Child Abuse—Be a part of the solution, not part of the problem

  • Each day in the United States more than 8500 and perhaps as many as 24,000 children suffer abuse and neglect at the hands of those they trust. In fact in the 60 minutes it takes the typical clinician to see four patients at least 350 new reports of abuse come into child protective service agencies.
  • Every day an estimated 14 to 22 more children die because of this abuse and neglect.
  • Some studies indicate that even more deaths from abuse and neglect occur but they are mis-classifiied as child homicide, sudden infant death syndrome or accidents.

Why are the statistics as high as they are?
For the first time in history we are acknowledging the true prevalence and significance of child abuse and neglect—even though they are age-old problems.
Recognition began in the United States in 1962 only after C. Henry Kempe and colleagues published an article describing five stages through which individuals and societies pass in their approach to child abuse and neglect:
  • Denial that the problem exists
  • Recognition of the problem
  • The inevitable attempt to rescue the child
  • Treatment of the family so the child can remain in the home
  • Prevention—as with many health issues primary prevention is the most cost-effective and sensible approach
The Kempe article stimulated an editorial outcry in the professional and lay media. It prompted action by the United States Children’s Bureau to convene a committee of experts to recommend ways of dealing with the newly rediscovered social and public health problems. This committee formulated the 1968 reporting laws that have since been adopted in every state.
Increased reporting in 2002—but we do not always rescue the battered child. We do not always treat the family. The argument is that we do not have time to teach child abuse prevention.

There are physical signs that could mean a child is being abused:
  • Bruises and welts—forming regular patterns often resembling the shape of the article used to inflict the injury, i.e., hand, teeth, belt buckle, electric cord, etc., often found in various stages of healing
  • Burns—cigar or cigarette burns, especially on the soles, palms, back or buttocks; or immersion burns, stocking or glove-like on the extremities without splash burns, doughnut shaped on buttocks or genitals
  • Lacerations/abrasions—rope burns, particularly on wrists, ankles, neck or torso
  • Abdominal injuries—bruises of the abdominal wall

There are also physical signs of sexual abuse but many of these victims may not have overt signs of these signs:
  • Pain or itching, bruises or bleeding around the genitals, stained or bloody underclothing, soft tissue tears to the external genitalia, vagina or anus
  • Difficulty walking or sitting
  • Sexually Transmitted Diseases (STD) or pregnancy
  • Bizarre, overly sophisticated or unusual behavior or knowledge inconsistent with the child’s age

The physical signs of mental abuse are:
  • Impaired sense of self-worth, withdrawal
  • Extremes in behavior such as overly aggressive or overly passive
  • Delayed physical, emotional or intellectual development, failure to thrive
  • Speech disorders
  • Empty facial appearance

The physical signs of neglect are:
  • Constant hunger—begging or hoarding food
  • Fatigue or listlessness
  • Poor hygiene—matted hair, dirty skin
  • Inappropriate dress
  • Unattended physical or dental problems
  • Evidence of alcohol or drug use

Reasons people give for not reporting child abuse/neglect
  • Reporting will upset the family.
  • Not certain that the child has been abused.
  • Reporting abuse is a waste of time.
  • It takes too much time.
  • It is problematic.
  • It is not always worth it.

None of these beliefs is necessarily wrong. Child abuse is upsetting, especially to the victim, and certainly requires a commitment of time that many people feel they do not have. Nevertheless failing to report suspected abuse is shortsighted at the least. When health providers, especially those working in primary care, start thinking of an endangered child as another “time intensive case” or “problematic” patient to be passed off, or worse yet ignored, this constitutes a passive acceptance that in effect supports child abuse.

It is important to remember:
Those of us who do not report, do not intervene and do not prevent it, are supporting abuse as surely as if we abused the children ourselves. We are also condoning the consequences of abuse. All of us were children once. All children who live long enough will grow up to be a president or a terrorist, a Pa or a thief, an asset to, or drain on society. It might appear too obvious to say, but if we fail to protect children, we fail to protect our future.