Child abuse

Subject: Child abuse Thu Jan 20, 2011 1:12 pm

Child abuse
Filed under: Children's Health
Child abuse takes many forms:

* Physical abuse. Physical child abuse occurs when a child is purposefully injured.
* Sexual abuse. Sexual child abuse is any sexual activity with a
child, including fondling, oral-genital contact, intercourse and
exposure to child pornography.
* Emotional abuse. Emotional child abuse includes verbal and
emotional assault — such as continually belittling or berating a child —
as well as isolating, ignoring or rejecting a child.
* Neglect. Child neglect is failure to provide adequate food, shelter, affection, supervision or medical care.

Most child abuse is inflicted by someone the child knows and trusts,
often a parent or other relative. If you suspect child abuse, report the
abuse to the proper authorities.

©1998-2011 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.
Expand Arrow DownSymptoms

A child who's being abused may feel guilty, ashamed or confused. He or
she may be afraid to tell anyone about the abuse, especially if the
abuser is a parent, other relative or family friend. That's why it's
vital to watch for red flags, such as:

* Changes in behavior or school performance
* Withdrawal from friends or usual activities
* An apparent lack of supervision
* Frequent absences from school
* Reluctance to leave school activities, as if he or she doesn't want to go home
* Attempts at running away
* Physical clues, such as bruising or blood in underwear

There also are specific signs and symptoms to look out for, depending on the type of abuse.

Physical abuse signs and symptoms

* Unexplained injuries, such as bruises, fractures or burns
* Untreated medical or dental problems
* Poisoning
* An apparent fear of parents or adult caregivers
* A discrepancy between the extent of the injuries and the explanation given for the injuries

Sexual abuse signs and symptoms

* Inappropriate sexual behavior for child's age
* Sexual knowledge that's inappropriate for the child's age
* Sleep problems, such as nightmares or night terrors
* Changes in behavior, such as aggression or hyperactivity
* Blood in the child's underwear
* Depression or anxiety
* Social withdrawal
* Abuse of other children sexually
* Statements that he or she was sexually abused
* Attempts to undress other people
* Trouble walking or sitting

Emotional abuse signs and symptoms

* Delayed or inappropriate emotional development
* Extremes in behavior, from very aggressive behavior to complete passivity
* Loss of self-confidence or self-esteem
* Sleep problems
* Headaches
* Stomachaches
* Avoidance of certain situations, such as refusing to go to school
* Seeks affection from other adults
* Depression

Neglect signs and symptoms

* Poor growth
* A lack of fat in cheeks, buttocks and extremities
* Indifference
* Poor hygiene
* Frequent absences from school

Sometimes a parent's demeanor or behavior also sends red flags about child abuse. Warning signs include a parent who:

* Shows little concern for the child
* May not offer comfort during a medical exam
* Denies that any problems exist at home or school, or blames the child for the problems
* Consistently blames, belittles or berates the child
* Describes the child with negative terms, such as "worthless"
* Uses harsh physical discipline or asks teachers to do so
* Demands an inappropriate level of physical or academic performance
* Severely limits the child's contact with others
* Offers conflicting or unconvincing explanations for a child's injuries, or no explanation at all
* Appears unable to recognize physical or emotional distress in children
* Seems jealous of other family members getting attention from the child

Keep in mind that warning signs are just that — warning signs. The
presence of warning signs doesn't necessarily mean that a child is being
abused.

Although most child health experts strongly advise against the use of
violence in any form, some people still use corporal punishment
(spanking etc.) as a way to discipline their children. Sometimes it can
be difficult to tell if the line between discipline and abuse has been
crossed. Corporal punishment that injures or leaves marks is excessive
and considered abuse by child protection agencies in the United States.
Any corporal punishment may leave emotional scars.

Certain parental behaviors — even when done in the name of discipline — are clearly child abuse, such as:

* Biting
* Kicking
* Burning
* Scalding
* Threatening extreme violence, such as using a knife or a gun
* Cutting
* Breaking bones
* Bruising
* Spanking multiple times a day
* Spanking an infant

When to see a doctor
If you're concerned that your child or another child has been abused,
seek help immediately. Contact the child's doctor, a local child
protective agency or the local police department. Keep in mind that
health care professionals are legally required to report all suspected
cases of child abuse to state authorities.

If you're worried that you might abuse your own child, stop what you're
doing and put some distance between you and your child. If there's
someone who can watch your child, leave the house and go for a walk.
Call your own primary care doctor or your child's pediatrician for
advice and a treatment referral. If you don't think you can control your
temper, call 911 or take your child to the nearest emergency room for
help.

©1998-2011 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.
Expand Arrow DownRisk factors

Child abuse occurs across all socioeconomic levels and ethnic groups.
Factors that may increase a person's risk of becoming abusive include:

* A history of mistreatment as a child
* Depression
* Anxiety
* Marital conflict or single parenting
* Domestic violence
* Financial stress
* Social isolation
* Lower parental education
* Alcoholism or other forms of substance abuse
* A child in the family who was born prematurely or who is developmentally or physically disabled
* Young children in the family, especially multiple children under age 5

©1998-2011 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.
Expand Arrow DownComplications

Some children overcome the physical and psychological effects of child
abuse, particularly those who have high self-esteem, an optimistic
attitude and strong social support. For others, however, child abuse has
lifelong consequences. For example, child abuse may lead to:

* Death
* Physical disabilities
* Learning disabilities
* Low self-esteem
* Depression
* Difficulty establishing or maintaining relationships
* Challenges with intimacy and trust
* An unhealthy view of parenthood
* Anxiety
* Substance abuse
* Eating disorders
* Post-traumatic stress disorder
* Personality disorders
* Delinquent or violent behavior
* Abuse of others
* Suicide attempts

©1998-2011 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.
Expand Arrow DownTests and diagnosis

Options for the abused child
Psychotherapy can help a child who has been abused learn to trust again,
as well as teach the child about normal behavior and relationships.
Therapy can also teach children conflict management and can boost
self-esteem. Several different types of therapy may be effective for
children who've been abused:

* Trauma-focused cognitive behavioral therapy. This type of therapy
helps an abused child to better manage distressing feelings and to deal
with trauma-related memories. Eventually, the nonabusing parent and the
child are seen together so the child can let the nonabusing parent know
exactly what happened.
* Child-parent psychotherapy. This treatment focuses on improving
the parent-child relationship and on building a stronger attachment
between the two.

Children who are placed in foster care because their home situation was
deemed too dangerous will also need mental health services, and specific
therapies are available for children in foster care.

Options for the abusing parent
Psychotherapy can help an abuser discover the roots of abuse and learn
effective ways to cope with life's inevitable frustrations. If the child
is still in the home, social services may schedule home visits and make
sure essential needs, such as food, are available.

Several different types of therapy have been found helpful for parents, including:

* Parent-child interaction therapy. This therapy is a short-term
treatment that teaches positive ways to manage children's behavior. This
therapy also teaches parents how to build a better relationship with
their children.
* Abuse-focused cognitive behavioral therapy. This short-term
treatment helps parents learn to regulate emotions. It also teaches
parenting skills and what behaviors to expect from different ages of
children, as well as positive ways to discipline children.

Places to turn for help
If you need help because you're at risk of abusing a child, or you think
someone else has abused or neglected a child, there are organizations
that can provide you with information and referrals, such as:

* National Child Abuse Hotline: 800-4-A-CHILD (800-422-4453)
* Prevent Child Abuse America: 800-CHILDREN (800-244-5373)
* Stop It Now (for sexual abuse): 888-PREVENT (888-773-8368)

©1998-2011 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.
Expand Arrow DownCoping and support

If a child tells you he or she is being abused, take the situation seriously:

* Encourage the child to tell you what happened. Remain calm as you
assure the child that it's OK to talk about the experience, even if
someone has threatened him or her to keep silent. Ask open-ended
questions such as, "What happened then?"
* Remind the child that he or she isn't responsible for the abuse.
The responsibility for child abuse belongs to the abuser. Say, "It's not
your fault" over and over again.
* Offer comfort. You might say, "I'm so sorry you were hurt," "I'm
glad that you told me," and "I'll do everything I can to help you." Let
the child know you're available to talk or simply listen at any time.
* Report the abuse. Contact a local child protective agency or the
local police department. Authorities will investigate the report and, if
necessary, take steps to ensure the child's safety.
* Seek medical attention. If necessary, help the child seek appropriate medical care.
* Help the child remain safe. Don't let the child be alone with the
abuser. If that's not possible, do what you can to eliminate the
abuser's access to the child. Make sure the child knows how to call for
emergency help if needed.
* Consider additional support. You might help the child seek
counseling or other mental health treatment. Age-appropriate support
groups also can be helpful.

©1998-2011 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.
Expand Arrow DownPrevention

You can take simple steps to protect your child from exploitation and
child abuse, as well as prevent child abuse in your neighborhood or
community. For example:

* Offer your child love and attention. If you feel overwhelmed or
out of control, take a break. Don't take out your anger on your child.
* Think supervision. Don't leave young children home alone. In
public, keep a close eye on your child. Volunteer at school and for
extracurricular activities so that you get to know the adults who are
spending time with your child. Don't allow your child to go anywhere or
accept anything without your permission. When your child is old enough
to leave home without parental supervision, encourage your child to hang
out with friends rather than alone — and to tell you where he or she is
at all times.
* Know your child's caregivers. Check references for baby sitters
and other caregivers. Make unannounced visits to observe what's
happening. Don't ever allow substitutes for your usual child care
provider if you don't know the substitute.
* Emphasize the importance of saying no. Make sure your child
understands that he or she doesn't have to do anything that seems scary
or uncomfortable. Encourage your child to leave a threatening or
frightening situation immediately and seek help from a trusted adult. If
something does happen, encourage your child to talk to you or another
trusted adult about the episode. Assure your child that it's OK to talk,
and that he or she won't get in trouble.
* Teach your child how to stay safe online. The Internet is a
tremendous tool, but it's important to use it safely. Cover ground rules
such as not sharing personal information and not responding to
inappropriate, hurtful or frightening messages. Don't allow your child
to share photos or videos online or arrange to meet an online contact in
person without your permission. Check your child's privacy settings on
social networking sites, and tell your child to let you know if someone
he or she doesn't know makes contact via a social networking site.
Consider it a red flag if your child is secretive about his or her
online activities. Place the computer in a common area of the home, and
use the parental controls to restrict the types of Internet sites your
child can visit.
* Reach out. Meet the families in your neighborhood, including both
parents and children. Or, join a parent support group so you have an
appropriate place to vent your frustrations. If a friend or neighbor
seems to be struggling, offer to baby-sit or help in another way.

If you're concerned that you might abuse your child, seek help
immediately, especially if you were abused as a child. Start by talking
with your family doctor. He or she may offer a referral to a parent
education class, counseling or a support group for parents so that you
can learn appropriate ways to deal with your anger. If you're abusing
alcohol or drugs, ask your doctor about treatment options. Remember,
child abuse is preventable — and often a symptom of a problem that may
be treatable. Ask for help today.

If you, the parent, were a victim of any type of child abuse, get
counseling to assure you don't continue the abuse cycle or teach those
destructive behaviors to your child.

©1998-2011 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.