Child sexual abuse and neglect

Child maltreatment, sometimes referred to as child abuse and neglect, includes all forms of physical and emotional ill-treatment, sexual abuse, neglect and exploitation that results in actual or potential harm to the child’s health, development or dignity. Within this broad definition, five subtypes can be distinguished – physical abuse, sexual abuse, neglect and negligent treatment, emotional abuse, and exploitation.[World Health Organization (WHO)]

Definition of a child: A child is recognised as a person under 18, unless national laws recognise the age of majority earlier.[Convention on the Rights of the Child]

The closest definition to child sexual abuse is any kind of physical or mental violation of a child with sexual intent, usually by a person who enjoys the child’s trust or has powers over the child. It also defined child sexual abuse as any sexual behaviour directed at a person under 16, without informed consent.

Instances of child sexual abuse and neglect are on the rise in the recent past. According to experts, it is not an increase in the number of cases of child sexual abuse but an increase in number of instances reported. Recently many parents are coming forward to get their children tested for child sexual abuse and treatment.

A common question asked by many of the parents is what they should do to prevent child sexual abuse? Having open conversation with the children can lead to right solution. Mental health professionals says that stigma around talking about private parts often leads to inability among children to communicate to their parents regarding sexual abuse they are facing. When there is freedom and awareness coming from parents, a child will know the limits of intimacy and beyond which the child will respond or report.

Child abuse is more than bruises or broken bones. While physical abuse is shocking due to the scars it leaves, not all child abuse is as obvious. Ignoring children’s needs, putting them in unsupervised, dangerous situations, or making a child feel worthless or stupid are also child abuse. Regardless of the type of child abuse, the result is serious emotional harm.

Types of child abuse

There are several types of child abuse, but the core element that ties them together is the emotional effect on the child. Children need predictability, structure, clear boundaries and the knowledge that their parents are looking out for their safety. Abused children cannot predict how their parents will act. Their world is an unpredictable, frightening place with no rules. Whether the abuse is a slap, a harsh comment, stony silence or not knowing if there will be dinner on the table tonight, the end result is a child that feel unsafe, uncared for and alone.

Emotional child abuse

Sticks and stones may break my bones but words will never hurt me? Contrary to this old saying, emotional abuse can severely damage a child’s mental health or social development, leaving lifelong psychological scars. Examples of emotional child abuse include:

• Constant belittling, shaming and humiliating a child.

• Calling names and making negative comparisons to others.

• Telling a child he or she is “no good," “worthless,” “bad” or “a mistake.”

• Frequent yelling, threatening or bullying.

• Ignoring or rejecting a child as punishment, giving him or her the silent treatment.

• Limited physical contact with the child—no hugs, kisses or other signs of affection.

• Exposing the child to violence or the abuse of others, whether it be the abuse of a parent, a sibling or even a pet.

Child neglect

Child neglect—a very common type of child abuse—is a pattern of failing to provide for a child’s basic needs, whether it be adequate food, clothing, hygiene or supervision. Child neglect is not always easy to spot. Sometimes, a parent might become physically or mentally unable to care for a child, such as with a serious injury, untreated depression or anxiety. Other times, alcohol or drug abuse may seriously impair judgement and the ability to keep a child safe.

Older children might not show outward signs of neglect, becoming used to presenting a competent face to the outside world, and even taking on the role of the parent. But at the end of the day, neglected children are not getting their physical and emotional needs met.

Physical child abuse

Physical abuse involves physical harm or injury to the child. It may be the result of a deliberate attempt to hurt the child, but not always. It can also result from severe discipline, such as using a belt on a child or physical punishment that is inappropriate to the child’s age or physical condition.

Many physically abusive parents and caregivers insist that their actions are simply forms of discipline—ways to make children learn to behave. But there is a big difference between using physical punishment to discipline and physical abuse. The point of disciplining children is to teach them right from wrong, not to make them live in fear. Children living in intense fear have a lifelong impact in their mind.

Physical abuse vs. discipline

In physical abuse, unlike physical forms of discipline, the following elements are present:

• Unpredictability. The child never knows what is going to set the parent off. There are no clear boundaries or rules. The child is constantly walking on eggshells, never sure what behaviour will trigger a physical assault.

• Lashing out in anger. Physically abusive parents act out of anger and the desire to assert control, not the motivation to lovingly teach the child. The angrier the parent, the more intense the abuse.

• Using fear to control behavior. Parents who are physically abusive may believe that their children need to fear them in order to behave, so they use physical abuse to “keep their child in line.” However, what children are really learning is how to avoid being hit, not how to behave or grow as individuals.

Child sexual abuse: a hidden type of abuse

Child sexual abuse is an especially complicated form of abuse because of its layers of guilt and shame. It’s important to recognise that sexual abuse doesn’t always involve body contact. Exposing a child to sexual situations or material is sexually abusive, whether or not touching is involved.

While news stories of sexual predators are scary, what is even more frightening is that sexual abuse usually occurs at the hands of someone the child knows and should be able to trust—most often close relatives. And contrary to what many believe, it’s not just girls who are at risk. Boys and girls both suffer from sexual abuse. In fact, sexual abuse of boys may be underreported due to shame and stigma.

The problem of shame and guilt in child sexual abuse

Aside from the physical damage that sexual abuse can cause, the emotional component is powerful and far-reaching. Sexually abused children are tormented by shame and guilt. They may feel that they are responsible for the abuse or somehow brought it upon themselves. This can lead to self-loathing and sexual problems as they grow older—often either excessive promiscuity or an inability to have intimate relations.

The shame of sexual abuse makes it very difficult for children to come forward. They may worry that others won’t believe them, will be angry with them or that it will split their family apart. Because of these difficulties, false accusations of sexual abuse are not common, so if a child confides in you, take him or her seriously. Don’t turn a blind eye!

Myths and facts about child abuse and neglect

MYTH #1: It’s only abuse if it’s violent.

Fact: Physical abuse is just one type of child abuse. Neglect and emotional abuse can be just as damaging, and since they are more subtle, others are less likely to intervene.

MYTH #2: Only bad people abuse their children.

Fact: While it’s easy to say that only “bad people” abuse their children, it’s not always so black and white. Not all abusers are intentionally harming their children. Many have been victims of abuse themselves, and don’t know any other way to parent. Others may be struggling with mental health issues or a substance abuse problem.

MYTH #3: Child abuse doesn’t happen in “good” families.

Fact: Child abuse doesn’t only happen in poor families or bad neighbourhoods. It crosses all racial, economic and cultural lines. Sometimes, families who seem to have it all from the outside are hiding a different story behind closed doors.

MYTH #4: Most child abusers are strangers.

Fact: While abuse by strangers does happen, most abusers are family members or others close to the family.

MYTH #5: Abused children always grow up to be abusers.

Fact: It is true that abused children are more likely to repeat the cycle as adults, unconsciously repeating what they experienced as children. On the other hand, many adult survivors of child abuse have a strong motivation to protect their children against what they went through and become excellent parents.

Effects of child abuse and neglect

All types of child abuse and neglect leave lasting scars. Some of these scars might be physical, but emotional scarring has long lasting effects throughout life, damaging a child’s sense of self, ability to have healthy relationships, and ability to function at home, at work and at school. Some effects include:

• Lack of trust and relationship difficulties. If you can’t trust your parents, who can you trust? Abuse by a primary caregiver damages the most fundamental relationship as a child—that you will safely, reliably get your physical and emotional needs met by the person who is responsible for your care. Without this base, it is very difficult to learn to trust people or know who is trustworthy. This can lead to difficulty maintaining relationships due to fear of being controlled or abused. It can also lead to unhealthy relationships because the adult doesn’t know what a good relationship is.

• Core feelings of being “worthless” or “damaged.” If you’ve been told over and over again as a child that you are stupid or no good, it is very difficult to overcome these core feelings. You may experience them as reality. Adults may not strive for more education, or settle for a job that may not pay enough, because they don’t believe they can do it or are worth more. Sexual abuse survivors, with the stigma and shame surrounding the abuse, often especially struggle with a feeling of being damaged.

• Trouble regulating emotions. Abused children cannot express emotions safely. As a result, the emotions get stuffed down, coming out in unexpected ways. Adult survivors of child abuse can struggle with unexplained anxiety, depression or anger. They may turn to alcohol or drugs to numb out the painful feelings.

Warning signs of child abuse and neglect

Sooner we get to know about the abuse, the better the chance of recovery and appropriate treatment for the child. Child abuse is not always obvious. By learning some of the common warning signs of child abuse and neglect, you can catch the problem as early as possible and get both the child and the abuser the help that they need.

It’s important to dig deeper, looking for a pattern of abusive behaviour and warning signs, if you observe, like.

Warning signs of emotional abuse in children

• Excessively withdrawn, fearful or anxious about doing something wrong.

• Shows extremes in behaviour (extremely compliant or extremely demanding; extremely passive or extremely aggressive).

• Doesn’t seem to be attached to the parent or caregiver.

• Acts either inappropriately adult (taking care of other children) or inappropriately infantile (rocking, thumb-sucking, throwing tantrums).

Warning signs of physical abuse in children

• Frequent injuries or unexplained bruises, welts or cuts.

• Is always watchful and “on alert,” as if waiting for something bad to happen.

• Injuries appear to have a pattern such as marks from a hand or belt.

• Shies away from touch, flinches at sudden movements or seems afraid to go home.

• Wears inappropriate clothing to cover up injuries, such as long-sleeved shirts on hot days.

Warning signs of neglect in children

• Clothes are ill-fitting, filthy or inappropriate for the weather.

• Hygiene is consistently bad (unbathed, matted and unwashed hair, noticeable body odour).

• Untreated illnesses and physical injuries.

• Is frequently unsupervised or left alone or allowed to play in unsafe situations and environments.

• Is frequently late or missing from school.

Warning signs of sexual abuse in children

• Trouble walking or sitting.

• Displays knowledge or interest in sexual acts inappropriate to his or her age, or even seductive behaviour.

• Makes strong efforts to avoid a specific person, without an obvious reason.

• Doesn’t want to change clothes in front of others or participate in physical activities.

• A sexually transmitted infection (STI) or pregnancy, especially under the age of 14.

• Runs away from home.

Child abuse and reactive attachment disorder

Severe abuse early in life can lead to reactive attachment disorder. Children with this disorder are so disrupted that they have extreme difficulty establishing normal relationships and attaining normal developmental milestones. They need special treatment and support.

Risk factors for child abuse and neglect

While child abuse and neglect occurs in all types of families—even in those that look happy from the outside—children are at a much greater risk in certain situations.

• Domestic violence. Witnessing domestic violence is terrifying to children and emotionally abusive. Even if the mother does her best to protect her children and keeps them from being physically abused, the situation is still extremely damaging. If you or a loved one is in an abusive relationships, getting out is the best thing for protecting the children.

• Alcohol and drug abuse. Living with an alcoholic or addict is very difficult for children and can easily lead to abuse and neglect. Parents who are drunk or high are unable to care for their children, make good parenting decisions and control often-dangerous impulses. Substance abuse also commonly leads to physical abuse.

• Untreated mental illness. Parents who suffering from depression, an anxiety disorder, bipolar disorder or another mental illness have trouble taking care of themselves, much less their children. A mentally ill or traumatised parent may be distant and withdrawn from his or her children, or quick to anger without understanding why. Treatment for the caregiver means better care for the children.

• Lack of parenting skills. Some caregivers never learned the skills necessary for good parenting. Teen parents, for example, might have unrealistic expectations about how much care babies and small children need. Or parents who were themselves victims of child abuse may only know how to raise their children the way they were raised. In such cases, parenting classes, therapy and caregiver support groups are great resources for learning better parenting skills.

• Stress and lack of support. Parenting can be a very time-intensive, difficult job, especially if you’re raising children without support from family, friends or the community or you’re dealing with relationship problems or financial difficulties. Caring for a child with a disability, special needs or difficult behaviours is also a challenge. It’s important to get the support you need, so you are emotionally and physically able to support your child.

Recognising abusive behaviour in yourself

Need of professional help...

Recognising that having a problem is the biggest step to getting help. If a child is raised in an abusive situation, that can be extremely difficult. Children experience and perceive abusive situation as normal. It may have been normal in your family to be slapped or pushed for little to no reason, or that mother was too drunk to cook dinner. It may have been normal for some parents to call their children stupid, clumsy or worthless. Or it may have been normal to watch mother get beaten up by the father.

It is only as adults that we have the perspective to step back and take a hard look at what is normal and what is abusive.

Indicators if one has crossed the boundary:

• You can’t stop the anger. What starts as a swat on the backside may turn into multiple hits getting harder and harder. You may shake your child harder and harder and finally throw him or her down. You find yourself screaming louder and louder and can’t stop yourself.

• You feel emotionally disconnected from your child. You may feel so overwhelmed that you don’t want anything to do with your child. Day after day, you just want to be left alone and for your child to be quiet.

• Meeting the daily needs of your child seems impossible. While everyone struggles with balancing dressing, feeding and getting kids to school or other activities, if you continually can’t manage to do it, it’s a sign that something might be wrong.

• Other people have expressed concern. It may be easy to bristle at other people expressing concern. However, consider carefully what they have to say. Are the words coming from someone you normally respect and trust? Denial is not an uncommon reaction.

Breaking the cycle of child abuse

Children having history of abuse retain strong memories and feelings that may have repressed. This may happen when a child is born, or at later ages when you remember specific abuse. Children may be shocked and overwhelmed by anger, and feel like it cannot be controlled. But we can learn new ways to manage our emotions and break old patterns.

Tips for changing your reactions

• Learn what is age appropriate and what is not. Having realistic expectations of what children can handle at certain ages will help you avoid frustration and anger at normal child behaviour. For example, newborns are not going to sleep through the night without a peep, and toddlers are not going to be able to sit quietly for extended periods of time.

• Develop new parenting skills. While learning to control your emotions is critical, you also need a game plan of what you are going to do instead. Start by learning appropriate discipline techniques and how to set clear boundaries for your children. Parenting classes, books and seminars are a way to get this information. You can also turn to other parents for tips and advice.

• Take care of yourself. If you are not getting enough rest and support or you’re feeling overwhelmed, you are much more likely to succumb to anger. Sleep deprivation, common in parents of young children, adds to moodiness and irritability—exactly what you are trying to avoid.

• Get professional help. Breaking the cycle of abuse can be very difficult if the patterns are strongly entrenched. If you can’t seem to stop yourself no matter how hard you try, it’s time to get help, be it therapy, parenting classes or other interventions. Your children will thank you for it.

• Learn to get emotions under control. The first step to getting your emotions under control is realising that they are there. If you were abused as a child, you may have an especially difficult time getting in touch with your range of emotions. You may have had to deny or repress them as a child, and now they spill out without your control.

Helping an abused or neglected child

What should you do if you suspect that a child has been abused? How do you approach him or her? Or what if a child comes to you? It’s normal to feel a little overwhelmed and confused in this situation. Child abuse is a difficult subject that can be hard to accept and even harder to talk about.

Just remember, you can make a tremendous difference in the life of an abused child, especially if you take steps to stop the abuse early. When talking with an abused child, the best thing you can provide is calm reassurance and unconditional support. Let your actions speak for you if you’re having trouble finding the words. Remember that talking about the abuse may be very difficult for the child. It’s your job to reassure the child and provide whatever help you can.

Tips for talking to an abused child

• Avoid denial and remain calm. A common reaction to news as unpleasant and shocking as child abuse is denial. However, if you display denial to a child, or show shock or disgust at what they are saying, the child may be afraid to continue and will shut down. As hard as it may be, remain as calm and reassuring as you can.

• Don’t interrogate. Let the child explain to you in his or her own words what happened, but don’t interrogate the child or ask leading questions. This may confuse and fluster the child and make it harder for them to continue their story.

• Reassure the child that they did nothing wrong. It takes a lot for a child to come forward about abuse. Reassure him or her that you take what is said seriously, and that it is not the child’s fault.

• Safety comes first. If you feel that your safety or the safety of the child would be threatened if you try to intervene, leave it to the professionals. You may be able to provide more support later after the initial professional intervention.

Reporting child abuse and neglect

If you suspect a child is being abused, it’s critical to get them the help the child needs. Reporting child abuse seems official. But many people are reluctant to get involved in other families’ lives.

Understanding some of the myths behind reporting may help put your mind at ease if you need to report child abuse.

• I don’t want to interfere in someone else’s family. The effects of child abuse are lifelong, affecting future relationships, self-esteem and sadly putting even more children at risk of abuse as the cycle continues. Help break the cycle of child abuse.

• What if I break up someone’s home? The priority in child protective services is keeping children in the home. A child abuse report does not mean a child is automatically removed from the home - unless the child is clearly in danger. Support such as parenting classes, anger management or other resources may be offered first to parents if safe for the child.

• They will know it was me who called. Reporting is anonymous. In most states, you do not have to give your name when you report child abuse. The child abuser cannot find out who made the report of child abuse.

• It won’t make a difference what I have to say. If you have a gut feeling that something is wrong, it is better to be safe than sorry. Even if you don’t see the whole picture, others may have noticed as well, and a pattern can help identify child abuse that might have otherwise slipped through the cracks.

Reporting child abuse can bring up a lot of difficult emotions and uncertainty. You may ask yourself if you’re doing the right thing, or question if your voice will even be heard. Here are some tips for communicating effectively in difficult situations.

Reporting child abuse

• Try to be as specific as you can. For example, instead of saying, “The parents are not dressing their children right,” say something like, “I saw the child running outside three times last week in subzero weather without a jacket or hat. I saw him shivering and uncomfortable. He seemed to want to come inside.” However, remember that it is not your job to “prove” abuse or neglect. If suspicions are all you have, you should report those as well.

• Understand that you may not learn of the outcome. Due to confidentiality laws, unless you are a mandated reporter in an official capacity, you probably won’t be updated by Child Protective Services (CPS) about the results of their investigation. The family may not broadcast that they have been mandated services, either—but that doesn’t mean they are not receiving them.

• If you see future incidences, continue to call and report them. Each child abuse report is a snapshot of what is going on in the family. The more information that you can provide, the better the chance of getting the best care for the child.

Last but not the least, witnessing abuse in our own home or suspecting abuse in a custody situation brings its own set of challenges and concerns. One may be afraid of what abuser will do and retrospectively whether my children will be harmed if I speak up. Culturally, it may not be acceptable for you to separate, adding additional feelings of shame and isolation. You may also be afraid of having your children taken away from you.

Making awareness and letting children know about body basics, sex and sexuality topics having open interaction between parents on matters of sexuality should be encouraged. Unless the child feels free allowing them to tell her parents about what she/he is going through, these matters will be go under the carpet.