Child maltreatment

Child abuse is the physical, sexual or emotional maltreatment or neglect of a child or children. Child abuse consists of any act of commission or omission that endangers or impairs a child’s physical or emotional health and development. Child abuse includes any damage done to a child which cannot be reasonably explained and which is often represented by an injury or series of injuries appearing to be non-accidental in nature.

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Forms of Child Abuse

Physical abuse

Any non-accidental injury to a child. This includes hitting, kicking, slapping, shaking, burning, pinching, hair pulling, biting, choking, throwing, shoving, whipping, and paddling.

Sexual abuse

Any sexual act between an adult and child. This includes fondling, penetration, intercourse, exploitation, pornography, exhibitionism, child prostitution, group sex, oral sex, or forced observation of sexual acts.

Neglect

Failure to provide for a child’s physical needs. This includes lack of supervision, inappropriate housing or shelter, inadequate provision of food and water, inappropriate clothing for season or weather, abandonment, denial of medical care and inadequate hygiene.

Emotional abuse

Any attitude or behavior which interferes with a child’s mental health or social development. This includes yelling, screaming, name-calling, shaming, negative comparisons to others, telling them they are “bad, no good, worthless” or “a mistake.” It also includes the failure to provide the affection and support necessary for the development of a child’s emotional, social, physical and intellectual well-being. This includes ignoring, lack of appropriate physical affection (hugs), not saying “I love you,” withdrawal of attention, lack of praise and lack of positive reinforcement.

Psychological Abuse Just As Damaging As Physical Abuse

Psychological abuse can be just as damaging to a child’s physical, mental and emotional health as physical abuse, according to experts. And it may be the most prevalent form of child abuse, according to a position statement from the American Academy of Pediatrics (AAP) in the August issue of the journal Pediatrics.

Psychological abuse may be difficult to pinpoint, but it includes belittling, denigrating, exploiting or neglecting a child, said Harriet MacMillan, M.D., a professor in the departments of psychiatry and behavioral neurosciences and pediatrics at McMaster University.

“We are talking about extremes and the likelihood of harm, or risk of harm, resulting from the kinds of behavior that make a child feel worthless, unloved or unwanted,” she said, giving the example of a mother leaving her infant alone in a crib all day or a father involving his teenager in his drug habit.

A parent raising their voice after asking a child for the eighth time to put on their shoes is not psychological abuse, MacMillan said. “But, yelling at a child every day and giving the message that the child is a terrible person, and that the parent regrets bringing the child into this world, is an example of a potentially very harmful form of interaction,” she explained.

First described 25 years ago, psychological abuse has been under recognized and underreported, according to MacMillan, who said that its effects “can be as harmful as other types of maltreatment.”

Psychological abuse interferes with a child’s development. She noted it has been linked with attachment disorders, developmental and educational problems, socialization problems and disruptive behavior. “The effects of psychological maltreatment during the first three years of life can be particularly profound,” she said.

Although there are few studies on the prevalence of psychological abuse, the position statement notes that large studies in both Britain and the U.S. found that about 9 percent of women and 4 percent of men report they were exposed to “severe” psychological abuse during childhood.

The statement goes on to say that pediatricians need to be alert to the possibility of psychological abuse, even though there is little evidence on potential strategies that might help.

What do I do if I think someone is abusing a child?

If a child discloses that he or she has been abused by someone, it is important that you LISTEN to them most of all.

Ask ONLY four questions

  • What happened?
  • Who did this to you?
  • Where were you when this happened?
  • When did this happen?
    Asking any additional questions may contaminate a case!

DO NOT

  • Investigate
  • Ask leading questions (a question that suggests the answer or contains the information the questioner is looking for – That man touched you, didn’t he?)
  • Make promises
  • Notify the parents or the caretaker

DO

  • Provide a safe environment (be comforting, welcoming, and a good listener)
  • Tell the child it was not his/her fault
  • Listen carefully
  • Document the child’s exact quotes
  • Be supportive, not judgmental
  • Know your limits
  • Tell the truth
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