Violence directed at children can be traced back to a variety of causes, and prevention programs are prepared to handle each case differently. But the ultimate act of prevention is the first act - professionals who report suspected cases of abuse.
Heidi Emmerling Jones, RDH, BS
At 5 a.m., a neighbor brought eight-year-old Diane to the emergency room. Diane had two swollen eyes, a bloody nose, and a swollen ear. She would not tell the doctors what had happened to her. The neighbor acknowledged hearing intermittent screams from next door for most of the night. And this latest episode was not the first time. Ever since Diane and her parents had moved into the duplex six months previously, the neighbor had sporadically heard loud noises and blood-curdling screams, especially on Saturday or Sunday nights.
The neighbor responded like most of us; she was just minding her own business. However, this time she was unable to ignore the screams because Diane came knocking on her door for help, compelling her to respond.
Why was there no previous intervention? Every day infants and children are abused in our own neighborhoods while we shun involvement. Are the abusers the only ones at fault?
Vincent Fontana, a pediatrician and noted advocate for children`s rights, writes that the abuse we inflict on our children is an extreme form of the violent and self-serving child-rearing practices firmly established in western culture. Throughout history, children have been abused, murdered in sacrificial rituals, starved, neglected, enslaved, and sold as chattel. The justification for harsh treatment was maintaining discipline and education, as well as expelling evil spirits. Five thousand years ago, ancient philosophers beat their pupils unmercifully. Traditionally, parents felt the axiom, "Spare the rod, spoil the child," justified beating the devil out of children.
Today, even with outstanding advances, some children are undergoing the same type of suffering. The failure to protect children from disease, neglect, exploitation, abuse, and hunger is undoubtedly the most egregious sin of the century. We see street children whose existence consists of sniffing glue and having sex, either with each other or by selling themselves to adults. We witness misuse of child labor. We hear stories of battered and abused children.
Child prostitution and exploitation is an industry. The illegal buying and selling of children from the Third World to the United States grows each year. And many children who have disappeared have never been found. Innocent babies are being born with AIDS, Fetal Alcohol Syndrome, or addicted to crack cocaine.
What emerges is a chillingly clear picture of the violation of children`s rights and the betrayal of innocence.
Passing the stress along to the kids
In an attempt to understand (not excuse) child abuse, experts have found that parents who are unstable, violent, immature, or addicted to drugs, have a high potential for abusing their children. In addition, the presence of a child who is handicapped, hyperactive, ill, or in need of extra attention can often provoke an impulsive overreaction from an at-risk parent.
Child abuse often occurs during a crisis. For example, job loss, a fight with the landlady, or any situation that results in feelings of inadequacy and rejection on the part of the parent, may be just enough to make the demands of an inquisitive child unbearable.
Rosamond Murdock, a pediatrician and author, cites the case of "Charlie" that illustrates how an external event affecting an adult harms a child.
A second grade teacher noticed that Charlie came into her classroom quietly with a straddling gait quite different from his usual robust, strutting, and noisy entry. Throughout the morning, Charlie squirmed in his seat, rejected her verbal requests to participate in classroom activities, and finally ran out into the hall.
The school principal found Charlie hiding in the restroom. He dragged Charlie, who was kicking, screaming, and yelling profanities, to the health office. Charlie ran and embraced the school nurse, and he broke down crying. The nurse was able to discover what was hurting him - at least physically. Charlie was bleeding from his anus. His entire penis and scrotum were red and raw. Like most young children, he would not reveal the identity of the person who had violated him.
Upon learning of Charlie`s condition, his mother suspected her live-in partner. He had arrived home late the night before so drunk and enraged about losing his job that she left the apartment rather than take the abuse. Her son took it for her - brutally. It did not have to be a partner who abused Charlie. It could have been an out-of-control spouse, ex-spouse, or anyone who was hurting or disturbed.
Like Charlie`s abuser, most parents who abuse find it difficult to cope with stress. While some may refuse help, many simply are afraid to ask or do not know how to get help. A large part of child abuse prevention is to make sure parents seeking help get with the right programs.
The abusive can get help
Short-term treatments for abusive parents include life-saving telephone lines and crisis nurseries. Telephone lines provide immediate relief as personal support to a stressed parent or to a battered child in need of rescue. In addition to telephone lines, crisis nurseries are resources for parents who feel they may batter their child. Parents can leave the child at the nursery until the crisis situation has abated.
Trouble often begins when a parent feels isolated, without friends or family, and when he or she has difficulty in turning to others for help. These short-term resources, along with numerous other self-help agencies designed to provide assistance for families, provide valuable outlets to the parent.
Other treatments involve long-term therapy to help parents overcome their own devastating past histories. When planning the treatment, the social worker or psychotherapist focuses the therapy and treatment mode to best suit the idiosyncratic nature of each case. This long-term treatment is complex but critical.
Fortunately, with timely intervention and appropriate treatment, the future for many abusive families is promising: 80 percent of abusive families are able to have the children return home - never to be injured again.
The remaining 20 percent of families are untreatable. Half are very seriously mentally ill (delusional psychotics, aggressive sociopaths with low boiling points, sadists, or religious fanatics). The other half are technically treatable but fail. In untreatable families, the parental rights are terminated early to free the child for prompt adoption. A child`s developmental timetable does not allow for delay; we cannot use the child as an educational instrument for the parent.
Reporting abuse may save a life
Whether impulsive or chronic, child abuse must be stopped by each and every bystander immediately - not hours, days or months later by some governmental agency. When it is apparent that things are out of control, it is not the time to "mind your own business." When we see abuse, we are often unsure if it is our duty to report or someone else`s, presumably someone "more qualified." It is everyone`s duty to report.
We may erroneously believe that if we make a report that turns out to be unfounded or unproven, we would be vulnerable to civil litigation by the child`s parents. We may be concerned about our inability to prove the abuse. In most cases, it is virtually impossible for us to provide proof. We do not have to. Obtaining such proof is the job of trained investigators. Once the case gets into their hands, the original person reporting the suspected abuse has little to do with it. Only if the report is held to be malicious is an individual subject to criminal sanctions.
All 50 states require certain people who work with or care for children to report suspected cases of abuse. These occupations, for example, include physicians, dental hygienists, nurses, and teachers. But these professionals report only 33 percent of suspected cases.
Private practice physicians are extremely reluctant to report. One reasons is because health care providers do not want to believe middle-class clients would abuse their children.
People try to cover up for the affluent. It is much easier for the public to accept the story that the child keeps falling off the bicycle than that their parents are intentionally hurting their own children. Police detectives confirm that, although child abuse knows no socioeconomic boundaries, poor families are much more likely to be reported.
The Steinberg case is a classic example of this phenomenon. The daughter, Lisa, died of abuse and neglect while in her adoptive father`s care. Yet business associates, social workers, neighbors, police, teachers, and other parents did not report or ignored reporting responsibilities. The shared reluctance of all witnesses to intervene on Lisa`s behalf suggests that the social status of Joel Steinberg (an affluent attorney) and his spouse, Hedda Nussbaum (once a writer and editor of children`s books) sheltered them from investigation.
Professionals also may hesitate to report abuse because they feel it will adversely affect rapport. However, rapport actually tends to be enhanced by a professional`s display of concern. Regardless, a child`s well-being is far more important in the long run. The failure to recognize and act on behalf of a child may be dangerous and even fatal for the child.
Actually, failure by a person mandated to report a suspected case is a crime punishable by sentences ranging from a few days in jail and a $10 fine to a year in prison and a $5,000 fine.
Undramatic interventions can help too
Child abuse is an extremely complex problem that has numerous causes, varying for different individuals and groups. Rising divorce rates and the increased frequency of teenage parents contribute to the problem. Poverty, crime, and drugs feed into child abuse, and child abuse feeds into them.
Prevention programs can substantially reduce the incidence of abuse. However, the success of prevention depends on individual involvement. The National Committee for the Prevention of Child Abuse recommends that we:
- Watch a stressed parent`s child in order to allow the parent to calm down.
- Suggest to someone that he or she attend a parenting class.
- Volunteer at a local abuse program.
- Help ourselves if we feel stressed or overwhelmed with our own children.
- Act when we see mistreatment of a child in a public place by saying or doing something supportive ("Children can wear you out, can`t they? Is everything OK?").
Finally, the NCPCA stresses reporting suspected abuse or neglect because protection of our children demands that each of us assumes our individual responsibility. Only in this way will the problem come to the attention of authorities. "Exercise your power to make a difference in the lives of millions of children by deciding to do at least one thing now," the NCPCA emphasizes. "Volunteer; advocate to eliminate corporal punishment in schools; advocate for comprehensive quality child abuse prevention programs in your community; get others involved; become better informed on the subject of abuse; do something. The children are in your hands. They are helpless; you are not."
Stop the cycles of abused generations
According to American Humane Association statistics, more than 2.4 million cases of child abuse were reported in 1989 and at least three children die every day of child abuse in the United States. The magnitude and complexity of the problem demand that society take a closer look and get serious about solving this shameful problem. If we continue to fail our maltreated children and their families, we will be starting the next century with a grim legacy: One generation after another of disturbed, violent, hollow young individuals.
We must take responsibility for our own behavior and assume responsibility for the less responsible. John Walsh, a father who initiated a crusade for missing children after his own son, Adam, was found brutally murdered, has demonstrated the power of individual action.
Child protection laws are in place. Funding is available for child abuse prevention and treatment, but the responsibility remains with the individual. In spite of the fact that we may become distressed when we read about physically or emotionally abused children, or that we feel pessimistic about whether we can make a difference, we must not be demoralized or fail to keep pushing forward.
Joseph Joubert writes: "Children have more need of models than of critics." Let`s be models for all children.
References are available upon request. Contact the author at (702) 626-6008 for more information.
Heidi Emmerling Jones, RDH, BS, is a freelance writer and practices dental hygiene in Sparks, Nevada.
Seeing past the `accidents`
Since head, facial, or oral trauma occurs 50 to 65 percent of the time, why is it so rare that hygienists identify suspected cases of child abuse? Police detectives explain that, if the caregiver is the abuser, the caregiver will wait until physical symptoms disappear before bringing the child in for dental visits. However, even when a child presents with signs of abuse, we will often attribute these signs to "accidents."
We often don`t want to believe our middle-class clients are abusing their children. Or we`re afraid of being sued because we can`t prove the abuse.
As licensed health care professionals, we are mandated to report suspected cases of abuse. These laws are in place to protect us and, ultimately, the child abuse victims. Detectives investigate the case once the report is made. It is their job, not ours, to prove the case. Although the original source has very little to do with the investigation, making the report is crucial to initiating the process and, perhaps, saving the life of a child. Here`s what to look for:
Oral Signs of Abuse
- Fractured teeth or jaws.
- Abrasions at corners of mouth (suggesting a gag).
- Injuries or scarring of tongue.
- Bruised, swollen, or scarred lips.
- Lacerations of frena (forced feeding or traumatic blows).
- Oral manifestations of venereal disease (syphilitic chancres, papules, and patches).
- Untreated dental care, including rampant caries, pain, and bleeding gingiva.
General Signs of Abuse
- Either fearful or withdrawn behavior.
- Acts differently when parent is present than when alone.
- Failure to thrive, including malnutrition.
- Clothing inappropriate for the weather or for covering the body.
- Abrasions and lacerations of varying degrees of healing; unexplained "accidents."
- Burns, bite marks, or trauma to eyes, ears, or neck; welts or bald spots.
- Pain or itching in genital area; difficulty walking or sitting.
Sources: Clinical Practice of the Dental Hygienist by Esther Wilkins and Tim Yardic, a detective with the Reno, Nevada, Police Department.