1. Running Head: CHILD ABUSE PAPER Seminar in Public Justice 1
Child Abuse
Michael Schuster
State University of New York College at Oswego
Seminar in Public Justice
Professor. Kurst-Swanger
May 4, 2015
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Abstract
The purpose of this paper is to educate the reader about child abuse. Further discussion
will cover who the most common abusers are, the damage done to the abused both physically
and psychologically and their treatment post-abuse. The effects of child protective services and
the preventive programs they advocate on the victim and their families will also be analyzed.
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Introduction
Of all the crimes committed, the most abhorring are those perpetrated against children.
Unfortunately, incidents of crime against children have increased dramatically during the past
decade (Swanson, Chamelin, Territo & Taylor, 2012). Since childhood is a developmental stage,
in which we as individuals begin to grow and perceive the world around us, they are vulnerable.
The purpose of this paper is to illustrate the damage done to abused children, as well as
prevention programs and the surrounding issues with identifying child abuse. Due to their age
most children lack the ability and knowledge to defend themselves both physically and socially.
Inadequate physical defense refers to a child’s inability to fight off the abuser due to their
incomplete physical development. I say socially because a child is not always aware of what
constitutes normal and acceptable behavior. A child is considered abused if he or she is treated in
a way that is unacceptable in a given culture at a given time. (Meadow, 2007). Forms of child
abuse consist of physical, sexual and emotional abuses as well as exploitation and child neglect.
Each of which can drastically hinder a child’s psychological development and will be discussed
in depth later. Under the New York State penal code, some of the acts deemed to be any of the
mentioned forms of child abuse can be prosecuted as class A or B felonies.
Examples of groups accepting degrees of child abuse as normal
Before going into detail about the types of abuse, their effects on victims, the role of
Child Protection Services and the problems they face, I would like to mention a few statistics
regarding child abuse. As previously mentioned and supported by Hakan any form of physical
and/or emotional ill-treatment, sexual abuse, neglect or negligent treatment, exploitation,
resulting in actual or potential harm to the child’s health, survival, development or dignity
constitutes child abuse. However, such acts of abuse can be attributed to cultural and social
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practices. The documentary film Taboo: Child Rearing by Lewman, 2004 supports this notion. In
this documentary Lewman, 2004 narrates the child raising practices of China’s state child rearing
program and an Indonesian clan’s hands off parenting style. In regards to China these children
are raised by the state, so that they can represent China in the Olympics. As a result these
children only receive half the education given to a normal Chinese child and are subjected to
intense training regiments. As the documentary mentioned these child gymnasts were forced to
increase their flexibility by having pressure placed on their bodies as they stretched often to the
point where the children would literally cry from pain (Lewman, 2004). Lewman’s documentary
on child rearing had also shown Indonesian boys venturing off into the jungle on their own,
where they would be gone for days. As supported by Hakan, 2012 such practices would be
consistent with child abuse, as they show a neglect for the child’s safety and subject them to
physical injury. Yet as Meadow, 2007 stated, a child can only be abused if they are treated in
ways that are viewed as unacceptable within their given culture. Furthermore children are treated
differently not only in different countries but within a multicultural country; and even within a
city, there are subcultures of behaviour and variations of opinion about what constitutes abuse of
children (Meadow, 2007). By comparing the perspectives of different cultures we can see
ambiguity when it comes to identifying what is and is not child abuse, as what is acceptable
within one culture may be taboo in another (Lewman, 2004).
Statistics
The two most common ways of measuring abuse have been by retrospective survey of
older children and adults and by quantifying the recorded activity of the agencies and services
dealing with abused children (Meadow, 2007). In 2005, the National Child Abuse and Neglect
Data System (NCANDS) reported an estimated 3.3 million referrals of child abuse or neglect
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were received by public social service or CPS agencies. Of these referrals, 899,000 children were
confirmed to be victims of abuse or neglect (American Humane Association, 2015). In New
York State alone 68,375 victims were reported in 2012 compared to the 72,917 victims reported
in 2008. Throughout the nation 678,810 confirmed victims were noted in 2012 compared to
704,714 victims in 2008. This displays 16% decrease in confirmed cases for the state of New
York and a 3.8% decrease in the nation, despite the 3% increase in referred cases that have been
noted since 2005.
Year 2008 2009 2010 2011 2012
Total 72,917 77,620 77,011 72,625 68,375
Year 2008 2009 2010 2011 2012
Total 704,714 693,485 688,157 676,545 678,810
In Child Maltreatment 2012, the Children’s Bureau also found a trend regarding abuse rates and
child age depicted in figure 1. They found that the younger the child was the higher the rate of
child abuse was. For infants (less than 1 year) the victimization rate was 21.9, while ages 1, 2 &3
had rates of 11.8, 11.9, and 11.6 respectively. These results could reflect the child’s dependency
on a caregiver, as well as their level of vulnerability. This data is further supported by Swanson
et al (2012) in their stating a majority of children burn victims are less than 2 years old and
significantly decreases for children 10 and older.
Chart 1: displays the total number of child abuse victims reported in the state of New York
from 2008-2012. This data was retrieved from the Children’s Bureau, which is a subgroup of
U.S the Department of Health & Human Services.
Chart 2: displays the number of child abuse victims reported nation-wide from 2008-2012.
This data was also retrieved from the Children’s Bureau, (2013).
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SUIDS deaths
Lastly the report noted a trend in child mortality rates in accordance with their age. It also
reported 1,593 fatalities originating from 49 states. Nearly three-quarters (70.3%) of all child
fatalities were younger than 3 years and in general, the child fatality rate decreased with age
(Children’s Bureau, 2012). Their report further noted that 69.9% of infants died as a result of
neglect, while 44.3% died as a result of physical abuse. The high percentage of child abuse
related fatalities recorded is likely due to the improved classification of SUIDS related deaths.
SUIDS stands for Sudden Unexpected Infant Death Syndrome a phenomena in which a
previously healthy infant <365 days old dies without an obvious cause before a medico legal
investigation (Shapiro-Mendoza, Camperlengo, Kim & Covington 2012). There are three main
causes for the occurrence of SUIDS: Sudden Infant Death Syndrome (SIDS), unknown cause and
0
5
10
15
20
25
birth 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
Rateper1,000Children
Age
Exhibit 3 -D Victims by Age, 2012
Figure 1: Displays the rate of abuse per 1,000 children based upon their age. This chart
was retrieved from Child Maltreatment 2012.
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accidental asphyxiation in bed. These SUIDS accounted for about 4000 US infant deaths in
2007, with 2323 classified on US death certificates as SIDS, 1058 as unknown causes, and 588
as accidental suffocation or strangulation in bed (ASSB) (Center for Disease Control, 2011 &
Shapiro-Mendoza et al, 2012). By further classifying SUIDS into three main causes, there is a
decline in SIDS being the cause of death. As supported Hymel (2006), Shapiro-Mendoza et al
(2012) & Swanson et al (2012), most SUIDS deaths are associated with the child’s sleep
environment. According to both Shapiro-Mendoza et al (2012) & Swanson et al (2012) when the
physiologic stability of such infants becomes compromised during sleep, they may not arouse
sufficiently to avoid the noxious insult or condition. Autopsies of SIDS victims have found
abnormalities within brainstems which may cause delayed development of arousal,
cardiorespiratory control, or cardiovascular control (Hymel, 2006). However, autopsies are not
always capable differentiatiating between ASSB and SIDS. Such can be the case if the child was
suffocated by a soft object (pillow/blanket), possibly from smothering or being wedged up
against the object.
In 2012 NCANDS, Child Protection Service (CPS) agencies received 3.4 million cases
involving 6.7 million children (Administration for Children and Families, 2013). Based on their
current data, approximately 684,248 children were determined to be victims of child abuse. This
value depicts the occurrence of child abuse to be every 12 seconds in the United States. This
frequency of child abuse is probably inaccurate and more frequent due to the fact that not all
cases are reported. In accordance with Maguire-Jack & Byers (2013) Child Protection Service
workers as well as mandated reporters have a limited amount of information and exposure time
to observe the signs of abuse required to make decisions regarding screening and confirming
maltreatment allegations. These signs of abuse can include: bruising inconsistent with rough
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physical playing, burns, frequent emergency room visits, flinches when touched, always vigilant,
inability to establish personal connections, portrays emotional extremes (passive/aggressive,
etc.), withdrawal, wears long clothes on hot days, poor hygiene practices, caregivers do not give
them supervision, constantly sick, has trouble walking/sitting, has significant knowledge of sex
and sexual interests, is afraid to remove clothes around others, runs away from home, has an
STD or suddenly and unexplainably dies. The presence of these symptoms may be the result of
another abnormality, but are common symptoms found in neglected, exploited, physical,
emotional & sexual abused children and therefore cannot be ignored.
Physical abuse
The physical abuse of a child can be thought of as the intentional infliction of bodily
harm upon a child via beating, shaking, burning, cutting, poisoning or suffocating them. Physical
abuse is the most noticeable form of child abuse, as such acts often leave physical marks on the
victim’s body. These marks may be bruises, swelling, burns, cuts, scars/deformities or
discoloration of the skin as depicted below. These injuries are most likely to be found on the face
or in areas where they can be easily hidden, like the back, ribs, buttocks, genitals or soles of the
feet (Swanson, Chamelin, Territo & Taylor, 2012). In accordance with Maguire, Mann, Sibert &
Kemp (2015) bruises indicating physical abuse among physically abused children were not
located on bony areas of the body, but the head, chest, abdomen, and hands. They also noted that
physically abused children had clustered bruises that were often visible regardless of the season
(Swanson et al, 2012. If physical abuse is suspected the following questions should be answered
by the child and/or the caregiver: 1) How the injury occurred 2) When did the injury occur? 3)
Who was present when it occurred? 4) Where did the injury occur? 5) Does the story match up
with the mechanism of injury? 6) Was the injury self-inflicted? & 7) Is there a pattern of injury?
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(Kemp & Mok, 2007). The reason these questions should be answered is that as children become
older and more active, it becomes more likely than not, that a child will exhibit some type of
injury as a result of rough play. Kemp and Mok found that children between 0-6 months had less
than a 1% chance of exhibiting unintentional bruising, 6-12 months showed a 10-12% chance,
12-24 months exhibited a 40-50% chance while 24-168 months exhibited a 60-80% chance of
unintentional bruising. The opposite was found regarding fractures, which were present in 11-
55% of physically abused children (Chapman, 2007). It should also be noted that children who
suffer from physical abuse are more susceptible to developing attachment disorders, post-
traumatic stress disorder (PTSD), externalized behavior problems such as aggression and
delinquency, have poor peer relationships, lower academic achievement and are an estimated
30% more likely to become abusive parents (Forbes, 2007).
Shaken Baby Syndrome
The most common cause of child deaths is physical abuse, often perpetrated by the
parents and commonly termed battered-child syndrome (Swanson, Chamelin, Territo & Taylor,
2012). As discussed in figure 1, infants are the targets of abuse more frequently than older
children. Due to their small size, infants and younger children are more likely to be burned than
older children. Infants in particular are often the victims of shaken baby syndrome. As of 2012,
there were an estimated 1200 cases of shaken baby syndrome (SBS) within the United (Faase,
2015). Shaken baby syndrome is when a caregiver, normally the parent violently shakes the
infant in order to make an inconsolable infant stop crying. As stated by Faase (2015) this can
cause the baby to become drowsy and cease crying. The abuser, having obtained the desired
result, is likely to repeat the shaking on other occasions when again the irritable infant cannot be
consoled. The resulting mechanism of injury occurs as the child’s head flies forward towards
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their chest, only to be suddenly jerked all the way back. This motion generates enough inertia to
cause the brain to smash into skull and subsequently cause intracranial hemorrhaging. This
motion can be thought of like a pendulum. The pendulum is originally stationary, until a force is
exerted on it and will continue to smack back and forth until that force is removed. In cases of
SBS, the severity of victims’ injuries usually does not correlate with caretakers’ descriptions of
what happened to the children, and contradictory statements or changing stories are often given
(Faase, 2015). Which would result in a mechanism of injury known as a coup-contrecoup injury
and refers to a blow to the head, in which the impact causes the brain to smash into the opposite
side of the skull (Swanson et al). The result is a mirror-image hemorrhaging on both sides of the
brain and as supported by Faase (2015) would prove inconsistent with injuries caused from
shaking.
Brief on Munchhausen Syndrome by Proxy
Other forms of physical abuse are poisoning and smothering. This method is typically
performed on children by persons with the psychological disorder Munchausen Syndrome by
Proxy (MSBP). Munchausen Syndrome by Proxy is a psychological disorder, in which a
caregiver will deliberately injure the child for whom they are taking care of as a means of
receiving attention. By doing so these caregivers subject children to harm by exposing them not
only to the trauma to garner attention, but also to unneeded medical intervention in the form of
medications and/or surgery. However, it should be taken into consideration, that accidental
poisonings and cases of smothering are not uncommon. As noted in Shapiro-Mendoza et al
(2012) it is not an uncommon practice for parents to co-sleep with their children, roll on top of
them and accidentally suffocate them. In the event of any homicide involving a child,
investigators should always have an autopsy performed as a means of establishing whether or not
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the death is the result of SUIDS or child abuse. When differentiating a SUIDS death from child
abuse, the investigators and examiners should rule out trauma as a cause, perform various checks
for toxins with the blood and tissue, examine past medical history and observe the scene (Hymel,
2006). If the autopsy indicates the cause of death to be the result of child abuse, due to shaken
baby syndrome the abuser under New York State penal law can be convicted of reckless assault
of a child (B Felony).
Sexual Abuse
The other most publicized form of child abuse is that of sexual abuse. Sexual abuse can
be defined as any unwanted sexual advance or expression designed to stimulate the aggressor.
Such acts deemed as child sexual abuse include: inappropriate fondling and masturbation to
intercourse, sex tourism and the possession and creation of child pornography. All 5 acts of
which, facilitate the molestation of children. Such violations against the child can result in them
developing sexualized behaviors, self-harming behaviors, post-traumatic stress disorder, chronic
low mood, depression, drug and alcohol misuse as well as bulimia nervosa (Forbes, 2007). As
Swanson et al mention in their book Criminal Investigation, there are two main types of child
molesters. There are the situational child molesters who don’t have sexual desires for children in
particular, but still engage in sexual activities with them. The second type is preferential child
molester who have a blatant sexual preference for children (Swanson et al, 2012). Each of which
have their own categories, with their characteristics, motivation, victim criteria and methods.
Case precedent
In U.S v. Brown, 2009 the question of what constitutes child pornography? Was raised. The case
involved the defendant (Brown) taking possible sexual photographs of his granddaughters. After
obtaining a search warrant, customs agents seized his computer which contained over 1,000
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images of child pornography. Among these images and videos were some of his granddaughters
in the bath tub, on the toilet and naked on a bed. Of these images 6 were found to be focused on
their genital area and one picture had one of the girls on her back spreading her vagina open with
both her hands. The government admitted that it could not “confidently prove beyond a
reasonable doubt” that Defendant had taken lascivious photographs of both step-granddaughters,
but argued that a number of images were borderline and that the court was entitled to make a
determination as to the nature of the photographs (United States v. Brown, 2009). To answer the
question of what constitutes child pornography, the courts applied a 6 factor test, using United
States v. Dost, 636 F.Supp. 828, 832 (S.D.Cal.1986) as the precedent. In accordance with United
States v. Dost an image constituted pornography pending
1) whether the focal point of the visual depiction is on the child's genitalia or
pubic area; 2) whether the setting of the visual depiction is sexually suggestive,
i.e., in a place or pose generally associated with sexual activity; 3) whether the
child is depicted in an unnatural pose, or in inappropriate attire, considering the
age of the child; 4) whether the child is fully or partially clothed, or nude; 5)
whether the visual depiction suggests sexual coyness or a willingness to engage in
sexual activity; 6) whether the visual depiction is intended or designed to elicit a
sexual response in the viewer.
As (United States v. Brown) demonstrates through Brown’s collection of child pornography as
well as the pornographic photos/videos he had of his granddaughters, caretakers are capable of
exploiting children. These children can be exploited for money and to fulfill lustful fantasies. As
Swanson et al (2012) note, some adults maintain and sell their own child erotica/pedophile
paraphernalia. This paraphernalia comes in the form of child pornography, advertisements for
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“man-boy love”, erotic novels/audiotapes, sex tourism and child prostitution (Swanson et al,
2012).
Child Neglect
When we as a society think about the term child abuse, we immediately perceive it as
either physical or sexual abuse. Although the two are the easiest to observe and receive the most
public attention, child neglect is just as dangerous and harmful to a child’s development. Child
Neglect represents a guardian’s overall failure to acknowledge a child’s physical and
psychological needs, resulting in the depressing of the child’s development, as well as the
intentional exposure of the child to harm. In accordance with Forbes 2007, the detrimental
effects of neglect are most noticeable within the child’s first two years of life. These neglected
children can develop an overall failure
to thrive, attachment disorders,
concentration and learning problems,
poor interpersonal relationships and
aggression. Maslow’s hierarchy of
needs consists of physiological, safety,
love/belonging, esteem needs and
ultimately self-actualization. The
lower level needs such as
physiological (shown in figure 2 on
the right) and safety needs are
considered the basic needs for
survival, while the upper level needs
age Nutritional needs and weight
Birth to
6 months
110 cal/kg/day (0.46 MJ/kg/day) as breast
milk or approved infant formula Newborns:
about 150 ml/kg milk/day Double birth weight
by 4–6 months
6 months
to 1 year
105 cal/kg/day (0.44 MJ/kg/day) 6 months:
introduction of solids (mushy foods) –
families vary widely in their practices, and this
is often done earlier than 6 months, mostly
without ill effect 10 months: introduction of
food that the child can feed itself Type of milk
until 1 year: breast milk or approved infant
formula Aim to triple birth weight by 1 year
1–3
years
100 cal/kg/day (0.42 MJ/kg/day) Weight gain
about 2 kg/year
4–6
years
85–90 cal/kg/day (0.36–0.38 MJ/kg/day)
Weight gain about 2 kg/year. Average 5 year
old weighs about 20 kg
7–10
years
about 150 ml/kg milk/day Double birth weight
by 4–6 months 80–85 cal/kg/day (0.33–0.36
MJ/kg/day)
Figure 2: illustrates the nutritional requirements needed
to satisfy a child’s physiological needs (Rosenberg, 2007)
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for children, can signify belonging. The bottom three tiers are easily achieved in the
families/lives of most children. According to Rosenberg & Cantwell (2007) the remaining tiers
correspond as follows: safety needs are satisfied through clothing, safekeeping and providing
shelter. The child’s love/belonging and esteem needs are satisfied by the parent’s
nurturing/rearing of the child. While self-actualization can be reached through the parent’s
teaching. As Rosenberg & Cantwell (2007) further note types of neglect include medical,
supervision and developmental neglect. Medical neglect consists of any act of omission or
commission that can cause a considerable risk of harming the child. Supervision neglect occurs
when the parent/guardian fails to provide attendance, guidance, and protection to a child who
cannot comprehend or anticipate danger (Rosenberg & Cantwell, 2007). According to Rosenberg
& Cantwell (2007) developmental neglect, occurs when there is a lack of stimulation of the
child, restriction or forbidding of natural developmental impetus, lack of teaching, and lack of
reasonably consistent limit setting (deprivation).
In the life of a neglected child, only 1 if any of their needs are met. Because not even
their basic needs are being met, these neglected children become trapped in an environment
where they cannot achieve happiness. During the 2012 year it was reported that 74,055 children
were reported as neglected and another 4,093 children medically neglected in the state of New
York alone. (Administration for Children and Families, 2013).
PTSD in abused children
As I mentioned previously childhood is a period of psychological and intellectual growth
for us as individuals. Any traumatic attack during this developmental stage warps our
understanding and perception of the world. Memories of the abuse can plague the child much
into their adult life and eventually develop into Post Traumatic Stress Disorder (PTSD).
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Intrusions in PTSD consist of highly detailed sensory memories of the traumatic event that
intrude into awareness uninvited, accompanied by a strong sense of current threat
(Padmanabhanunni & David, 2014). The trauma associated with that memory overwhelms the
system, preventing these processing steps from taking place. (Padmanabhanunni & David, 2014).
As a means to treat PTSD amongst individuals who were abused as children Padmanabhanunni
and David applied cognitive therapy to PTSD. By forcing the individual to face their fear they
aimed to rebuild the abused person’s mental state. Reliving the memory allows a return to the
implicational level of cognitive representation, where it was encoded in childhood, and therefore
corrective information can be inserted directly into the specific cognitive structure where the
distressing meanings are encoded (Padmanabhanunni & David, 2014).
Padmanabhanunni and David address the problem of how to reintegrate an abused person
back into society. But the bigger issue is how do we identify persons who are being abused? This
is a problem that many Child Protection Service workers, mandated reporters and even the
general public have difficulty addressing. When assessing possible child abuse cases, CPS
workers are forced to make decisions on limited information. Further-more organizational factors
such as the policies and procedures of the agency, time and resource constraints, caseload size
and the organizational culture of the agency can further complicate adequate assessments
(Maguire-Jack & Byers, 2013).
As this paper notes abuse is not just limited to physical and sexual abuses. Children are
exploited and degraded on a daily basis. As the Children’s Bureau points out the occurrence of
such violations of a child’s dignity must be addressed. These attacks on children can be very
traumatic and have serious implications on the child’s development. There also exists a
cultural/societal acceptance of abusive practices between cultures and across generations.
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Although there have been advancements in categorizing abuse from SUIDS, this is not enough as
the data shows. Continuous improvements must be made in the identification of child abuse, if
the issue is to ever be stopped.
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U.S v. Brown 579 F.3d 672 United States Court of Appeals, Sixth Circuit. (2009)