3.6: Child Abuse and Neglect

Types of Abuse

Child abuse takes many forms. Children can be physically or sexually assaulted, and they may also suffer from emotional abuse and neglect of many different forms. Whatever form it takes, child abuse is a serious problem. It is especially difficult to know how much child abuse occurs. Infants obviously cannot talk, and toddlers and older children who are abused usually do not tell anyone about the abuse. They might not define it as abuse, they might be scared to tell a trusted adult, they might blame themselves for being abused, or they might not know with whom they could talk about their abuse. Whatever the reason, children usually remain silent, thus making it very difficult to know how much abuse takes place. Up-to-date statistics on the different types of child abuse in the United States can be found at the U.S. Children’s Bureau website.

Abuse can occur in multiple forms and across all family relationships. Breiding, Basile, Smith, Black, and Mahendra (2015) define the forms of abuse as:

• Physical abuse, the use of intentional physical force to cause harm. Scratching, pushing, shoving, throwing, grabbing, biting, choking, shaking, slapping, punching, and hitting are common forms of physical abuse;
• Sexual abuse, the act of forcing someone to participate in a sex act against the person’s will. Such abuse is often referred to as sexual assault or rape.
• Psychological abuse, aggressive behavior that is intended to control someone else. Such abuse can include threats of physical or sexual abuse, manipulation, bullying, and stalking.

The most common form of child abuse is neglect. Child neglect is a deficit in meeting a child’s basic needs, such as failure to provide adequate nutrition, supervision, health care, clothing, or housing, as well as other physical, emotional, social, educational, and safety needs. All societies have established necessary behaviors a caregiver must provide in order for a child to develop well within the domains of physical, social, and emotional development. Causes of neglect may result from caregivers experiencing problems associated with mental disorders, unplanned pregnancy, substance abuse, unemployment, over-employment, domestic violence, and, in special cases, poverty.
Child neglect depends on how a child and society perceives the caregivers’ behaviors; it is not how parents or caregivers believe they are behaving toward their child. Caregiver’s failure to provide for a child, when options are available, is different from failure to provide when options are not available. Poverty and lack of resources are often contributing factors that may prevent caregivers from meeting children’s needs, when they otherwise would be able to meet those needs.

There are various types of child neglect which include:

• Physical neglect is the failure to provide a child with basic necessities of life such as adequate food, shelter, and clothing.
• Medical neglect is the failure of caregivers to meet a child’s basic health care needs. Examples include not brushing teeth on a daily basis, not bathing a child, and/or taking children to doctor visits when needed.
• Emotional neglect is the failure to provide emotional support such as emotional security and encouragement (love, nurturance, etc.).
• Educational and developmental neglect include the failure to provide children with experiences necessary for normative growth and development. These may include failing to ensure children receive adequate education or experiences that help foster normative, developmental standards.
• Depending on the laws and child protective policies in one’s area, leaving a young child unsupervised may be considered neglect, especially if doing so places the child in danger.

Child Abuse, Neglect and Foster Care

All types of abuse are complex issues, especially within families. There are many reasons people may become abusers, such as poverty, stress, and substance abuse are common characteristics shared by abusers, although abuse can happen in any family. Children who experience any type of abuse may “act out” or respond in a variety of unhealthful ways. This is the language that children use to communicate when they are hurting. These may include acts of self-destruction, withdrawal, and aggression, and struggles with depression, anxiety, and academic performance. Researchers have found that abused children’s brains may produce higher levels of stress hormones. These hormones can lead to decreased brain development, lower stress thresholds, suppressed immune responses, and lifelong difficulties with learning and memory. Abused children are much more likely than children who are not abused to end up with various developmental, psychological, and behavioral problems throughout their life course. In particular, they are more likely to be aggressive, to use alcohol and other drugs, to be anxious and depressed, and to get divorced if they marry.

Children who experience abuse or neglect are at risk of developing lifelong social, emotional, and health problems, particularly if neglected before the age of two years. This is consistent with what research tells us about Adverse Childhood Experiences (ACEs). However, it is important to note that not all children who experience abuse and neglect will have the same outcomes. As we learned, there are many ways in which we can foster stable, permanent, safe, secure, nurturing, loving care for children who have been associated with reduced effects of ACEs. It is extremely important to understand the ways in which child abuse and neglect can be prevented. For more information, visit the CDC Child Abuse and Neglect web page.

Adverse Childhood Experiences (ACEs) are potentially traumatic events that occur in childhood Adverse Childhood Experiences (ACEs) | VitalSigns | CDC. The video below provides an overview of ACEs and how we can prevent the impact.

According to the Center for Disease Control and Prevention:

• ACEs can include violence, abuse, and growing up in a family with mental health or substance use problems.
• Toxic stress from ACEs can change brain development and affect how the body responds to stress.
• ACEs are linked to chronic health problems, mental illness, and substance misuse in adulthood.

These are experiences that have been identified as ACEs:

• Experiencing violence or abuse
• Witnessing violence in the home or community
• Having a family member attempt or die by suicide
• Also included are aspects of the child’s environment that can undermine their sense of safety, stability, and bonding such as growing up in a household with:
  • Substance misuse
  • Mental health problems
  • Emotional abuse or neglect
  • Instability due to parental separation or household members being in jail or prison

Currently, we are seeing the impact of COVID-19 and Racial Injustice on children and their families. Consider how this societal trauma with the disruptions, isolations, and uncertainty may contribute to outcomes for children in the early years. This may be exacerbated by children who are already experiencing toxic stress in their homes, school, and community.

Corporal Punishment

Worldwide initiatives have recommended banning the use of corporal punishment with or in children of all ages. According to the Global Initiative to End all Corporal Punishment of Children, corporal punishment is defined as “any punishment in which physical force issued and intended to cause some degree of pain or discomfort, however light”.

Examples include shaking, kicking, forcing ingestion (e.g., soap, hot sauce), and “smacking,” “slapping,” or “spanking” with any object or a hand. Nonphysical forms of punishment (e.g., verbal and emotional abuse) include activities that are intended to cause shame to a person such as humiliation, threats, ridicules, etc.
Vast amounts of research have consistently demonstrated strong correlations between youth who experienced harsh punishment (e.g., spanking) by their parents and increased risks of:

• changes in brain physiology that show on MRI studies,
• mental health disorders such as depression or anxiety,
• elevated cortisol levels,
• cognitive problems,
• aggressive behaviors,
• unhealthy caregiver-child relationships,
• suicide attempts,
• moderate-to-heavy drinking,
• substance use disorders,
• misconduct, and
• adverse outcomes that extend into adulthood.

Foster Care/Resource Families

In the United States and in some other countries, another way to immediately protect children from further abuse is to remove them from their primary caregivers and place them into foster care or with family members. Foster care is a system in which a minor is placed into a group home (residential child care community, treatment center, etc.), or private home of a state-certified caregiver, referred to as a “foster parent,” "resource family," or with a family member approved by the state. The placement of the child is normally arranged through the government or a social service agency. The institution, group home, or foster parent is typically compensated for expenses unless the child is placed with a family member.

In the United States, on any given day, there are more than 400,000 youth living in foster care (out-of-home care) primarily due to abuse and/or neglect. And, more than 100,000 of these youth are waiting to be adopted from foster care. This means that these parents have lost permanent legal rights and custody of their children, leaving their children without any permanently legal caregivers (the government assumes this responsibility until someone adopts the children). The average age of youth waiting to be adopted from foster care is eight years old. This is one way that a child may be adopted into a permanent family.

Adoption

Adoption of children is one of many ways in which families are formed. Adoption, the legal transfer of parental rights of a child to another person, can occur in many ways and elicit a wide variety of family types. In the United States, statistics for the total number of all types of adoptions are not compiled on a regular basis and statistics are not at all compiled for some adoption types. Adoption statistics and estimates are based on U.S. Census data and other sources. It is estimated that approximately 2-4% of all Americans are adopted.

As we learned previously, more than 100,000 youth (with an average age of 8 years) are waiting to be adopted from foster care. But, a majority of individuals wish to adopt an infant. According to research, millions of American women have expressed a desire to adopt an infant and tens of thousands of families are waiting to adopt an infant.
However, it is also estimated that fewer than 20,000 babies are voluntarily placed for adoption each year in the United States. Certainly, there are thousands fewer infants placed for adoption than families waiting to adopt an infant. Research has shown that placing a baby for adoption can serve as a preventive option of child abuse and neglect for individuals who are not ready to parent, able to parent, or willing to parent.

Thus, it is a best-practice approach that individuals experiencing unplanned or unwanted pregnancies be provided the most accurate information concerning their options for parenting, adoption, the processes associated with all options, etc.

In the U.S., it is common for birth parents to choose their baby’s adoptive parents, and in some cases, adoptive and birth family members are able to maintain some contact with each other. It is important to note that infants who are voluntarily placed are typically taken home immediately from the birthing location by their adopting family. In conclusion, fewer children may end up in foster care if their parents were advised of their options for adoption and parenting. To learn how to educate parents about the option of placing their baby for adoption.

Types of Adoptive Families

There are numerous adoptive family types. Below is a brief definition of each family type.

• Infant/newborn/domestic: A child who is born in a country and who is adopted shortly after birth (within the same country).
• Transnational/Intercountry/International: A child who is born in one country and is adopted by a family who lives in another country. Often, the child is orphaned. For statistics and information about intercountry adoptions visit this website.
• Kin: Children adopted by a relative such as an aunt, uncle, sister, brother, grandparent, or other relative.
• Foster care: Children who are no longer able to be cared for by their primary caregiver(s) who are adopted by another family member.
• Stepparent: Children adopted by one parent’s spouse; the spouse agrees to take full responsibility for the child.
• The following forms of adoption are a result of assisted reproductive technology (methods that utilize medical technology to achieve conception and birth). In most U.S. states, these forms require the legal transfer of parental rights to another parent(s).
• Embryo: Families can adopt an embryo produced from the sperm and egg of one couple. Clinics and agencies help match donating families and recipient/adopting families.
• Surrogacy: A surrogate mother carries a fertilized egg in utero. After the birth of the child, the intended parent(s) adopt(s) the child.

Below are some of the more commonly-used terms associated with adoption and the legal process.

• Adoption Triad: Birth parents, adoptive parents, and the adopted child(ren).
• Disrupted Adoption: An adoption agreement that ends before finalization.
• Dissolution of Adoption: An adoption that ends after finalization.
• Interstate Compact on the Placement of Children: A law that requires written notice and prior approval of the placement of a child for adoption or foster care from one state with a family in another state.
• Kinship care: The full-time nurturing of a child by someone related to the child by family ties or by prior relationship connection (fictive kin).
• Reunification: The returning of foster children to the custody of their parent(s) after placement outside the home.
• Relinquishment/Termination of Parental Rights: The legal step necessary for parents to voluntarily or involuntarily have their parental rights terminated to allow their child to be adopted by adoptive parents; sometimes referred to as a surrender or as making an adoption plan for one’s child.
• Special Needs: Children with physical, behavioral, or mental impairments, children with siblings in need of adoption, and at-risk children.
• Before and after the legal transfer of parental rights, families can decide how they may stay in contact after the child is no longer a legal member of the birth family. This decision is referred to as “levels of openness” or “degrees of contact.”

Levels of Openness/Degrees of Contact

Non-identifying information: Information that allows the members of the adoption triad to know about each other, but without identifying information. First names, physical descriptions, occupation, education, personality characteristics, hobbies, interests, religious affiliation, and medical information are examples of non-identifying information.

Semi-open adoption: An adoption in which a child’s birth parents and adoptive parents may exchange primarily non-identifying information. After the child is placed in the adoptive home, contact with the birth family may involve letters or pictures or other communications sent through the intermediary of the adoption agency or the attorney who assisted in the placement.

Closed adoption: An adoption that involves total confidentiality and sealed records; contact does not exist between any members of either family.
Identifying information: Information concerning birth parents which discloses their identities.

Open adoption: An adoption that involves some amount of initial and/or ongoing contact between birth and adoptive families, ranging from sending letters through the agency, to exchanging names, and/or scheduling visits.

Terminology
Using accurate adoption language can stop the spread of adoption-related misconceptions and educate others about adoption. For instance, the phrase “choosing to place your child for adoption” has a much more positive connotation than “giving up your baby.” “Choosing to place your child for adoption” focuses on the fact that parents most likely considered options and chose the option they felt was best for the child. It is important to use appropriate terms so that accurate language may someday be the norm.

Accurate and Inaccurate Adoption Terminology

Accurate language	Inaccurate language
Birthparent, first parent	Real parent, natural parent
My child	Adopted child
Choosing an adoption plan	Giving away/giving up your child
Finding a family to parent the child	Keeping your baby
To parent	To keep
Child in need of a family/parent	Adoptable child; Available child
Internation or intercountry adoption	Foreign adoption
Child who has special needs	Handicapped child, hard to place
Child from another country	Foreign child
Was adopted	Is adopted

References:

"Parenting and Family Diversity" by Diana Lang is licensed under CC BY-NC-SA 4.0

Center for Disease Control