Child Abuse
was considered abusive. In 1999, the WHO Consultation on Child Abuse Prevention drafted the following definition: ‘‘Child abuse or maltreatment constitutes all forms of physical and/or emotional ill-treatment, sexual abuse, neglect or negligent treatment or commercial or other exploitation, resulting in actual or potential harm to the child’s health, survival, development or dignity in the context of a relationship of responsibility, trust or power.’’
The definition given above covers a broad spectrum of abuse. This paragraph focuses primarily on manifestations and consequences of three types of child maltreatment, namely: physical abuse; sexual abuse; emotional abuse and the neglect.
Physical abuse of a child is defined as those acts that cause actual physical harm or have the potential for harm. Injuries inflicted by a caregiver on a child can take many forms. Serious damage or death in abused children is most often the consequence of a head injury or injury to the internal organs. Head trauma as a result of abuse is the most common cause of death in young children, with children in the first 2 years of life being the most vulnerable. Because force applied to the body passes through the skin, patterns of injury to the skin can provide clear signs of abuse. The skeletal manifestations of abuse include multiple fractures at different stages of healing, fractures of bones that are very rarely broken under normal circumstances, and characteristic fractures of the ribs and long bones.
Sexual abuse is defined as those acts where a caregiver uses a child for sexual gratification. Children may be brought to professional attention because of physical or behavioral concerns that, on further investigation, turn out to result from sexual abuse. It is not uncommon for children who have been sexually abused to exhibit symptoms of infection, genital injury, abdominal pain, constipation, chronic or recurrent urinary tract infections or behavioral problems. To be able to detect child sexual abuse requires a high index of suspicion and familiarity with the verbal, behavioral and physical indicators of abuse. Many children will disclose abuse to caregivers or others spontaneously, though there may also be indirect physical or behavioral signs.
Emotional abuse includes the failure to provide an appropriate and supportive environment, and includes acts that have an adverse effect on the emotional health and development of a child. Such acts include restricting a child’s activities, ridicule, threats and intimidation, discrimination, rejection. Neglect refers to the failure of a parent to provide for the development of the child – where the parent is in a position to do so – in one or more of the following areas: health, education, emotional development, nutrition, shelter and safe living conditions. Neglect is thus distinguished from circumstances of poverty in that neglect can occur only in cases where reasonable resources are available to the family or caregiver.
Many risk factors are responsible on child abuse phenomena, among which: community and social factors, age and sex. Numerous studies across many countries have shown a strong association between poverty and child maltreatment. Rates of abuse are higher in communities with high levels of unemployment and concentrated poverty. Such communities are also characterized by high levels of population turnover and overcrowded housing. Research shows that “chronic poverty adversely affects children through its impact on parental behavior and the availability of community resources”. Community correlation represents the degree of cohesion and solidarity that exists within communities. “Children living in areas with less ‘‘social capital’’ or social investment in the community appear to be at greater risk of abuse and have more psychological or behavioral problems” (Macmillan, 1994). On the other hand, “social networks and neighborhood connections have been shown to be protective of children” (Macmillan, 1994). This is true even for children with a number of risk factors – such as poverty, violence, substance abuse and parents with low levels of educational achievement – who appear to be protected by high levels of community correlation.
Vulnerability to child abuse – whether physical, sexual or through neglect – depends in part on a child’s age. Fatal cases of physical abuse are found largely among young infants. In reviews of infant deaths in Fiji, Finland, Germany and Senegal, for instance, the majority of victims were less than 2 years of age Kathleen,M(2004). Young children are also at risk for non-fatal physical abuse, though the peak ages for such abuse vary from country to country. For example, “rates of non-fatal physical abuse peak for children at 3–6 years of age in China, at 6–11 years of age in India