Lesson 2: Child Abuse and Maltreatment

Child Abuse and Maltreatment

Encompasses a range of harmful behaviors toward children.

Child abuse and maltreatment encompass a range of harmful behaviors towards children. These include:

• Physical Abuse

• Sexual Abuse

• Emotional Abuse

• Neglect

Physical Abuse

Any non-accidental physical injury inflicted upon a child.

Sexual Abuse

Any sexual act with a child or exploitation of a child for sexual purposes.

Emotional Abuse

Behaviors that harm a child's emotional development or sense of self-worth, such as constant criticism, threats, or rejection.

Neglect

Failure to provide for a child's basic physical, emotional, or educational needs.

What is an act of commission, regarding child abuse?

Acts that are intentionally committed to harm someone. For example physical, sexual and emotional abuse are seen as acts of commission.

What is an act of omission, regarding child abuse?

Acts that are the failure of a person to act. For example neglect is seen as an act of omission.

Child homicide

The intentional killing of a child. Motivations vary widely, and can include mental illness, desperation, and in some horrific cases, the belief that they are acting in the child's best interest.

Motivations for child homicide can be abuse-related deaths, meaning that the death of a child was a result from prolonged physical abuse.

Child homicide can also be a result of a failure to provide necessities and neglect on the part of the parents of caregivers which led to death. 

Filicide

The killing of a child by a parent.

Neonaticide

The killing of a newborn within 24 hours of life.

Infanticide

The killing od an infant within the first year.

Sexual homicide

The killing of a child where there is evidence of sexual abuse or a sexual motive.

Münchausen syndrome by proxy

Also known as “fictitious disorder imposed on another” (FDIA) and sexual homicide. This occurs when a caretaker intentionally makes a child sick in order to gain attention or sympathy. This can lead to physical sickness and sometimes even death.They also experience emotional trauma from being subjected to abuse and medical interventions.  

FDIA is a mental health disorder in which a caregiver fabricates or induces illness or injury to gain attention and sympathy from people in their life such as friends and family as well as medical professionals. The parent or caregiver may exaggerate symptoms, fabricate medical histories, tamper with medical tests, or even directly harm the child to create symptoms. The child may undergo unnecessary and potentially harmful medical procedures.

Sex trafficking

Forcing someone to preform sexual acts through force, threats, or coercion. Victims can be subjected to debt bondage or manipulated through romantic relationships or false job offers. Victims suffer physical and psychological harm, including injuries, diseases, post traumatic stress disorder, and suicidal thoughts.

Kidnapping

Involves the unlawful seizure or detention of a person, and is linked to both physical and sexual abuse of children.

The unlawful seizure or carrying away of an individual by force or fraud or seizing and detaining a person against their will to carry away that person later.

Types of kidnapping include:

• Family abduction

• Non-family abduction

• Stereotypical kidnappings

Child abuse and neglect statistics represent….

reported cases, and the actual prevalence is likely higher as these incidents can go unreported.

In 2022, an estimated 558,899 children…..

were victims of abuse and neglect in the U.S which translates to roughly 8 out of every 1,000 children

Neglect remains the most prevalent form of maltreatment, accounting for

74.3% of victims

Physical abuse happens to

17.0% of children

Sexual abuse to

10.6% of children

Psychological maltreatment to

6.8% of children

Approximately 1,990 children….

died from abuse and neglect

Boys tend to have a…

higher fatality rate than girls

Who are particularly vulnerable to child abuse and maltreatment?

Infants and very young children

Both child sexual abuse and family violence are rooted in..

power and control dynamics. Perpetrators seek to dominate and exploit their victims, whether it's a child. 

Victims of child sexual abuse are more likely than non-victims to experience the following mental health challenges:

• Drug abuse

• PTSD

• Depression

Drug abuse

Victims are 4 times more likely to develop

PTSD

Victims are 4 times more likely to develop this as adults

Depression

Victims are 3 times more likely to experience

Cinderella Effect 

The observed phenomenon of higher rates of child abuse and maltreatment by stepparents compared to biological parents. Suggesting that individuals have a greater tendency to invest resources and care in their biological offspring.

Stepparents may have less of an innate drive to protect and nurture stepchildren, potentially leading to increased risk of abuse.

Filicide Motivations

1. Altruistic Filicide

2. Acutely Psychotic Filicide

3. Unwanted Child Filicide

4. Accidental Filicide

5. Spousal Revenge Filicide

Altruistic Filicide

The parent believes they are acting in the child's best interest, often to relieve perceived suffering, preventing suffering and/or what they think would ultimately be the best for the child. This is often linked to severe mental illness or the parent's belief that the world is too cruel.

Acutely Psychotic Filicide

Occurs when a parent has a severe mental illness, and their perception of reality is distorted.

Unwanted Child Filicide

Occurs when the child was not planned or is now not wanted as is seen as burden or interference. This can also occur when the parent benefits from the child's death.

Accidental Filicide

Occurs when the death results from abuse or neglect, but the intent was not to kill. This can include cases where the abuse escalated.

Spousal Revenge Filicide

Occurs when a child is killed as a means of inflicting pain on the other parent. This also can be part of a custody/divorce dispute. 

Neonaticide Motivations

• Associated with mothers who conceal their pregnancies and may be experiencing severe psychological distress.

• If a pregnancy was unwanted or unexpected

• Individuals who fear social judgment or rejection, particularly related to unmarried mothers.

• There is also a connection between postpartum depression, limited social support, prenatal care, financial instability, and lack of access to resources can increase the risk.

• Teenage mothers are at a higher risk to commit acts of neonaticide.

• A woman has a history of physical, sexual, or emotional abuse.

Infanticide Motivations

• Severe mental health issues, such as postpartum psychosis

• Extreme social isolation or lack of support

• Unwanted pregnancies, particularly in situations of concealment and desperation and hopelessness.

• Often involve a combination of psychological, social, and economic factors.

Sexual Homicide Motivations

• Mental illness of a parent particularly postpartum depression can play a significant role in child murder.

• The severe stress, anxiety, and depression of a parent or caregiver can impact this crime as well.

• Children in homes with domestic violence are at increased risk of abuse and homicide.

• Children may be killed as a means of controlling or punishing a partner.

• A history of child abuse and neglect is a strong predictor of child homicide.

• This can include escalating abuse that can lead to fatal injuries.

• Poverty, lack of resources, and social isolation can increase stress and contribute to child maltreatment and homicide. 

Child Abuse and Maltreatment: Impact on Victims

Victims may suffer lifelong physical and mental health issues. Including injuries, disabilities, post-traumatic stress, anxiety, and depression. Child maltreatment and abuse can affect cognitive and academic development and performance.

There is also a risk of alcohol and drug abuse as well as smoking. In cases of sexual abuse, sexually transmitted diseases include gynecological disorders and unwanted pregnancy. Sexual abuse as a child can also increase the risk for risky sexual behaviors.

Beyond the health, social and educational consequences of child maltreatment, there is an economic impact, including costs of hospitalization, mental health treatment, child welfare, and longer-term health costs.

Prevention

• Focus on identifying and supporting at-risk families.

  • Children living in poverty are at a significantly higher risk of abuse and neglect. Substance abuse by caregivers is a major contributing factor. Children of color, particularly American Indian/Alaska Native and Black/African American children, experience disproportionately high rates of victimization.

• Providing resources and support to families to reduce stress and improve parenting skills.

• Strengthening child protection services is also necessary.

• Building strong community networks that offer support to families and children is essential to help prevent child abuse and maltreatment.

• Teaching children about their rights and how to recognize and report abuse is another key factor in prevention.

Physical Abuse

Nonaccidental physical injury because of behaviors such as punching, kicking, shaking, throwing, or stabbing. Infliction of the injury must be by someone who was responsible for the child at the time. The injury is abuse even if it was not intended as such. 

Physical Abuse Examples

• Hitting, slapping, punching, kicking, or biting 

• Shaking (shaken baby syndrome/abusive head trauma) 

• Burning or scalding 

• Choking or suffocating

Common Physical Signs of Child Physical Abuse

Unexplained bruises, especially in unusual locations (torso, back, buttocks). Children also may have burns, cuts, or welts, fractures or dislocations, head injuries, bite marks or injuries in various stages of healing.

Behavioral Signs of Child Physical Abuse

Fear of adults, especially parents or caregivers, withdrawal or anxiety, aggressive or acting-out behavior, changes in school performance, a reluctance to go home as well as an apprehension when other children cry

Factors that can increase the risk of physical abuse can include: 

• Parent/Caregiver

  • History of abuse or neglect 

  • Substance abuse

  • Mental health problems 

  • Lack of parenting skills

  • Stress or frustration 

• Child Factors

  • Age (infants and young children are particularly vulnerable)

  • Disabilities or special needs 

  • Difficult temperament 

• Environmental Factors

  • Poverty

  • Domestic violence

  • Social isolation 

Shaken Baby Syndrome (SBS)

Also known as abusive head trauma (AHT), is a severe form of physical child abuse that results from violently shaking an infant or toddler. SBS occurs when a baby or young child is forcefully shaken.

SBS is almost always triggered by frustration or anger on the part of the caregiver, often due to a baby's inconsolable crying.

Children under the age of 1 year old have the highest rate of victimization. Regarding gender, girls are more likely to experience victimization. Children who have caregivers with drug use issues or are involved in abusive relationships have high risk factors for experiencing victimization. 

Since infants have weak neck muscles, and their brains are fragile, this shaking causes the brain to move violently within the skull. This movement can lead to bruising, swelling and/or bleeding of the brain, as well as damage to blood vessels and nerves in the brain. SBS can lead to permanent brain damage, often resulting in cerebral palsy, intellectual disability, or even death.

Common symptoms a child may exhibit include extreme irritability, difficulty staying awake, breathing problems, lack of appetite/poor eating, vomiting, pale or bluish skin, seizures, paralysis or coma.

In addition to immediate injuries, there can be long-term impairments to the brain that can affect language, academic abilities, and cognitive abilities. SBS can cause blindness, cerebral palsy, seizures devastating and irreversible damage to motor functions. 

Sexual Abuse of a child

Activities by a caregiver, parent, or guardian that involve sexual touch, penetration, or exploitation, including production of child pornography.

Childhood sexual abuse

includes any sexual activity with a minor and does not need to include physical contact between an adult and a child.

Examples of child sexual abuse

Exhibitionism, or exposing oneself to a child, as well as obscene phone calls, speech, text messages, or online or digital interaction.

Most common form of child sexual abuse

incest, this refers to sexual abuse that occurs between family members, either by blood or marriage.

Physical warning signs of child sexual abuse

Such as bleeding, bruising, or swelling, as well as pain, itching, or burning in the genital area.

The child may have problems sitting or have frequent or reoccurring yeast infections.

A child's clothes may be torn or stretched/damaged, and they may have blood in their underwear.

Behavioral signs of child sexual abuse

The child may have developed inappropriate sexual knowledge or begun exhibiting sexual behaviors. The child may have nightmares, wet the bed, develop phobias or fears, and regress to behaviors such as thumb sucking. A sexually abused child can show signs of depression or PTSD, express suicidal thoughts or make suicide attempts, begin self-harming behaviors, engage in substance abuse, and have trouble in school. Running away from home or school is also a strategy many children employ to escape the abuse or the person perpetrating the abuse. They also may dislike physical contact or touch from others. 

Child Sexual Abuse in the Catholic Church

These cases include anal and oral penetration, pornography, fondling, and touching.

Sex Trafficking of Children

Occurs when a person (child or adult) is made to perform a sexual act due to the use of force, threat of force, or coercion by another. Individuals engaged in prostitution may also be victims of sex trafficking.

Can involve debt bondage, in which a child is forced to perform sexual acts for money to pay off an illegal debt incurred from transportation or the sale of that individual or a family member into modern-day slavery.

People who are sex trafficked suffer physically and psychologically. Physically they may suffer injuries such as broken bones, bruises, burns, and brain trauma. They may also suffer from starvation and infectious diseases. People who are trafficked experience rape and sexual assault, and, as a result, they may suffer physical injury to their genitals and the rest of the body, gynecological issues, and sexually transmitted diseases like HIV/AIDS. They may also experience pregnancy, miscarriages, or forced abortions. In addition to physical harm, trafficked people experience immense psychological harm, including posttraumatic stress disorder, depression, anxiety, and suicidal thoughts/attempts.

Family Abduction

This is the most common type, often occurring during custody disputes. A parent or family member takes the child without legal permission. Also often referred as “parental kidnapping” when it is a parent who does the kidnapping.

Non-Family Abduction

This involves kidnapping by someone the child knows (acquaintance) or a stranger. These cases, while less frequent, often receive more media attention.

"Stereotypical" Kidnappings

These are the rarest, involving a stranger abducting a child, transporting them a significant distance, and intending to keep them permanently, hold them for ransom, or harming them.

Child Neglect

The failure of a parent or caregiver to provide for a child's basic physical, emotional, educational, or medical needs. An act of omission, as it is a failure to take the necessary actions. 

Physical Neglect

The failure to provide adequate food, clothing, shelter, or supervision.

Examples of physical neglect can include the following: 

• Food

• Clothing

• Shelter

• Supervision

Example of physical neglect (Food)

• Failure to provide sufficient food or nutritious meals

• Withholding food as punishment

Example of physical neglect (Clothing)

• Providing inadequate clothing for the weather

• Not providing clean or appropriate clothing

• Forcing children to wear clothes that do not fit/uncomfortable

Example of physical neglect (Shelter)

• Providing unsafe or unsanitary housing 

• Lack of utilities (electricity, water, heating)

• Homelessness that puts the child at risk 

Example of physical neglect (Supervision)

• Leaving a child unsupervised or with inadequate caregivers

• Failing to protect a child from hazards in the environment 

While you cannot always tell by looking at a child if they are experiencing neglect, there are some signs that could include:

• Consistent hunger, begging for food, stealing or hoarding food

• Poor hygiene

• Inappropriate, inadequate or ill-fitting clothing

• Unsafe living conditions

• Frequent illnesses or untreated injuries

• Lack of medical or dental care

• Developmental delays

Risk factors that contribute to children experiencing neglect

Parents or caregivers who:

• Llive in poverty

• Abuse substances

• Suffer from mental health issues

• Have a lack of knowledge about childcare/child rearing

• Are facing stress and overwhelming circumstances

• Have a lack of access to resources

• Limited support systems

The impact of physical neglect on children includes:

• Malnutrition

• Failure to thrive

• General health problems

• Injuries

• Delays in physical and cognitive development

• Emotional distress

• Behavioral issues

• Social problems

the difference between neglect and the effects of poverty

While poverty can increase the risk of neglect, it does not automatically constitute neglect. Neglect involves a failure to provide for basic needs when resources are available or when help could be obtained. While poverty may mean less of things, neglect is not providing these things or trying to provide for children. 

Medical Neglect

Occurs when a caregiver fails to provide necessary medical care for a child, which can result in harm or a significant risk of harm to the child's health, or even death.

Different forms of medical neglect which include:

• Failure to seek treatment

• Failure to follow through with treatment

• Denial of care

Failure to seek treatment

This occurs when there are signs of illness or injury a parent or caregiver delays or refuses to seek medical attention

Failure to follow through with treatment

This type of medical neglect occurs when a parent or caregiver does not follow the prescribed medication directions, misses or does not take a child to medical appointments and/or disregards recommended medical advice or take a child for needed follow-up care

Denial of care

This occurs when a parent or caregiver refuses to consent to necessary medical procedures or treatments that are necessary to help a child due to illness or injury 

Factors that can impact medical neglect

• a lack of understanding of a child's medical needs

• unaware of what is happening and/or the severity

• religious beliefs or values that conflict with medical recommendations

• substance abuse or mental health issues that impair their judgment

• Financial barriers, such as being able to pay for care

• a lack of access to healthcare

Educational neglect

Occurs when a parent's or caregiver's fails to meet a child's educational needs. Parents or caregivers are to provide a child (of mandatory school age) with appropriate education. Failing to do so is a form of this

Examples of education neglect include:

• Failing to enroll a child in school

• Allowing chronic absences/truancy from school without valid reasons

• Failing to provide adequate homeschooling that does not meet state standards

• Refusing to get a child special education services that needs them, such as children with physical, learning or developmental disabilities

Supervisory neglect

Occurs when there is not adequate supervision of a child by a parent or caregiver. This occurs when a child is placed in situations where there is a risk of harm. In most cases, a child is at risk due to being unsupervised or placed in a situation where their age, maturity and/or the circumstances could lead to them being in danger of harm. 

Different types of supervisory neglect include: 

• Inadequate Supervision

• Exposure to Hazards

Inadequate Supervision

• Leaving young children unattended at home

• Leaving children in the care of individuals who are too young or incapable of providing adequate care 

• Failing to monitor a child's activities and whereabouts 

Exposure to Hazards

• Failing to protect children from dangerous environments or situations 

• Allowing children access to harmful substances or objects 

Emotional neglect

A failure to provide emotional support, nurturing, or affection and ignoring a child's emotional needs.

• This type of neglect is less visible than physical abuse or neglect, but it can be very harmful.

• Can create feelings of worthlessness, insecurity, and impaired emotional development in children.

Examples of emotional neglect include:

• Failure to provide needed mental health support

• Failure to provide a stable and predictable environment

• Creating a chaotic or unpredictable environment

• Exposing the child to domestic violence/violence

• Lack of affection and failure to provide warmth, love, and comfort

• Ignoring a child's attempts to seek comfort or affection

• Emotional unresponsiveness

• Ignoring or dismissing a child's feelings

• Failing to acknowledge a child's emotional experiences

• Being emotionally distant or unavailable to the child

• Failing to provide consistent emotional support

signs of emotional neglect

• A child becoming or appearing withdrawn, isolated, or unresponsive.

• Children also may have difficulty forming relationships with other children or adults.

• Children also may have low self-esteem.

• A child may display aggressive, disruptive, or self-destructive behaviors and have difficulty regulating their emotions.

• A child may also experience delays in emotional or social development as well as experience anxiety, depression, and PTSD.

• Children who experience emotional neglect are also at an increased risk of self-harm and suicide.

Psychological maltreatment

Also known as emotional abuse, is a pervasive and damaging form of child maltreatment and can be related to emotional neglect. It involves patterns of behavior by a caregiver that impair a child's emotional, social, and cognitive development.

• Is characterized by repeated patterns or extreme incidents of caregiver behavior that undermine a child's sense of worth and safety.

• It involves actions or inactions that convey to a child that they are unloved, unwanted, worthless, or endangered. 

Types of psychological maltreatment include: 

• Spurning

• Terrorizing

• Isolating

• Exploiting/Corrupting

• Emotional Unresponsiveness

Spurning

These are actions that reject and degrade a child, such as belittling, humiliating, and shaming.

Terrorizing

This involves creating a climate of fear through threats of harm, intimidation, and exposure to violence

Isolating

This occurs when a parent or caregiver restricts a child's social interactions and prevents them from forming healthy relationships

Exploiting/Corrupting

This happens when a child is encouraged to engage in inappropriate or harmful behaviors, such as substance abuse or criminal activity

Emotional Unresponsiveness

This is a failure to provide the child with needed emotional support, or ignoring the child’s emotional needs 

Psychological maltreatment effects may include:

• Low self-esteem

• Anxiety and depression

• Difficulty forming healthy relationships

• Behavioral problems

• Post-traumatic stress disorder (PTSD)

• Developmental issues