Child Abuse

Introduction

Child abuse has worldwide recognition as a crime against children. The legal and moral issues surrounding it will vary according to culturally accepted practices, but the underlying abhorrence of crimes against children will prevail. This paper will present a review of the literature on the topic of child abuse and the surrounding issues and implications for practice of the school nurse. Child abuse will be defined and background information and statistics will be provided. Legal issues will be presented as will their implications. The role of the school nurse will be presented as will the impact of poverty. Finally a summary of the literature will be provided.

Definition and Background Information

Lewis and Bear (2002) provide us with the following definition: "Child abuse is any situation in which a child suffers mistreatment or serious injury by other than accidental means. Child abuse encompasses physical, emotional, and sexual harm and neglect. The abuser can be a parent, sibling, custodian, or guardian." (p.337). The concept of abuse being comprised of these four categories is substantiated by the World Health Organization and the United Nations definitions which also include physical abuse, sexual abuse, neglect and emotional abuse (Campbell, 2005). Finally we are reminded by Massey-Stokes and Lanning (2004) that child abuse is a horrific public health and social problem.

Statistics provided by the National Clearinghouse on Child Abuse and Neglect Information (NAIC) tell us that an estimated 906,000 children in the United States were determined to be victims of child abuse or neglect in the year 2003. This represents a rate of 12.4 / 1000 children in the national population, a decrease from 13.4/1000 children in 1990. More than 60 percent of these victims experienced neglect. Approximately 19 percent were physically abused, another 10 percent were victims of sexual abuse and 5 percent were found to have suffered emotional abuse. The remaining 17 percent fell under the category of other types of maltreatment, reflected by specific State laws and policies. The age group with the highest rate of victimization was children between the ages of birth to 3 years at a rate of 16.4 / 1000 children of the same age group ( Child Maltreatment 2003: Summary of Key Findings , 2005).

In the year 2003 there were an estimated 2.9 million referrals made concerning almost 5.5 million children to various Child Protective Service (CPS) agencies across the United States. Of the referrals made approximately one-third were not accepted for investigation. More than 57 percent of these reports were initiated by what is referred to as mandatory reporters, such as educators, law enforcement and legal personnel, social workers, medical and mental health workers and child day care providers. An impressive 43 percent, however, were made by non professionals such as friends and relatives of the victims (Child Maltreatment 2003: Summary of Key Findings, 2005).

The most tragic outcome of child abuse is death. The NAIC report goes on to state that approximately 1,500 children in 2003 died as a result of abuse or neglect. Of these, 19 percent were under the age of 4 years old; 10 percent were 4 to 7 years old; 5 percent were 8 to 11 years old and finally 6 percent were 12 to 17 years. The group that had the highest rate of fatalities was that of infant boys, those under the age of 1 year, with nearly 18 deaths / 100,000 boys of the same age. Not entirely surprising, this report by the NAIC states that almost 80 percent of the reported perpetrators were parents of the children and of those, women comprised 58 percent of the offenders (Child Maltreatment 2003: Summary of Key Findings, 2005).

Massey-Stokes and Lanning (2004) present similar statistics from the year 2002 listing the number of referrals made to be approximately 2.6 million concerning almost 5 million children. They (Massey-Stokes and Lanning) tell us that nearly 4 children died each day as a result of abuse or neglect in the year 2000 and 80 percent of these fatalities occurred in children under the age of 5 years old. This fact puts child abuse together with congenital anomalies as the second leading cause of death for children age 1-4 years. Further stating that the economic cost associated with child abuse in the United States is approximately 94 billion dollars per year. With regard to children with disabilities Massey-Stokes and Lanning report that they are 1.7 times more likely to experience abuse at any age as compared to the general population of children (2004).

In a paper published by the NAIC, the subject of identifying the number of children with disabilities who are victims of child abuse is discussed. Children with disabilities are identified as being at a greater risk for abuse and neglect for numerous reasons. These reasons include increased family stress related to higher demands on caregiver's time and resources by disabled children, family isolation due to having a disabled child, and the disabled child's inability to recognize inappropriate treatment by a caregiver (In Focus: The Risk and Prevention of Maltreatment of Children with Disabilities, 2001).

There have been very few national studies done to identify abuse in this population of children. The last congressionally mandated study of the incidence of child abuse is from 1996. The difficulty researchers have in isolating data related to abuse of disabled children relates to how data in general is collected on abuse of children. Only 19 states have pre-existing conditions listed on their CPS forms. The paper does states that approximately 175,000 to 300, 000 children with disabilities are victims of abuse or neglect each year (In Focus: The Risk and Prevention of Maltreatment of Children with Disabilities, 2001).

Legal Issues and Implications

Every state has laws in place which require professionals, which are responsible for children, to report suspected abuse. Nurses and physicians are legally mandated to report suspected abuse to authorities. As a result of the 1974 Federal Child Abuse Prevention and Treatment Act, school staff members also became mandated reporters of suspected abuse (Schwab and Gelfman, 2005). As a consequence of these laws, school districts are encouraged if not mandated to write policies and procedures defining the roles of school personnel. These policies must address State reporting laws, staff training, procedures and criteria for reporting suspected child abuse and emergency procedures to be followed (Schwab and Gelfman, 2005).

We are further reminded by Schwab and Gelfman that a critical issue for school health professionals and educators is to be familiar with local State laws and regulations regarding