Child Maltreatment: What You Need to Know

Introduction 

Child maltreatment is an aspect of art and science that happens across the world with little knowledge on how to go about it. Since ancient civilizations, violence against children has rapidly increased with mutilation, infanticide, and abandonment acts registered in any part of the world. Historical records on child abuse indicate that malnourished, weak, sexually abused, and unkempt children were cast out by families and subjected to personal fending ( Thompson et al., 2016 ). Despite various existences of charitable groups that have advocated children protection towards maltreatment, there is no much attention by the general public as well as the medical profession regarding child abuse and neglect. Child abuse and neglect have had a big impact on the lives of those who survived child abuse. Although most people focus more on the physical aspect of child abuse, it is important to look at the effect on the mental and emotional factors. 

Child abuse is a global problem rooted in economic, cultural, and social practices. According to Brown et al. (2018) , the problem associated with child abuse and neglect requires a better understanding of causes and consequences resulting from child maltreatment. Across the world, culture defines society's behaviours and beliefs and offers an overview of how people within societies differ in terms of conduct. Additionally, culture defines how a child is reared and taken care of due to prevailing accepted principles that govern certain norms within a society ( Tran et al., 2017 ). Any society concept that omits or commission certain accepted principles leads to abuse and neglect, hence child maltreatment. Different cultures are ruled by different principles regarding what parenting practices accept. Various researches indicate that the rearing of a child across cultures differs depending on what is perceived abusive or not and therefore makes it difficult to reach a conclusive view on what neglect entails as far as diverse cultures and associated norms are concerned ( Haas et al., 2018 ). 

However, different culture measures what is abusive and not through particular parental behaviour with the notion that child maltreatment should be allowed with virtual unanimity based on extreme disciplinary actions as well as sexual abuse. A comparison of child maltreatment from different countries was made by the International Society for the Prevention of Child Abuse and Neglect to bring on board a harmonized understanding of what child abuse entails. From WHO consultation on Child abuse point of view, child abuse or maltreatment is an act characterized by sexual abuse, commercial child exploitation, and emotional as well as physical ill-treatment that offer potential harm to the development, health, dignity, and survival of the child ( Fowler & Schoeny, 2017 ). Another definitive comparison of what child maltreatment entails is based on an adult’s actions or behaviours that perceive harmful, threatening, and abusive to the child. However, some literature indicates that an explicit violent act of an institution or a school against children coupled up as child abuse. The above definitions indicate that child maltreatment ranges from parental, society misconception, and explicit institutional abuses. Additionally, child abuse can be through physical abuse, sexual abuse coupled with sexual gratification, and emotional abuse, such as the provision of inappropriate support environment that hinders child health development. Hence, despite gender, face, or economic classes, children are vulnerable to child maltreatment. 

The literature on fatal and non-fatal abuse 

A reflection on the mortality data and death registries gives us an overview and information regarding the numbers of children who die each year. In the year 2000, approximately 57 000 deaths resulting from homicide were registered as World Health Organization stipulated that children under 15 years are most vulnerable to homicide deaths ( Haas et al., 2018 ). Globally, young children, as well as infants, are at risk of child homicide, ranging from 0-4 years old as compared to 5-15 years old. However, the risk associated with fatal abuse depends on the regional as well as the country’s income level. According to McLaughlin et al. (2015) , the homicide rate for children under the age of 5 and living in high-income counties is 1.8 and 2.2 per 100,000 for girls and boys, respectively. While homicide rates for high-income countries such as the Western Pacific, Eastern Mediterranean, and European regions are low. In 2015, approximately 680 000 children were the victim of abuse and neglect, with 6.9% of victims subjected to mental abuse. 

Given that there is no proper recognition of the exact causes of infanticide and its measure, misclassification of the causes of deaths can be articulated through death certificates. For instance, in the United States, cases on the sudden death of an infant through syndrome and accidents have rapidly increased with apparent reinvestigation that this could be cases of homicides ( Brown et al., 2018 ). Head injuries, intentional suffocation, and abdomen injuries are the most attributed fatalities that cause fatal abuse in most countries across the world. Population-based surveys, official statistics, and case reports are sources that offer data on non-fatal abuse. However, we have differences in the above-proposed sources. For instance, official statistical reveals little information on child abuse patterns due to changes in legal as well as social systems, regional differences in cultural and legal definitions of abuse and neglect. Case series also indicates that public and professional awareness on how to raise a child, especially in local regions, fails to take place and, therefore, to increase the rate of child abuse. In this context, population surveys are used as essential elements in countries such as Chile, Romania, Brazil, Canada, and the United States, among other countries, to determine non-fatal child abuse. 

Both fatal and non-fatal cases of abuse are channels and instability placements that enhance and increases criminal activities for juveniles. Children subjected to child maltreatment opt to join street life and criminal activities, hence engaging in juvenile activities. According to Kemoli & Mavindu (2014) , neglected, and abused children are vulnerable to activities such as violence and crime-related activities. For instance, adolescents subjected to child maltreatment may attempt to revenge by killing their parents in terms of self-defence. A study by Thompson et al. (2016) indicates that there is a relationship between violent behaviour from negligence and child abuse in terms of delinquency. Despite differences in scope, design, and quality, violence as a result of child abuse is evident through neuropsychiatric vulnerabilities with a delinquent product of young adulthood engaging in crimes categorized as juvenile activities. In most underdeveloped countries, there has been a rapid increase in juvenile crime activities and arrest for violence, which are believed to project from child maltreatment activities and measured through violent behaviours from parents. 

Child Neglect 

People terms the lack of care from parents and caregivers as a harm or neglect act leading to child abuse. According to Van Berkel, Tucker, and Finkelhor (2018) , neglect at times is defined based on issues such as poverty and hunger, and therefore, there is no standard definition of neglect due to changes perceptions within global dimensions. There are various models as well as theories that explain how abuse and neglect happen within families. The ecological model is widely used to explain child abuse and neglect, where several characteristics involving the child, family, perpetrator, social, cultural, and economic environment. The ecological model considers nature of the local community ( Fowler & Schoeny, 2017 ). Three distinct factors that increase child abuse and neglect vulnerability risks are sex, age, and family characteristics. First, the age of the child, whether it is physical appearance, sexual abuse, or parental negligence, increases child abuse vulnerability. Cases of physical abuse are common for young infants with a high level of deaths exhibited in Finland, Senegal, Fiji, and Germany ( Brown et al., 2018 ). The risk level for non-fatal physical abuse as far as young children are concerned varies from one county to another in terms of peak ages. However, sexual abuse becomes vulnerable during puberty and adolescent period, although some cases involve young children. 

Second, the types of sex, especially girls, are more prevalent and risky to infanticide, forced prostitution, educational and nutritional neglect, as well as sexual abuse as compared to boys. Thompson et al. (2016) posit that more than 140 million children aged between 6 and 12 years, especially girls, are not in school and subjected to sexual abuse across the world. Girls in some countries are not allowed to attend to education and subjected to economic work or look after their siblings, which is an act of child abuse and neglect. However, male children are vulnerable to harsh physical treatments with the notion that they are preparing for adult roles and responsibilities. There is a cultural gap in terms of awareness and perception of what entails child abuse and neglect. 

Physical abuse 

Physical abuse can be temporary and permanent injury or damage derived from various parental behaviours when disciplining their children. According to Tran, Van Berkel, van IJzendoorn and Alink (2017) , 49 per 1000 children subjected to physical abuse are from bruises, burns, and abrasions due to being hit with an object, severe beating, kicking, and threatening the child with a gun or a knife. In most cases, physical abuse arises from harsh parental punishment, leading to the medical and physiological consequences of the child. Death and brain dysfunction comes as a result of physical abuse in infants as well as young children. Vulnerable to physical abuse and associated fatalities are children aged below 5 years with an estimate of 1,500 deaths of children registered yearly in the United States due to child abuse or neglect ( Haas, Berg, Schmidt-Sane, Korbin & Spilsbury, 2018 ). These deaths may be higher given that there is misclassification in child fatality reports and as far as physical maltreatment is concerned. Physical abuse involves brain injuries, and a child not only sustains brain injuries through beating but also vigorously shaking an infant through extremities. Additionally, infants who are shaken vigorously sustain intraocular as well as intracranial bleeding without indication of external head trauma. 

Cases on child neglect come at hand during the development of the child during childhood and later discovered by educators, health professionals, and child welfare workers. An infant encounters neglect when subjected to an environment coupled with nonorganic failure to thrive. Through objective scales of height weight, infant physical growth is predetermined to derive the cause and extent of neglect ( Kemoli & Mavindu, 2014 ). If an infant shows significant weight gain following child-parent removal or hospital admission, then this is due to neglect and deprivation dwarfish. More so, people can measure child neglect can through child growth impairment resulting from the absence of nutritional requirements for young children. However, emotional neglect resulting from psychological consequences persists even after the diagnosis and treatment of the child. Witt et al. (2017) argue that when physicians diagnose an infant as failure to thrive, the child, in most cases, becomes hostile and defiant even at the young adolescent period. Nonetheless, it is good to note that there is a big difference between factors triggering nonorganic failure to thrive and child neglect. Most children are subject to stressful behaviours such as irritability, social responsiveness deficits, and feeding problems in the early period of neglectful behaviours, and therefore, increased demands on parental care are paramount. But, a vicious emotional cycle coupled with cumulative psychological risk comes at hand when a child is subjected to increased maternal detachment and nutritional deprivation ( Thompson et al., 2016 ). 

There are serious health problems associated with child maltreatment and neglect, leading to adverse effects on the growth development of children. Physical studies on child abuse indicate that damage to the central nervous system, speech problems, physical defects, and mental as well as growth retardation are neuromotor health consequences resulting from child abuse and neglect ( Tran, Van Berkel, van IJzendoorn & Alink, 2017 ). When a child has physically abused both internal organs, and head trauma are evident given that the abused children have more skin markings, physical injuries, scars, and mild neurologic signs as compared to others not abused. 

Sexual abuse 

Sexual abuse in children is the involvement of a child in sexual involvement to provide satisfaction to the perpetrator ( Van Berkel, Tucker & Finkelhor, 2018 ). Forms of childhood sexual abuse may include violent acts by a stranger, seduction from a relative, prostitution, statutory rape, molestation, pornography, and other sexual activities. The definition of sexual abuse depends on the different forms, frequency levels, circumstance variation, and associated relationship. According to Thompson et al. (2016) , sexual abuse is an act full of individual sexual exploitation to another person without consent and obtained by coercion or seduction. However, childhood sexual abuse, no matter how it is defined, has pervasive and negative psychological impacts on the prevailing victims. The impact of childhood sexual abuse depends on the case and the person involved. For instance, a case on familial sexual abuse leads to a higher level of anxiety and depression as compared to non-familial abuse, especially when the act of abuse lingers in the victim's mind. The experience of the abuse, which is defined by the rate, impact, and extensiveness of the act, is the reason why childhood sexual abuse creates distress in the life of the victims. 

There is various long-term effect associated with childhood sexual abuse. Despite the guilt, eating disorder, anxiety, repression, relationship problems, shame, somatic, self-blame, dissociative patterns, concerns, sexual problems, and denial, depression is the most common long-term impact associated with childhood sexual abuse. Childhood sexual abuse victims always think negatively about themselves year in year out, and in turn, such negative self-thoughts makes them feel worthless by avoiding socialization with others. As per Chen and Chan (2016) , depressive actions for child sexual abuse is a subject of victims having a feeling of suicidal ideation, disturbed sleeping, and eating patterns that affect health in general. Self-blame, guilt, and shame are another long-term associated with child sexual abuse where the victims tend to take personal responsibility for the abuse. Victims always display self-destructive behaviours coupled with suicidal ideation as compared to those children who have not subject to sexual abuse. 

However, child sexual abuse leads to eating disorders and body tissues such as feeling ugly or dirty appearance dissatisfaction, and obesity. Additionally, child sexual abuse leads to distress with somatic concerns such as emotional distress, pelvic pains, and problems functioning. Other symptoms associated with somatic concerns include headaches, gastrointestinal problems, as well as difficulty in swallowing ( Brown et al., 2018 ). The act of sexual abuse is frightening, and most cases cause anxiety and stress due to prevailing past or recurring experience as well as a sexual abuse incident. Examples of anxiety and stress as one of the long-term effects caused by child sexual abuse include tension, phobias, chronic anxiety, and anxiety attacks. Victims of child sexual abuse always disassociate with people when they feel threatened or unsafe, hence feeling confused, disoriented, difficulty in expression, having nightmares, and flashbacks. Another long-term effect of child sexual abuse is repression and denial. Symptoms associated with repression and denial includes negative impacts of sexual abuse, amnesia, and feeling in need of forgetting experience regarding sexual abuse act ( Stoltenborgh et al., 2015 ). 

Issues with establishing interpersonal relationships are another long-term effect of child sexual abuse. It is a challenge for a child who exhibited sexual abuse to have a healthy relationship, hence hindering the prevailing development and growth of the relationship. Relationships difficulties may include lack of trust, passive behaviour, fear of getting into an abusive relationship, fear of intimacy, fear of being weird or different, and issues with establishing interpersonal boundaries ( Thompson et al., 2016 ). As per Fowler and Schoeny (2017) , sexual abuse in most cases involves people who children perceive to love most, and the severity of childhood abuse causes trust issues with the notion that such people will hurt them. Children that have been victims of child abuse can suffer for the rest of their lives, given the consequences associated with child sexual abuse. The most affected aspect is sexual functioning, which comes as a result of depression and dissociative patterns within the victim’s life. Sexual functioning carries symptoms such as approaching sex as an obligation, negative feelings such as guilt, disgust, and anger, avoiding fearing, difficulty with feeling sensation, emotionally distant, lack of interest in sex, and intrusive sexual thoughts. 

Conclusion 

Child abuse is a global health problem that requires attention since there is little recognition among public health professionals, and therefore, it has had a big impact on the lives of victims. Although most people focus more on the physical aspect of child abuse, it is important to look at the effect on the mental and emotional factors. Child abuse affects the emotion and mental of the victims in many ways. First, physical abuse is part of child abuse where the victim is subject to bruises, burns, and abrasions due to being hit with an object, severe beating, kicking, and threatening the child with a gun or a knife. Physical abuse always leads to a vicious emotional cycle coupled with cumulative psychological risk where a child subject to increased maternal detachment and nutritional deprivation. Death and brain dysfunction comes as a result of physical abuse in infants as well as young children. Additionally, infants may sustain intraocular as well as intracranial bleeding without indication of external head trauma resulting from vigorous shaking. Second, child abuse in terms of sexual abuse affects the victim’s mental health. Forms of childhood sexual abuse may include violent acts by a stranger, seduction from a relative, prostitution, statutory rape, molestation, pornography, and other sexual activities. Part of the solutions to child abuse and maltreatment include recognition, awareness, and prevention policies that address the issues within society. The victims of child abuse should be removed from their toxic environment and placed in a stable and safe environment, and when given the proper tools to heal from their trauma, children can have a normal life. 

References 

Brown, R. C., Heines, S., Witt, A., Braehler, E., Fegert, J. M., Harsch, D., &Plener, P. L. (2018). The impact of child maltreatment on non-suicidal self-injury: data from a representative sample of the general population. BMC psychiatry , 18 (1), 181. doi:10.1186/s12888-018- 1754-3. 

Chen, M., & Chan, K. L. (2016). Effects of parenting programs on child maltreatment prevention: A meta-analysis. Trauma, Violence, & Abuse , 17 (1), 88-104. 

Fowler, P. J., &Schoeny, M. (2017). Permanent Housing for Child Welfare-Involved Families: Impact on Child Maltreatment Overview. American journal of community psychology , 60 (1-2), 91–102. doi:10.1002/ajcp.12146 . 

Haas, B. M., Berg, K. A., Schmidt-Sane, M. M., Korbin, J. E., &Spilsbury, J. C. (2018). How might neighborhood-built environment influence child maltreatment? Caregiver perceptions. Social science & medicine (1982) , 214 , 171–178. doi:10.1016/j.socscimed.2018.08.033. 

Kemoli, A. M., &Mavindu, M. (2014). Child abuse: A classic case report with literature review. Contemporary clinical dentistry , 5 (2), 256–259. doi:10.4103/0976-237X.132380. 

McLaughlin, K. A., Peverill, M., Gold, A. L., Alves, S., & Sheridan, M. A. (2015). Child maltreatment and neural systems underlying emotion regulation. Journal of the American Academy of Child & Adolescent Psychiatry , 54 (9), 753-762. 

Stoltenborgh, M., Bakermans ‐ Kranenburg, M. J., Alink, L. R., & van IJzendoorn, M. H. (2015). The prevalence of child maltreatment across the globe: Review of a series of meta ‐ analyses. Child Abuse Review , 24 (1), 37-50. 

Thompson, R., Lewis, T., Neilson, E. C., English, D. J., Litrownik, A. J., Margolis, B., … Dubowitz, H. (2016). Child Maltreatment and Risky Sexual Behavior. Child Maltreatment , 22 (1), 69–78. doi: 10.1177/1077559516674595. 

Tran, N. K., Van Berkel, S. R., van IJzendoorn, M. H., &Alink, L. (2017). The association between child maltreatment and emotional, cognitive, and physical health functioning in Vietnam. BMC public health , 17 (1), 332. doi:10.1186/s12889-017-4258-z . 

Van Berkel, S. R., Tucker, C. J., &Finkelhor, D. (2018). The Combination of Sibling Victimization and Parental Child Maltreatment on Mental Health Problems and Delinquency. Child maltreatment , 23 (3), 244–253. doi:10.1177/1077559517751670. 

Witt, A., Brown, R. C., Plener, P. L., Brähler, E., &Fegert, J. M. (2017). Child maltreatment in Germany: prevalence rates in the general population. Child and adolescent psychiatry and mental health , 11 , 47. doi:10.1186/s13034-017-0185-0.