social work

 A non-accidental inflicted physical injury or risk of injury to children by caregivers (if injury is caused by non-caregivers it is labeled physical assault and not physical abuse)

 Younger children are more commonly victims (corporal punishment is more often used in younger children and it often precedes abuse)

 The impact on young children tend also to be more lethal

 Often co-occurs with other types of abuse.  Physical Abuse (PA) may exist as a pattern of

behavior or as isolated episodes

 Harm does not have to be intentional.  Often unintended result of harsh physical discipline.

 Physical abuse is less commonly substantiated by the Child Protective Services compared with cases of neglect. In 2010, 17.6% of confirmed maltreatment cases were those of physical abuse

 The definitions of physical abuse in state statutes are more uniform compared with definitions of neglect; physical evidence of abuse makes it easier to identify such cases

 Initial Definitions focused on harm (observable injuries lasting at least 48 hours)

 Endangerment: Behaviors that create high risk of injuries or danger to a child (e.g. attempts at using a weapon or attempts to choke or smother)

 Each week, CPS received more than 60,000 reports of child abuse and neglect (Children’s Bureau, 2006)

▪ Two-thirds substantiated ▪ 28% of these PA

 In majority of cases of PA, biological parent is perpetrator

 Children of single parents were 77% more likely to be harmed by PA

 Children from poorer families were 16 times more likely to physically harm their children (NIS)

 Slapping anyone is an act of violence: carried out intentionally to cause physical pain

 Physical Abuse is defined in the US as an act that causes physical injury or the risk of injury.

 Spanking or slapping are not considered physical abuse under this definition

 Would you consider it psychological abuse if spanking could be shown to cause psychological damage or injury?

 Early models of physical abuse: - Psychodynamic model: emphasizes abuser’s traits - Interactional model: emphasizes the interactions between abuser and victim - Environmental models: emphasize contextual stressors

 Today there is a consensus that no single cause of physical abuse can be identified; ecological models are typically used to organize various causes

 Interactional variables: - Relate to the dynamics between the abuser and the victim. For instance, parents perceive the child as difficult, punish him/her, which, in turn, brings more escalation in their behavior - Child conditions such as developmental disabilities, ADHD and ODD may contribute to the creation of abusive dynamics - Parental history of abuse during childhood may also contribute to such dynamics (inability to cope with parenting tasks)

 Environmental variables: - Poverty, unemployment, and lack of social support can contribute to parental stress and create abusive environments - Domestic violence - Environmental variables typically operate through influence on more proximal, family-related variables (e.g. poverty may contribute to anger and frustration, which in turn, influences parental practices)

 Social/Cultural/Economic Variables: - Cultural values and practices may sometimes be misinterpreted as physical abuse (important to consider when assessing minorities); values around corporal punishment - Child rearing patterns - Exposure to community violence

 Child risk factors: - Younger age

-premature infants - 28% of children abused are under 3, 52% under 7

- Parental perception of child as “difficult” or “demanding” - Physical and mental health problems; disabilities - “Rebellious” tendencies during adolescence

 Child protective factors: - Easy temperament - Sociability - Healthy attachment

 Parental risk factors: - Physical and mental health problems - Domestic violence and marital discord; lack of social support; inconsistent parenting - Economic stress, unemployment, lower level of education - Inadequate coping mechanisms and problem solving skills, negativity - Substance abuse - According to some studies: history of abuse during childhood

 Parental protective factors: - Social support - Ability to cope with anger - Being raised in functional family

 Injuries not adequately explained by account given

 Typically multiple injuries at different stages of healing: inspection of bruises and examination of x-rays

 . When bruises are found on parts of the body not usually involved in typical childhood falls (face and head; back, chest, back of legs)  Injuries that occur before a child is ambulatory

 When injuries have a clear pattern (hand, bite, buckle, loop mark may indicate a whipping with an extension cord, etc)

 When there are certain types of fractures (e.g. spiral fracture which is indicative of the child’s arm having been twisted)

 When fractures are not attended to immediately (How does that interact with parents who do not have medical insurance?).

 When there are internal injuries to the torso area (e.g. ruptured spleen, ruptured kidneys)

 Accounts for 50% of non-accidental deaths in children.  Affects approximately 1,500 children under 2  Results in brain damage and can result in death  It is typically diagnosed when the child is listless and is

examined by a doctor who detects the hemorrhaging of blood vessels in the retina

 Retinal detachment, nerve damage , hemorrhages, subdural hematomas

 Fractures of ribs and bones  Why are babies vulnerable?

- they can not support their own head - their brain is less well protected - their skull is unstable

Symptoms:  Extreme irritability  Poor sucking or swallowing  Lethargic  No smiling or vocalizing  Breathing problems  Convulsions  Vomiting  Pale, bluish skin

 Serious untreated burns may lead to infections and death.

 Children are particularly susceptible as they burn more quickly because they have thinner skin

 Burns can be accidental but in physical abuse burns we see a pattern (e.g. child is left with the shape of an iron or a curling iron on the skin; or a cigarette mark, or when the child is dipped into very hot water = immersion burns as punishment)

 Some scholars claim that abusive parents exhibit deficiencies in certain skills, which contribute to maltreating behaviors: - Getting their needs met: abusers learned that extreme behaviors are needed to get their needs met (i.e. using physical actions, rather than words) - Separating feelings from actions: e.g. being angry means hitting - Determining limits of responsibility: blaming children (e.g. “if you weren’t such a bad boy, your dad wouldn’t have left”) - Making decisions: allowing children to make decisions means “loosing control” - Delaying gratification: expect instant obedience from children

 When parents either: create symptoms or magnify common symptoms in order to elicit medical care and attention

 Parents bring children to physicians and subject the child to many procedures and interventions

 Parents typically appear caring; physicians often recommend the procedures

 Child is not fully aware of what has happened and may accept sickly self-image

 Diagnosis is often not clear until the parent does not have access to the child (by hospitalizing the child and preventing parent’s access); which is unlikely to happen and requires a lot of cooperation between medical and CPS personnel

 Munchausen Syndrome by Proxy: A case example http://www.youtube.com/watch?v=cHq-z5fb3L8&feature=related

http://www.youtube.com/watch?v=SwHUSTl-axE&feature=relmfu

 Additional information about the syndrome: http://www.youtube.com/watch?v=UVLqADEdrig

http://www.youtube.com/watch?v=esNkWBy0dOk&feature=related

 Abuse by siblings: - On the rise in recent years, may be more frequent than abuse by parents - May escalate to life-threatening behaviors (e.g. using knives or guns) - Witnessing domestic violence at home may relate to sibling abuse - Commonly, older male siblings are the perpetrators of abuse; however, females may also be perpetrators - Parental response is critical; some parents do not seek help, which may escalate the problem

 Chronicity and Frequency  Age of the child  Use of violence/ coercion as a pattern in the family in

general  Presence/ Absence of other forms of maltreatment:

(e.g. what are the psychological messages that accompany the abuse? What is the child being told about the violence that is being perpetrated on them? Are there other forms of child maltreatment present? Does the child receive other forms of good attention? Or does the child only receives attention through the PA and is neglected otherwise?

 Behavioral indicators of abuse: - Cry little or demonstrate high-pitch cry; passive watchfulness; little interaction

- Developmental delays (motor, social, language) - Appearing “old for their age”; little ability to play; withdrawal; verbal inhibition; hypervigilance

- Tantrums, oppositional tendencies, bizarre behaviors - Later in life: low self esteem, school problems, social problems - Some children develop compulsive behaviors; fearful of failure - Adolescents may attempt to run away; exhibit aggressive behaviors

 http://www.youtube.com/watch?v=rPFz2n1Q t7I