Thousands of children are abused each year. When it comes to these cases, knowing the facts is essential. We’ve compiled a guide to assist in understanding the different types of child abuse, how to recognize the signs, and the legal implications. Call the Childhelp National Hotline at 1-800-4-A-CHILD for immediate assistance if you suspect a child is being abused.
How prevalent is child abuse?
The third leading cause of death among children between one and four years of age is homicide.
Most Americans would be shocked to know that the third leading cause of death among children between one and four years of age is homicide. Only accidents and congenital issues claim more lives of toddlers than intentional death.
Each year, the Administration on Children and Families, a United States Department of Health and Human Services subsidiary, produces a report called Child Maltreatment. The report contains child abuse and neglect data collected via the National Child Abuse and Neglect Data System (NCANDS) and commentary and interpretation of that data. The report, now in its 23rd year, provides information about the number of child victims of abuse or neglect and the responses of Child Protective Services (CPS) agencies. (These agencies are referred to by many names across the country, including the Department of Family and Children Services (DFACS), Department of Social Services (DSS), Department of Children and Families (DCF), or Social Services.)
According to Child Maltreatment 2012, released in December 2013, abuse and neglect accounted for the deaths of 1,640 children in the United States during 2012.
On average, more than four children die every day because parents, caregivers, or others choose to have them die.
Of course, most cases of child maltreatment do not result in the death of a child. CPS agencies estimate that more than 6 million children were reported as potential victims of abuse or neglect in 2012. Eventually, a little over a third of the reports were screened out as not actual maltreatment cases. Anecdotally, most CPS agencies believe that child abuse is under-reported instead of over-reported, meaning that it would not be unreasonable to estimate the number of children abused at well over 5 million per year in the United States.
The children most likely to be abused are infants and toddlers. After age 4, the rate of abuse drops until the age of 12, when there is a slight increase again. The victims are primarily white (44 percent of all reports), followed by Hispanics at almost 22 percent and African Americans at 21 percent. Boys and girls were abused at nearly equal rates. Boys and girls were abused at almost identical rates.
Who abuses children?
The perpetrators of these crimes were overwhelmingly the individuals pledged to protect children. Mothers are involved in the abuse more than half the time. Nearly four-fifths of the time, one or both biological parents were shown to be responsible. Although often the target of bad press, foster homes, and group homes account for less than 1 percent of the total deaths. And the people we would like to blame, the people we teach our children to fear, are not often to blame. People with no caregiving responsibilities for the children, the strangers we would like to associate with the danger, commit only about 3 percent of the abuse of children.
TYPES OF CHILD ABUSE
In any discussion of child maltreatment or abuse, there is always the question—what distinguishes abuse? Although child-rearing experts overwhelmingly agree that no amount of corporal punishment is appropriate, most jurisdictions allow some degree of corporal punishment by parents and other caregivers. In fact, the line between discipline and abuse is sometimes almost impossible to discern.
Federal law defines child abuse and neglect as, at minimum: “Any recent act or failure to act on the part of a parent or caretaker which results in death, serious physical or emotional harm, sexual abuse or exploitation; or an act or failure to act which presents an imminent risk of serious harm.”
(42 U.S.C.A. §5106g) However, while the reality of death is clearly understood, the concept of “serious physical or emotional harm” is less concrete.
Physical abuse, like pornography, seems to fall into the “I know it when I see it” category rather than an easily defined, clearly recognizable model. Recent cases involving sports figures make this point clear. When Vikings’ running back Adrian Peterson left bruises and open cuts on his four-year-old son’s legs and buttocks, Texas law enforcement called it child abuse. However, many fans called the action the appropriate discipline of a child. Commentator Charles Barkley went so far as to say that such “whippings” are so commonplace that if all law enforcement agencies implemented the law so strictly, “Every black parent in the South is going to be in jail.”
In a paper published in Law and Contemporary Problems, Coleman, Dodge, and Campbell point out that the diversity of the United States is a significant problematic factor in creating specific definitions. As these authors point out, different cultures have different views of discipline, religions have different ideas of appropriate medical care, and other ethnicities have different parenting practices. To codify a single definition that could withstand the pressures of challenges from the different groups would be almost impossible.
Some states have tried. Pennsylvania identifies abuse as an injury that “causes a child severe pain; or significantly impairs a child’s physical functioning, either temporarily or permanently.” Arkansas law forbids striking a child under six in the head or face, although whether that is permissible for older children is not addressed. Florida’s law is quite specific with regard to “serious injury” and designates abuse as “willfully inflicted sprains, dislocations, or cartilage damage” or “intracranial hemorrhage or injury to other internal organs.”
Although it is unclear how to define child abuse, most authorities accept the six fundamental forms of child abuse described in the Federal Child Abuse Prevention and Treatment Act: Physical, Sexual, Emotional, Neglect, Abandonment, and Substance Abuse.
On the other hand, since some forms of physical discipline are allowed in every state, it may be difficult to distinguish between acts done in the name of parenting and those done as abuse.
In its severest form, physical abuse is one of the most easily recognized forms of child abuse. Although active children often have scrapes or bruises from their rough and tumble play, it is difficult to explain away specific evidence. For example, it is difficult for the back of the legs to sustain bruising accidentally. On the other hand, since some forms of physical discipline are allowed in every state, it may be difficult to distinguish between acts done in the name of parenting and those done as abuse.
Some courts have held that bruises in any location that are so severe that they last more than a week are a cause for action. Other courts have used the site of the bruising (apart from the buttocks), the duration of the bruising (more than one week), or the severity of the bruising (demonstrated by the color of the bruise). The North Carolina Court of Appeals upheld that spanking was an acceptable method of child discipline, whether an implement such as a belt was used. However, in a 2006 decision, that court did provide a list of incidents and injuries that should be considered abusive: choking, hitting with fists and glass objects, pulling out hair, and burning. Although this may seem strange to view as a breakthrough, many previous courts had only used the nebulous term “reasonableness” as a criterion for distinguishing abuse and discipline.
Significantly, some jurisdictions have acknowledged that physical contact beyond the child’s understanding is abusive. For example, in 2004, the Canada Supreme Court ruled that spanking a child under the age of two was abuse because the child was developmentally incapable of understanding the concept of discipline. Connecticut’s courts have also ruled that the child’s level of understanding is a factor in determining whether the actions taken rise to the level of abuse.
Sexual abuse is a concept that seems more apparent to most Americans. Simply put, sexual activity with a person under the age of consent is repugnant to the majority of the population. But the line may be fuzzier in some areas. Fondling genitals, exposing children to explicit sex acts, and using children to create pornography are also forms of abuse. Of course, there are the most blatant sexual abuses of children, such as child prostitution, but far more common are cases of incest, statutory rape, and indecent exposure. These occur frequently in the home under the guise of “expressing love” or helping the child understand sexuality.
Emotional or psychological abuse is defined by the Federal Child Abuse Prevention and Treatment Act as a pattern of behavior that impairs the child’s emotional development or feelings of self-worth. Emotional abuse is one of the most difficult types of abuse to prosecute. CPS agencies rarely try to bring this case unless there is also some other form of abuse. However, other forms of abuse seldom exist without some psychological component.
Like adult battered domestic violence victims, abused children are often told that they have brought this punishment on themselves, that no one but the abuser could ever tolerate them, and that they are worthless.
Courts sometimes trivialize emotional abuse because it is often used as a ploy rather than a legitimate complaint in contested child custody cases. In an effort to obtain custody, one parent claims that the other “withholds love” from the child or “constantly criticizes” the child. If there is no outward sign of maltreatment, these charges are hard to substantiate without costly psychological investigation. Instead, they are often dismissed altogether.
Interestingly, 22 states now recognize that witnessing the abuse of other people, even if the child is not touched, damages the child. If a child is required or allowed to see domestic violence, these states impose additional consequences, varying from requiring the abuser to pay for counseling for the child to allowing add-on charges of child maltreatment.
Neglect is defined as failure to provide for the child’s basic needs. There are four different forms of neglect: physical, medical, educational, and emotional.
- Physical neglect occurs when the caregiver fails to provide adequate food or shelter. Additionally, children with inadequate supervision are considered neglected by federal and most state laws. This includes children left alone or in the care of another minor unable to provide adequate supervision. A child is also neglected if he is left with someone who cannot provide care due to developmental or physical disabilities or who is impaired by substance abuse. The finding of neglect does not require injury to the child to result from the lack of supervision.
- Medical neglect occurs when a child is denied appropriate medical or mental health care. This form of neglect is frequently an area of contention. Of course, the level of care that is appropriate is often open to argument. Further, certain religious sects believe that healing is achieved through prayer and other religious acts rather than through intervention by medical or mental health professionals.
- Educational neglect occurs when a child is denied educational or special educational opportunities. Examples include failing to enroll a child in school, refusing the child the opportunity to attend available school, or refusing appropriate special education programs open to the child.
- Emotional neglect includes inattention to a child’s emotional needs, refusing access to appropriate psychological care, and withholding emotional support.
The finding of emotional neglect depends on several factors, such as cultural values, the standards of care in the local community, and poverty. For example, if there is no access to psychological care in the community, failing to provide this care is not maltreatment. A lack of resources to provide adequate clothing for a child to attend school might be considered a defense to failing to send a child to school. However, if information or other resources are made available to the family so that the children’s needs can be met and yet the neglect continues, neglect can rise to the level of legal intervention.
Abandonment is closely related to neglect. A child is considered abandoned when the parent’s identity or whereabouts are unknown or if a parent has failed to provide reasonable support or make contact over a certain length of time. Abandonment also occurs when a child is left alone and suffers serious harm regardless of how long that period is. Most states allow parents of infants to relinquish custody of their infants to a safe haven, usually a hospital, fire station, or police station. However, no state provides for the safe transfer of custody for children over the age of a year.
Substance abuse and maltreatment of a child are acknowledged in most states. This form of maltreatment can take several forms.
- Prenatal exposure of a child to harm because of the mother’s use of an illegal drug or other substance is one form of substance abuse of a child. According to the National Center on Substance Abuse and Child Welfare, this affects 10 to 11 percent of all births in the United States. It is noteworthy that the prenatal use of certain drugs, including alcohol, can result in the child’s physical, emotional, or developmental difficulties. Several studies by P. Sullivan and J. Knutson over the course of several years showed that children with disabilities were 3.4 times as likely to be abused as children without disabilities. Prenatal substance abuse is not only a form of child maltreatment but can also set the child up for long-term abuse.
- The manufacture of methamphetamine in the presence of children is considered child maltreatment in many states. Not only are the fumes produced by the manufacturer toxic, but the conditions of most methamphetamine labs are also conducive to violence, including violence against children. Neglect by caregivers more interested in meth production than child care or caregivers impaired by the drug is rampant in these situations. The Federal Office for the Victims of Crime reports that the children rescued from homes where meth was produced frequently suffer from hepatitis, coli, venereal disease, and HIV due to contaminated paraphernalia in the home. The children often exhibit attachment disorder and other mental illnesses due to lacking parenting, requiring long-term mental health care and nurturing homes to live productive lives.
- Selling, distributing, or giving illegal substances to a child is a form of maltreatment many Americans do not know about. However, in a report based on National Poison Data System data, Dr. Shan Yin identified approximately 160 cases a year where children were given medication with malicious intent, often as punishment. The medications included analgesics, stimulants, street drugs, sedatives, and hypnotics. This did not include the tricks of stressed-out parents who used medicines such as cough syrups to induce children to sleep or alcohol to blunt teething pains.
ABC News aired a report in August 2014 that showed that 20 percent of drug abusers in 70 Phoenix House drug treatment programs were introduced to illegal substances by their parents or other family members while they were minors. Whether this was an ill-advised attempt at bonding or simply because the parents were too involved in their drug use to care whether the children were using drugs is not clear from the research.
The fourth way of abusing or neglecting a child through substance abuse is when the caregiver is so impaired by substance abuse that he cannot care for the child. This is often the case in homes serving as meth labs or homes where substance abusers gather.
RECOGNIZING CHILD ABUSE
When child abuse is presented in a school, it is common for a child to self-disclose that he has been abused. Until then, the child had not realized that what was happening to him was not happening to other children.
Of course, some child abuse or neglect is easy to identify. Unexplainable bruises, burns in unexpected places, or severe malnutrition are fairly easy to see. Bruising in the genital area or pregnancy in a minor is an obvious sign of sexual activity. But other signs may be more subtle. Some signs of normal childhood growth patterns mimic the behavior of abused children. Other stresses in the family home, such as divorce or a new child, can also look like signs of early abuse. Most signs of child abuse need to be investigated not as sure indicators that abuse is occurring but as indicators that the child may be concerned about something. Care must be taken. Remember that a clumsy investigation may be more traumatic to the child than the occurring activity.
Accordingly, these signs indicate that more investigation may be needed.
- Unexplained injuries. If the child is bruised or injured more frequently or severely than other children of the same age, this may prompt questions. Occasionally, the injury’s location is an indicator. Burns, for example, are more likely to be on hands or arms as a child touches or brushes against a hot stove. Burns on the legs or back are less likely to have an innocent explanation. Further, a bruise in the shape of a fist or a belt buckle needs investigation.
- Explanations that are nonexistent or inconsistent. Children may find it hard to keep a false story straight. They may tell the caregiver they fell down the stairs but tell a playmate they fell while climbing a tree. Bear in mind that children experiment with self-aggrandizement, but if the story changes too much or makes no sense, there may need to be an investigation. Likewise, investigations should be initiated if a caregiver explains an injury that she says she witnessed differently from the child’s explanation or if the explanation is inconsistent with the injury. Particular interest should be paid when the caregiver identifies all injuries as the child’s “fault.” Certainly, some children are clumsier than others, and some take more risks on play equipment, leading to more injuries. But if a caregiver identifies a child in one location as “awkward and always falling” but seems well coordinated in other locations, there is reason for concern.
- Fear in the child. Children sometimes cry when sent to school because home is more fun. Likewise, some children want to stay at daycare where their friends are. However, suppose a child seems frightened of changing locations. In that case, if she fights being moved to a new location or seems extremely uncomfortable around the person trying to take her to the new location, this may be a cry for help.
- Returning to earlier behaviors. An abused child often wants to return to a time before this abuse happened. At the age of five, he may suddenly demand a bottle instead of a cup or regress to thumb-sucking and bed-wetting. However, these signs often pop up during other stressors, even happy ones. A new child in the home, a move to a new home, or other changes might make a child want to return to “the good old days.” Again, this indicates a cause for concern but not necessarily a cause for alarm.
- Changes in eating or sleeping. Children being abused sometimes eat for comfort and sometimes in a desperate attempt to gain so much weight that they will be unlikely to be the object of someone’s sexual desire. Some children seem to eat almost uncontrollably at school because they know there will be no food at home. Abused children may also refuse to eat because they have no real interest in continuing their lives. Stress can change eating and sleeping patterns for children, just as it does for adults. Certainly, abuse can be a significant stressor, but these signs may also mark a growth spurt or a concern about school or home that has nothing to do with abuse. Again, significant changes should be investigated, although they are not sure indicators of abuse.
- Changes in school attendance. Home-based abusers sometimes keep children home until bruises fade or may keep the children home and away from their friends as a punishment for a child. Significant absences may also indicate a lack of concern for the child’s education due to substance abuse or apathy. Children may also miss school because of an illness that has not been addressed. The child may not be receiving adequate medical care. It may even be that the child is not sent to school because he has no clothes. In any case, truancies need to be investigated.
- Significant changes in behavior patterns. These may be a sign of maturity or another sign of abuse. Previously cautious or “normal” kids who suddenly engage in risk-taking behaviors like drug use or carrying weapons may have decided their lives are not worth being cautious about. Kids who go from happy-go-lucky to perfectionist may believe that if they can just be “good enough,” they will no longer be abused.
- Lack of personal hygiene. This can indicate a neglectful parent or, in older children, a personal choice. A lack of hygiene in small children may also mean the child is raised in a methamphetamine manufacturing house. Due to caustic materials being poured down toilets or sinks, it is not uncommon for meth houses to be without running water.
- Sexual behavior is inappropriate for age. Children who have been sexually abused may assume that all adults wish to use them that way. They may demonstrate overly sexual behavior or use sexually explicit language. Of course, this same behavior may be seen as usual exploration and experimentation in older teens.
- Fearful or watchful behavior. Children who are being abused become adept at becoming inconspicuous when they feel threatened. This may include hiding when a threat is perceived or shrinking away from any touch. Victims may seem pessimistic, always expecting something bad to happen.
At one time, abuse by parents was considered a private, domestic matter and was not addressed by law enforcement until severe damage was inflicted. Over time, this has changed. Now, 48 states have “required” or “mandated” reporters such as social workers, teachers, doctors, counselors, childcare providers, and law enforcement officers. New Jersey and Wyoming do not require that any group of people report suspicions of child abuse but join with all states in allowing and encouraging all individuals to report suspected abuse or neglect. Some states add other professionals to the mandated reporters list. Among the additional professions are film developers, parole and probation officers, college staff, staff of children’s activity centers, and members of the clergy.
PREVENTING CHILD ABUSE
Child abuse has numerous causes, and preventing it is a complex process. Factors that contribute to child abuse often cause societal issues in general, such as drug use, poverty, unemployment, mental illness, and ignorance. Addressing these problems as a whole is overwhelming, but addressing small parts has proven effective.
Effective programs are run by some private and government-based groups that address prevention. On a nationwide basis, these include Prevent Child Abuse America, FRIENDS National Resource Center, Circle of Parents, and Stop It Now!
Among activities that have shown promise are:
- Strengthening parenting. Child abuse can result when the parents feel overwhelmed by the stressors in the home. Accordingly, some programs offer parenting classes, anger management classes, and home visiting programs that provide support and assistance to expecting and new mothers. Additionally, parent support groups, where parents can work together to develop parenting strategies and strengthen families, have been effective.
- Crisis control. A crisis can turn an otherwise healthy home into an unsafe environment. In these cases, some programs offer respite care and crisis care for children, hoping to defuse situations that might lead to abuse or neglect.
- Making more people aware of child abuse and its signs. Public awareness campaigns such as public service announcements, posters, and brochures can help identify maltreatment. Additionally, this can help caregivers realize when they need help controlling their behaviors. These public information campaigns can also help promote healthy parenting and child safety and provide information about how to report suspected maltreatment.
- Child education. Skills-based lesson plans can teach children safety and protection skills, specifically regarding sexual abuse. Programs that help children distinguish between “good touch” and “bad touch” and between “bad secrets” and “happy surprises” have shown progress in helping children protect themselves against predators. These presentations also help children understand that the fault lies in someone other than themselves if they have been abused.
- Family resource centers. These centers provide various services and educational opportunities to help people in the community. The key to their success is shaping programs to the surrounding neighborhoods’ specific needs.
CHILD ABUSE AND THE LAW
Once a charge of child maltreatment has been brought, Child Protective Services (CPS) agencies and often law enforcement step in. The prosecution of maltreatment cases is notoriously difficult for numerous reasons. Along with the problem of drawing lines between appropriate discipline and abuse, there are other issues to consider.
- Children usually do not want to talk about the abuse. This may be because they have been told by the abuser that it is a secret, because of a sense of shame or guilt, or because they do not have the language to describe it adequately. In any case, this lack of detail from the person who is the victim and often the only witness makes preparing a case more challenging.
- Despite the abuse, there is sometimes an emotional bond between the child and the abuser. Even if the child wants the abuse to stop, he sometimes does not want the abuser punished.
- Child maltreatment crimes often occur over time. Since children may have only a minimal understanding of time, the facts are sometimes hard to establish.
- Despite popular belief, children do lie about abuse. They may accuse an innocent party because of a bond they have with the actual abuser; they may make up a story of abuse to avoid punishment for an infraction they themselves committed, or they may even create fiction for attention. In one documented case, an officer interviewed a girl of eight regarding the domestic abuse between her mother and father. The kindly officer bought her an ice cream and a stuffed animal. Although there was no further abuse in the home, the child knew there was no use asking her impoverished family for ice cream or toys. She called 911 and reported further abuse to have these threats again.
- Child maltreatment cases often cross jurisdictional lines, involving civil, criminal, and administrative investigations.
- The criminal justice system was not built to handle children’s special needs as victims or witnesses.
All states have statutes allowing a maltreated child to have a representative in the judicial process. Depending on the state, this may be an attorney, a guardian ad litem (GAL), or a court-appointed special advocate (CASA). The local requirements for a GAL or CASA representative vary from a trained layperson to an attorney. The duties of these representatives vary from court to court, but usually include:
- Meeting face-to-face with the child on a regular basis, including before all hearings
- Conducting an independent investigation of the circumstances of the case
- Attending all hearings and staffing related to the case
- Monitoring cases to ensure that court orders for services have been fulfilled
- Submitting written reports to the court and parties to the case
- Determining whether appropriate services are being offered to the child and family
Since the GAL or CASA is not directly involved in sanctions for the abuser, he can concentrate more fully on the needs of the child victim. He will seek services the child may need for rehabilitation and ensuring they are delivered. Additionally, he may be involved in one of the most difficult of decisions: whether to remove the child from the abusive home.
Where does the child go?
Occasionally, this issue is settled by the sanctions of the court. If the abuser is a parent and is sentenced to prison, there may be no home for the child to return to. Care in either some form of a foster home or a relative’s home will be required. In other cases, where the abusers remain in the home, the court or the CPS agency determines the child’s return to the home.
Public opinion on whether a child should or should not be removed from an abusive home swings like a pendulum. Parents’ rights groups advocate for maintaining the family unit. Additionally, many child advocates believe that if the original home can be made safe, it is the best environment for the child. Permanency is a valuable part of a child’s sense of well-being. Foster care can seldom provide a permanent placement. Children in foster care have an average of three placements, and it is not uncommon for a single child to be moved 20 to 30 times.
However, when a CPS or court order is overly optimistic and returns a child to the home only to see the child further brutalized or killed, the public demands that children be removed from an abusive home permanently.
Unfortunately, licensed foster care and appropriate relative care are not always available. Overcrowding of these resources is notorious, and the demand is unending. For example, the Georgia United Methodist Children’s Home, a state-approved foster organization, reports that it receives between 20 and 25 weekly requests for foster care that it cannot fulfill.
And the cost is overwhelming.
At nearly $40,000 a year per child, Americans spend $22 billion a year on the foster care system.
Ideally, the GAL or CASA remains involved while the child is in an out-of-home placement. If the representative remains in touch with the child, there is evidence that:
- The child receives more services, such as counseling
- The stay in foster care is reduced by an average of eight months
- The child is more likely to stay in a single foster home rather than be bounced from home to home
- The child is more likely to pass school courses and less likely to have poor conduct in school
The most common goal in the foster care system is successful reunification with the family. However, studies by the University of California, Berkley pointed out that 25 percent of reunification efforts ended with the child back in care. The study concluded that the common “ready or not, here I come home” reunification program almost assured failure. Careful planning, resources for the family, and other services were needed.
OUR ATTORNEYS CAN HELP
Call the Childhelp National Hotline at 1-800-4-A-CHILD for immediate assistance if you suspect a child is being abused. If you have any suggestions for improving this guide, please get in touch with us.