It is very important to have an understanding of the relationship between child development and child maltreatment. Childhood is typically a time of rapid change and growth. Each stage of development brings new challenges and changes in the physical, cognitive, and behavioral makeup of a child. These changes are reflected in the epidemiology of maltreatment, which is the pattern of abuse and neglect that is commonly seen. Child development affects all of the following: the precipitating factors that lead to maltreatment; the susceptibility of a child to different types of maltreatment at different ages; the physical findings of abuse or neglect; the treatment options following maltreatment; and the likelihood of long-term sequelae (secondary effects) from abuse or neglect.
Infants are at the greatest risk for all types of maltreatment, including fatal maltreatment. This is relatively easy to understand from a developmental standpoint. Child neglect occurs commonly as infants are the most dependent on their caregivers to provide the basic necessities of life in a stable, secure environment. Parents who are overwhelmed by life stressors and have personal limitations, or have certain cognitive or medical conditions (such as mental retardation or depression) may become caregivers who cannot pick up on infant cues. In these situations there is a risk of poor attachment and emotional neglect. Parents can also be easily frustrated by an infant whose crying or temperament makes them difficult to handle, leading to the potential for physical abuse. This risk is dangerously high given that infants are already at higher risk for physical abuse because of their physical attributes, such as softer bones, small size, and the inability to resist physical harm or verbalize what happens to them. The ''shaken baby syndrome'' illustrates this principle. An infant has limited muscle tone, particularly in the neck, and an infant's head size is proportionately larger than other parts of its body. An infant that is forcibly shaken can get a form of whiplash, which creates forces that shear the deli cate and developing brain. These infants suffer significant neurological damage and often die as a result of the brain injury and swelling.
The toddler and preschool years provide new challenges as children are growing and developing new physical skills. These physical skills enable children to run, climb, and openly explore in areas they previously could not, so caregiver supervision becomes increasingly important. A neglectful caregiver will not make the environment safe or provide appropriate boundaries. Verbal skills increase and children vocalize their emerging independence. A parent unprepared for the typical use of the word "no" may interpret this as defiant behavior and resort to harsh physical punishment that becomes abusive, not recognizing the appropriateness of the child's behavior for this developmental stage. Toilet training during these years is one of the more common parental stressors and precipitant of abuse.
School-age children and adolescents have a lower overall risk of maltreatment. They spend less time in the presence of caregivers because of school, after-school activities, and peer interactions. They are also less dependent as their physical and cognitive development allows them to do many things for themselves. Physically they are larger in size, stature, and strength, and it takes more force to cause injury. Sexual abuse, however, is more prevalent among schoolage children and teens, particularly girls. The reason for this increase is related in part to the physical developmental changes that occur in both boys and girls as they enter puberty.
When it is determined that a child has been abused or neglected, the system will intervene. The primary state agency responsible for children is social services, but children are first identified in any number of ways: by neighbors, relatives, day-care staff, teachers, or medical professionals. Medical professionals and day-care staff often identify young children, because the doctor's office and the day-care center are common places for children to be seen on a regular basis. School personnel frequently identify older children when changes in behavior, attendance, or school performance are noticed. Suspicions of abuse or neglect are then referred to the appropriate social services agency for a more thorough investigation.
One of the first concerns for social services is the safety of the child. The agency's primary purpose is to ensure that no further harm comes to the child. If the perpetrator of maltreatment (the person suspected of abusing or neglecting the child) is to continue to have access to the child, this can be handled in
several ways. What happens next will depend on the type and severity of abuse or neglect and the mandates of the state. The perpetrator will often contract with social services and agree not to maltreat the child. The person can agree to leave the home temporarily. The child can also be removed from the unsafe environment and placed in the care of a relative or foster family.
Many times children will require a medical evaluation to determine what harm has been done, document the extent of harm, and treat any new or existing medical conditions. The needs of the whole child should be addressed during a medical evaluation, although emergent needs are prioritized. In the case of shaken baby syndrome, for example, the majority of these children are brought in on an emergency basis when they stop breathing at home. Obviously these children require intensive care even before the determination of abuse is made. For other children, the medical evaluation may entail treating a broken bone, tending to lacerations, evaluating bruises, or examining for sexually transmitted diseases. It can also involve recommending a developmental evaluation for a child who is developmentally delayed or recommending medical and behavioral treatment for depression.
Further treatment usually involves obtaining mental health services or additional services for the family. The goals of these services are to assist the child and family in coping with the maltreatment and to restore family functioning. Mental health services can be directed to the child or to the child's caretakers, if the child is too young or unable to participate actively in treatment sessions on her own. Play therapy is very commonly employed in this setting. For the family, evaluating the home environment and the circumstances surrounding the abuse or neglect is critical to assisting the family and preventing maltreatment from reoccurring. There may be social services such as food stamps or parenting education that can assist the family and reduce family stressors. Parents and caregivers may also be prior victims of child maltreatment and/or violence in other forms and benefit from mental health, substance abuse, or domestic violence resources themselves.
The consequences of maltreatment for children who are abused or neglected vary a great deal. There are many factors that affect what happens after maltreatment, including: the developmental stage of the child at the time of the abuse or neglect, the type and chronicity of abuse or neglect, the relationship of the perpetrator to the child, and the child's temperament and natural ability (intelligence). There are also several different categories of consequences, including: medical or physical consequences; emotional, behavioral, or cognitive consequences; short-term versus long-term consequences; and consequences with or without intervention by social services or others.
One significant principle that appears in the child maltreatment literature repeatedly is that children suffering multiple types of abuse or neglect tend to have a poorer outcome than children who suffer only one type or incident of abuse or neglect. Studies that document the long-term effects of child abuse and neglect mirror these findings. These studies show that lifestyle choices and responses to stress may be altered, leading to greater risk for adult criminal behavior and significant health problems (such as heart disease) in adulthood.
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