmental and emotional needs. Understanding appropriate developmental milestones may help you set reasonable expectations for a child. Creating social connections with family, friends and the community gives encouragement and can help improve parent child relationships. There is also concrete community support that assists with food, clothing, housing and access to healthcare.  You can contact you physician for information about these services.

In Pennsylvania report concerns for child abuse and neglect to ChildLine 1-800-932-0313