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What is child abuse? It is the physical or emotional abuse of a child by a parent,
guardian, or other person. Reports of child abuse, including sexual abuse, beating, and
murder, have climbed in the United States and some authorities believe that the number of
cases is largely under reported. Child neglect is sometimes included in legal definitions
of child abuse to cover instances of malnutrition, desertion, and inadequate care of a
child's safety. When reported, child abuse cases are complicated by inadequate foster care
services and a legal system that has trouble accommodating the suggestible nature of
children, who are often developmentally unable to distinguish fact from make-believe (Hay,

In 1993, the United States Advisory Board on Child Abuse and Neglect declared a child
protection emergency. Between 1985 and 1993, there was a 50 percent increase in reported
cases of child abuse. Three million cases of child abuse are reported in the United States
each year. Treatment of the abuser has had only limited success and child protection
agencies are overwhelmed (Lewitt, 1997).

Recently, efforts have begun to focus on the primary prevention of child abuse. Primary
prevention of child abuse must be implemented on many levels before it can be successful.
Prevention plans on the social level include increasing the economic self-sufficiency of
families, discouraging corporal punishment and other forms of violence, making health care
more accessible and affordable, expanding and improving coordination of social services,
improving the identification and treatment of psychological problems, and alcohol and drug
abuse, providing more affordable child care and preventing the birth of unwanted children.
Prevention plans on the family level include helping parents meet their basic needs,
identifying problems of substance abuse and spouse abuse, and educating parents about
child behavior, discipline, safety and development. Primary prevention is both the
prevention of disease before it occurs, and the reduction of its incidence. In the case of
child abuse, primary prevention is defined as any intervention designed for the purpose of
preventing child abuse before it occurs (Hay, 1996).

Between 1985 and 1993, the number of cases of child abuse in the United States increased
by 50 percent. In 1993, three million children in the United States were reported to have
been abused. Thirty-five percent of these cases of child abuse were confirmed. Data from
various reporting sources indicates that improved reporting could lead to a significant
increase in the number of cases of child abuse verified by child protection agencies. The
lack of verification does not indicate that abuse did not occur, only that it could not be
verified. The facts are that each year 160,000 children suffer severe or life-threatening
injury and 1,000 to 2,000 children die as a result of abuse. Of these deaths, 80 percent
involve children younger than five years of age, and 40 percent involve children younger
than one year of age. One out of every 20-murder victims is a child. Murder is the fourth
leading cause of death in children from one to four years of age and the third leading
cause of death in children from five to fourteen years of age. Neonaticide, which is the
murder of a baby during the first 24 hours of life, accounts for 45 percent of children
killed during the first year of life (Lewitt, 1997).

As I stated above, deaths from abuse are under reported and some deaths classified as the
result of accident and sudden infant death syndrome might be reclassified as the result of
child abuse if comprehensive investigations were more routinely done. Most child abuse
takes place in the home and is started by persons are know to and trusted by the child.
Even though it has been widely publicized, abuse in day-care and foster-care settings
accounts for only a small number of confirmed cases of child abuse. In 1996, only two
percent of all confirmed cases of child abuse occurred in these settings. Child abuse if
fifteen times more likely to occur in families where spousal abuse occurs. Children are
three times more likely to be abused by their fathers than by their mothers. No
differences have been found in the incidence of child abuse in rural versus urban areas.
Following are the types of abuse and the percentages of the different types.

Neglect - 54%
Physical abuse - 25%
Sexual abuse - 11%
Emotional abuse - 3%
Other - 7%
(Davis, 1998).

Not only do children suffer from the physical and mental cruelty of child abuse, they
endure many long-term consequences, including delays in reaching developmental milestones,
refusal to attend school and separation anxiety disorders. Other consequences include an
increased likelihood of future substance abuse, aggressive behaviors, high-risk health
behaviors, criminal activity, depressive and affective disorders, personality disorders,
post-traumatic stress disorder, panic attacks, schizophrenia and abuse of their own
children and spouse. Research has shown that a loving, caring and stimulating environment
during the first three years of a child's life is important for proper brain development
(Davis, 1998).

There have been some recent changes in regards to the causes of child abuse. The results
of research initiated by the National Research Council's Panel on Research on Child Abuse
and Neglect showed the first important step away from the simple cause and effect
patterns. The panel stated that the simple cause and effect patterns have certain
limitations, mostly related to their narrow focus on the parents. These patterns are
limited by asking only about the isolated set of personal characteristics that might cause
parents to abuse their children. These patterns failed to account for the occurrence of
different forms of abuse in one child. These patterns had very little explanatory power in
weighing the value of various risk factors involved in child abuse. As a result, they were
not very accurate in predicting future cases of child abuse. To replace the old static
pattern, the panel has substituted what it calls an ecologic model. This model considers
the origin of all forms of child abuse to be a complex interactive process. This ecologic
model views child abuse within a system of risk and protective factors interacting across
four levels: (1) the individual, (2) the family, (3) the community and (4) the society.
Some factors are more closely linked with some forms of abuse than others. The following
are factors thought to contribute to the development of physical and emotional abuse and
neglect of children:

Community/society Parent-related
High crime rate Personal history of physical or sexual abuse
Lack of or few social services Teenage parents
High poverty rate Lack of parenting skills
High unemployment rate unwanted pregnancy
Emotional immaturity
Child-related Poor coping skills
Prematurely Low self-esteem
Low birth weight Personal history of substance abuse
Handicap Known history of child abuse
Domestic violence
Lack of preparation for extreme stress of having a new infant
(Understanding Child Abuse and Neglect, 1996).

Many people would argue that our society does not really value its children. This argument
is highlighted by the fact that one in four children in the United States lives in
poverty, and many children do not have any form of health insurance. The presence of high
levels of violence in our society is also thought to contribute to child abuse. Deadly
violence is more common in the United States than in seventeen other developed countries.
Seventy-five percent of violence occurring in this country is domestic violence. The
United States leads developed countries in homicide rates for females older than 14 years
and for children from five to fourteen years of age. Other factors that may contribute to
high rates of violence include exposure to television violence and reliance on corporal
punishment (McKay, 1997).

Poverty is the most frequently and persistently noted risk factor for child abuse.
Physical abuse and neglect are more common among the people who are the poorest. Whether
this is brought on by the stress of poverty-related conditions or results from greater
scrutiny by public agencies, resulting in over reporting, is debated. Other factors
include inaccessible and unaffordable health care, fragmented social services and lack of
support from extended families and communities (Besharov, 1990).

Parents who were abused as children are more likely than other parents to abuse their own
children. Lack of parenting skills, unrealistic expectations about a child's capabilities,
and ignorance of ways to manage a child's behavior and of normal child development may
further contribute to child abuse. It is estimated that forty percent of confirmed cases
of child abuse are related to substance abuse. It is also estimated that eleven percent of
pregnant women are substance abusers, and that 300,000 infants are born each year to
mothers who abuse crack cocaine. Domestic violence also increases the risk of child abuse
(Helfer, 1998).

Other factors that increase the risk of child abuse include emotional immaturity of the
parents, which is often highly correlated to actual age, as in the case of teenage
parents, poor coping skills, often related to age but also occurring in older parents,
poor self-esteem and other psychological problems experienced by either one or both
parents, single parenthood and the many burdens and hardships of parenting that must be
borne without the help of a partner, social isolation of the parent or parents from family
and friends and the resulting lack of support that their absence implies, any situation
involving a handicapped child or one that is born prematurely or at a low birth weight,
any situation where a sibling younger than 18 months of age is already present in the
home, any situation in which the child is the result of an unwanted pregnancy or a
pregnancy that the mother denies, any situation where one sibling has been reported to the
child protective services for suspected abuse, and finally, the general inherent stress of
parenting which, when combined with the pressure of anyone or a combination of the factors
previously mentioned, may exacerbate any difficult situation (Besharov, 1990).

The United States Advisory Board on Child Abuse and Neglect has stated that only a
universal system of early intervention, grounded in the creation of caring communities,
could provide an effective foundation for confronting the child abuse crisis. It is
believed that successful strategies for preventing child abuse require intervention at all
levels of society. No agreement has been formed concerning which programs or services
should be offered to prevent child abuse. This is because research on the prevention of
child abuse is limited by the complexity of the problem, the difficulty in measuring and
interpreting the outcomes, and the lack of attention to the interaction among variables in
determining risk status for subsequent abuse. A broad range of programs has been developed
and implemented by public and private agencies at many levels; little evidence supports
the effectiveness of these programs (Rushton, 1997).

As 1994 look back on a review of 1,526 studies on the primary prevention of child abuse
found that only thirty studies were methodologically sound. Of the eleven studies dealing
primarily with physical abuse and neglect, only two showed a decrease in child abuse as
measured by a reduction in hospital admissions, emergency department visits or reports to
child protective services. Although there is a need for better-designed research to
evaluate the effectiveness of prevention strategies, recommendations for preventive
interventions are based on what we currently know about causes of child abuse (Hay, 1996).

Primary prevention strategies based on risk factors that have a low predictive value are
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