Battered Child Syndrome
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.
Internal injuries, cuts, burns, bruises and broken or fractured bones are all possible signs of battered child syndrome. Emotional damage to a child is also often the by-product of child abuse, which can result in serious behavioral problems such as substance abuse or the physical abuse of others. Approximately 14% of children in the United States are physically abused each year, and an estimated 2,000 of those children die as a result of the abuse. Between 1994-1995, 1.1 million cases of child abuse were recorded in the United States; of that number, 55% of the victims were less than a year old.
Battered child syndrome (BCS) is found at every level of society, although the incidence may be higher in low-income households where adult caregivers suffer greater stress and social difficulties, without having had the benefit of higher education. The child abuser most often injures a child in the heat of anger, and was often abused as a child himself. The incessant crying of an infant or child may trigger abuse. Symptoms may include a delayed visit to the emergency room with an injured child; an implausible explanation of the cause of a child’s injury; bruises that match the shape of a hand, fist or belt; cigarette burns; scald marks; bite marks; black eyes; unconsciousness; bruises around the neck; and a bulging fontanel in infants.
Battered child syndrome is most often diagnosed by an emergency room physician or pediatrician, or by teachers or social workers. Physical examination will detect bruises, burns, swelling, retinal hemorrhages. X rays, and other imaging techniques, such as MRI or scans may confirm fractures or other internal injuries. The presence of injuries at different stages of healing (i.e. having occurred at different times) is nearly always indicative of BCS. Establishing the diagnosis is often hindered by the excessive cautiousness of caregivers or by actual concealment of the true origin of the childþs injuries, as a result of fear, shame and avoidance or denial mechanisms.
Child abuse involves a complex and dangerous set of problems that include child neglect and the physical, emotional, and sexual abuse of children.
Child neglect is the most frequently reported form of child abuse and the most lethal. This form of abuse is defined as the failure to provide for the shelter, safety, supervision and nutritional needs of the child. Child neglect can be physical, educational, or emotional neglect.
Physical neglect includes refusal of or delay in seeking health care, abandonment, expulsion from the home or refusal to allow a runaway to return home, and inadequate supervision.
Educational neglect includes the allowance of chronic truancy, failure to enroll a child of mandatory school age in school, and failure to attend to a special educational need.
Emotional neglect includes such actions as marked inattention to the child’s needs for affection, refusal of or failure to provide needed psychological care, spouse abuse in the child’s presence, and permission of drug or alcohol use by the child.
Physical abuse is the second most frequently reported form of child abuse and is defined as physical injury inflicted upon the child with cruel and/or malicious intent. Physical abuse can be the result of punching, beating, kicking, biting, burning, shaking, or otherwise harming a child. The parent or caretaker may not have intended to hurt the child, rather the injury may have resulted from over-discipline or physical punishment.
Emotional abuse is the third most frequently reported form of child abuse and includes acts or omissions by the parents or other caregivers that could cause serious behavioral, emotional, or mental disorders. For example, the parents/caregivers may use extreme or bizarre forms of punishment, such as confinement of a child in a dark closet. Emotional child abuse is also sometimes termed psychological child abuse, verbal child abuse, or mental injury of a child.
Sexual abuse is the least frequently reported form of child abuse and is believed to be the most under-reported type of child maltreatment because of the secrecy or “conspiracy of silence” that so often characterizes these cases. Sexual abuse includes fondling a child’s genitals, intercourse, incest, rape, sodomy, exhibitionism, and commercial exploitation through prostitution or the production of pornographic materials.
Fatal injuries from maltreatment can result from many different acts including severe head trauma (injury), shaken baby syndrome, trauma to the abdomen or chest, scalding, burns, drowning, suffocation, poisoning, etc.
Medical treatment for battered child syndrome will vary according to the type of injury incurred. Counseling and the implementation of an intervention plan for the child’s parents or guardians is necessary. The child abuser may be incarcerated, and/or the abused child removed from the home to prevent further harm. Reporting child abuse to authorities is mandatory for doctors, teachers, and childcare workers in most states as a way to prevent continued abuse. Both physical and psychological therapy are often recommended as treatment for the abused child.
The prognosis for battered child syndrome will depend on the severity of injury, actions taken by the authorities to ensure the future safety of the injured child, and the willingness of parents or guardians to seek counseling for themselves as well as for the child.
Recognizing the potential for child abuse in a situation, and the seeking or offering of intervention and counseling before battered child syndrome occurs is the best way to prevent it. Signs that physical abuse may be forthcoming include parental alcohol or substance abuse; previous abuse of the child or the child’s siblings; history of mental or emotional problems in parents; parents abused as children; absence of visible parental love or concern for the child; child’s hygiene neglected.
Tags: adequate shelter, battered child syndrome, cases of child abuse, child sexual abuse, deliberate injury, emotional abuse, emotional damage, health welfare, internal injuries, medical treatment, physical abuse, verbal abuse