Physical Abuse

What is Physical Abuse

How wide spread is the problem?
Identification and Reporting
Behavioral Indicators
Impact of Physical Abuse on Children
Prevention
 

What is Physical Abuse

As a general rule, physical abuse refers to the infliction of physical harm on a child by a parent or caregiver. It is not necessary for the harm to be intentionally inflicted, and in the majority of situations physical abuse is the unintentional end result of harsh disciplinary methods or corporal punishment that have escalated to point of physical injury or the risk of physical injury. Physical abuse often occurs simultaneously with other forms of child maltreatment. An unfortunate but common example of this is when a child is hit with close fists or an object  while also being belittled and verbally insulted. In this case, the child would be considered to have experienced both physical and emotional abuse.

Child abuse could include bruises, abrasions, cuts, burns, fractures, bites, or any of a number of other injuries. Also, physical assault by a parent or caregiver that presents a substantial risk of physical injury is considered abuse. Hitting a child with a hard instrument or with closed fists, burning, scalding, poisoning, suffocating, drowning, kicking, shaking, choking, and stabbing are amongst behaviors that are considered to be abusive. Although these actions may not result in observable injuries such as bruises or cuts, they are still considered abusive.

How wide spread is the problem?

Physical abuse is a widespread problem all over the world. The phenomenon of physical abuse is not limited to any specific subset of the population. Families from all racial and ethnic and socioeconomic backgrounds engage in physical abuse, and children can be subjected to physical abuse regardless of their sex or age. However, certain social and demographic factors are correlated with higher levels of reported physical abuse such as single parenting and low income.

Single parents often find themselves socially isolated from sources of support that could help decrease the burdens of parenting, and they can also lack adequate models to help them make disciplinary choices that are less likely to lead to physical abuse. Low income normally accumulate finical stress which may lead the parents to engage in discipline methods that are likely to become physically abusive.

Overall, studies examining risk for physical abuse shows that any conditions that increase distress for the family, parent or disrupt interaction between parent and child will increase the risk for physical abuse. Such conditions include: children with complex medical problems or developmental delays, children who are unwanted, “difficult" children who are hyperactive, children whose caregivers are under significant life stresses or have unrealistic developmental expectations of the children.


Identification and Reporting

It is important to remember that Child Abuse thrives and empowers in the shadows of privacy and secrecy; it lives by inattention. The first step in preventing and treating physical abuse is identification. Children may disclose physical abuse to teachers, physicians, family friends, or their own friends. Disclosures may be indirect, such as a child saying, “I have a friend whose father hits them and hurts them.” Many children find it difficult to openly discuss the abuse that is occurring. They might also be frightened, since many abusers threaten the child in order to make him or her remain silent and not to discuss family matters outside of the home.  

Physical abuse is the most visible form of Child Abuse or maltreatment because physical indicators are the first to be noticed. The first step to eliminating child physical abuse is to acknowledge that it occurs. The next step is to learn to recognize the signs and symptoms in order to determine if a child is being abused. There are several factors to be considered in raising the question of possible physical abuse. First, the location, nature, and the extent or severity of the injury are important to consider.

Does the injury fit with the explanation given? Is the child's age or developmental stage is consistent with the type of injury? For example, burns that are in the shape of an iron, grill, or cigarette, or immersion burns that children could not have inflicted upon themselves. Other indicators may include human bite marks, fingernail scratches that leave parallel linear marks, or other lacerations or abrasions that may indicate an instrument used. Some children may have missing, loose, or broken teeth, bald spots on their head, or bruises/welts in various stages of healing all over the body.

Behavioral Indicators

Depending on the child’s age, level of functioning, and developmental stage, behavior can be an indication that something is wrong. The following are some of the behavioral indicators which may suggest possible physical abuse on the child:

• Unusual wary of physical contact with adults or is overly friendly to adults, in other words, is not aware of social boundaries.

• Has a low frustration level, becomes upset very easily or is far too tolerant or patient.

• Seems frightened of parents or other adults

• Afraid to go home, or is overly compliant with authority.

• Wet the bed and exhibit regressed behavior.

• Shy, withdrawn, and uncommunicative or hyperactive, aggressive, and disruptive.

• Do not show emotion when hurt.

• Offer implausible explanations of injuries.

• Habitually absent from school or late without an explanation from the parents.

• Thinks he or she is bad and deserves punishment.

• Wear inappropriate long-sleeved or high collared clothing on hot days to hide injuries.

• Accident prone or moves or walks awkwardly.

It is important to pay attention to these indicators and not dismiss them as insignificant, especially when several of these occur together. Older children may exhibit different behavioral signs than younger children. For example, they may be engaging in acting out behavior such as running away, getting involved in criminal activities, or engaging in self-destructive behaviors such as abuse of drugs and alcohol.

Impact of Physical Abuse on Children

Child physical abuse damages children physically, emotionally and socially. The most obvious and immediate result is physical.

Physical:

An abused child may experience one of more of the following: hitting, shaking, choking, biting, kicking, punching, burning, poisoning, suffocating, or being held underwater. Physical abuse may lead to bruises, cuts, welts, burns, fractures, internal injuries, or in the most extreme cases death.

Initial impact on children will be the immediate pain and suffering and medical problems caused by the physical injury. However, the pain will last long after the bruises and wounds have healed. The longer physical abuse of a child occurs, the more serious the impact. Chronic physical abuse can result in long term physical disabilities, including brain damage, hearing loss, or eye damage.

The age at which the abuse takes place influences the impact of the damage. For example, infants who are physically abused are more likely to experience long-term physical effects and neurological alterations such as irritability, lethargy, tremors, and vomiting. In more serious cases where the abuse was more forceful or longer in duration, the infant may experience seizures, permanent blindness or deafness, mental and developmental delays or retardation, coma, paralysis, and in many cases death. This has recently been called the “Shaken Baby Syndrome” since it most often occurs as a result of violent shaking or shaking of the head. 

Emotional:

Beyond the physical problems experienced by children, there are other consequences of physical abuse. Studies of physically abused children and their families indicate that a significant number of psychological problems are associated with child physical abuse. Abused children compared with non-abused children may have more difficulty with academic performance, self- control, self-image and social relationships. A recent US study comparing physically abused and non-abused children provided considerable evidence of the negative and lasting consequences of physical abuse. The physically abused children in the study experienced far greater problems at home, at school, amongst peers and in the community.

Children who are physically abused have a predisposition to a host of emotional disturbances. They may experience feelings of low self-esteem and depression or may be hyperactive and overly anxious. Many of these children may exhibit behavioral problems such as aggression towards other children or siblings. Other emotional problems include anger, hostility, fear, humiliation, and an inability to express feelings. The long-term emotional consequences can be devastating. For example, children who are abused are at risk of experiencing low self-esteem, depression, drug or alcohol dependence, and increased potential for child abuse as a parent.
 

Social

The social impact on children who have been physically abused is perhaps less obvious, yet still substantial. Immediate social consequences can include an inability to form friendships with peers, poor social skills, poor cognitive and language skills, distrust of others, over-compliance with authority figures, and a tendency to solve interpersonal problems with aggression. In their adult life, the long-term consequences can impact both their family and their community. There are financial costs to the community and society in general, e.g., funding social welfare programs and services and the foster care system. Studies have shown that physically abused children are at a greater risk for mental illness, homelessness, crime, and unemployment. All of these affect the community and society in general and are the social costs of physical abuse.

Interventions

Every family that experiences physical abuse is different. Therefore, effective interventions must target the problems and deficits specific to each family that increase the risk of physical abuse. An inability to appropriately control and express anger is an example of a risk factor that is frequently associated with parents whom engage in physical abuse. For those parents, anger management would be a useful intervention. Goals of anger management include the lessening of heightened arousal levels during challenging parenting situations, the improvement of abusive parents’ coping skills, and the reduction of the probability that parents will have uncontrolled emotional reactions that end in physical abuse. Techniques that can be used to attain these goals including training parents in the use of positive imagery and relaxation methods, helping them identify when they are angry before their emotions get out of control, and teaching them how to come up with thoughts that help them stay calm.

Another risk factor associated with physical abuse is social isolation, a concern that can be addressed through the use of education and support groups. Parents also engage in physically abusive behaviors because they are unaware of effective parenting techniques. Educating these parents about such useful skills such as:

Active listening.

Unambiguous communication.

Nonviolent means of discipline.

Setting meaningful rewards.

Consequences for specific behaviors.

Having the education and awareness on the above points can go a long way towards reducing the risk for the recurrence of physical abuse. Interventions focusing on skills training should give parents plenty of opportunities to observe others model parenting techniques and should also provide parents with role-playing and real-life exercises that allow them to practice what they’ve learned in a safe, non-threatening environment. These interventions can also allow parents to receive honest feedback about their parenting behaviors from experienced professionals.

Finally, other conditions that go beyond simple deficits in knowledge or difficulty managing anger can interfere with the ability of parents to appropriately discipline their children. These include external pressures such as financial problems, interpersonal difficulties like marital strife or domestic violence, and serious mental health conditions such as schizophrenia, major depression, and substance abuse problems. When these circumstances are linked to physical abuse, wide-ranging solutions must be sought, whether this means connecting parents with appropriate social services or locating referrals for marital counseling, psychotherapy or psychiatric care.

Intervening when physical abuse is identified not only involves working with the perpetrators of the abuse but also includes treating the wide-ranging emotional and behavioral consequences that physical abuse can have for children. For example, it is common for children to experience symptoms of post-traumatic stress in the aftermath of physical abuse. Providing these children with anxiety management techniques and psycho education about family violence can be a useful intervention for these symptoms.

Play therapy can also be helpful in providing children with an opportunity to express and work through the painful emotions that may be contributing to anxiety, depression, or behavioral difficulties. Often, those whom have been physically abused need help expressing their anger in appropriate ways. For these children, interventions include teaching them relaxation techniques, engaging them in role-playing exercises, providing them with supervised group interactions and feedback, and helping them identify the signs of anger early in order to prevent inappropriate outbursts.

Children whom exhibit difficulties in their relationships with peers and adults as a result of their abuse can benefit from social skills training that teaches them how to have positive interactions with other children and come up with solutions to problems and ways of handling negative social situations. Another useful intervention with children who have poor peer relationship skills pairs them with children who have been identified as having strong social skills. These children then engage in positive play activities together with the expectation that the less socially-adept children will begin to behave in more appropriate ways towards their peers. While mental health professionals deliver the majority of these interventions, school personnel can also be brought in to help with both the academic deficits and behavioral problems that can result from a history of abuse.


Prevention

Prevention and intervention techniques need to be  designed to help decrease the scope and frequency of child physical abuse. Knowledge is the first step to prevention of child abuse.
Early detection of physical abuse starts with teachers, day care center, hospitals, and other agencies that serve children and families. Beyond educating those who might detect abuse, prevention efforts need to be focused on both the population in general as well as population subgroups that have been identified to have a higher risk of engaging in abusive behaviors. They can include such indirect means as using media campaigns designed to spread information on child development or parenting skills.

Other prevention efforts that will be helpful will involve establishing peer help lines to provide support for parents experiencing crises that could increase their likelihood of abusing their children. Another approach is to develop ways to get parents who would otherwise be isolated from their child-rearing peers linked to social support networks.

An example of a more direct prevention program would be one that provides in-home family support for parents who are considered to be at risk: families with lower socioeconomic status, single parents, inexperienced or isolated parents, or those with alcohol or drug problems. Health services professionals often offer such preventative measures to parents at stressful transition points in their lives when the risk of physical abuse is judged to increase.

Because abuse is transferred from one generation to the next, it is important to understand that children who are abused are at higher risk for being abusers. It is understandable that children who have not received the needed nurturance and support from their parents may find it difficult to provide this for their children. Prevention efforts must acknowledge the intergenerational patterns of violence and work with children who are abused to prevent them from becoming abusers themselves.