Dr. Phyllis M. Wallace

“Until we extend the circle of compassion to all living creatures, we will not find peace.”— Albert Schweitzer

Child maltreatment (neglect and abuse) is an alarming and universal issue that deserves attention, protection, and preventive measures at every level—individual, community, national, and international (World Health Organization, 2006).

April is National Child Abuse Prevention Month. During this month, more so than any other, health educators pause, reminded of emotional and physical atrocities directed at children—and we offer a silent prayer of safety for children everywhere. We are also astutely aware that victimization against children has not abated, but is a present force requiring immediate attention and resolve, according to statistics from the Centers for Disease Control and Prevention.

Definitions
The World Health Organization (WHO) defines child maltreatment as “all forms of physical harm, emotional ill treatment, sexual assault, abuse [an act of commission (Dieckman, Brownstein, & Gausche-Hill, 2000)], neglect [an act of omission], and exploitation resulting in actual or potential harm to the child’s health, survival, development, or dignity in a milieu of a caretaker’s responsibility, trust, power” (2006).

Demographics of Abuse

• The overall goal of the Women’s World Summit Foundation (WWSF) is to empower women and promote human rights for women and children worldwide (2006). This humanitarian, non-governmental, international nonprofit organization reported that “over 1 million children are exploited every year in the multibillion-dollar sex industry, more than 14 million are orphaned by HIV/AIDS, 30,000 are child soldiers, 180 million children work in the worst forms of child labour, and 121 million children in the world are not in school, of which 65% are girls.”
• According to WHO, an estimated 57,000 children under 15 years of age died by homicide in 2000. The homicide rates for children aged 0–4 years were over twice as high as rates among children aged 5–14 (Bethea, 1999; WHO, 2006). Head injuries are the most frequent cause of death, followed by abdominal injuries and suffocation (WHO, 2006).
• In the United States in 2002, there were 906,000 cases of child maltreatment confirmed by child protective services. Among those physically and emotionally battered children: 61% experienced neglect, 19% were physically abused, 10% were sexually abused, and 5% were emotionally or psychologically ill-treated (CDC, 2003). Neonaticide (the murder of an infant during the first 24 hours of life) accounts for 45% of children killed during their first year of life (Bethea, 1999).
• Through its National Child Abuse and Neglect Data Systems (NCANDS), the National Clearinghouse on Child Abuse and Neglect Information (NCCANI) reported an estimated 1,400 child fatalities in 2002 (2004).
• The CDC (2006) reported that children younger than 4 years accounted for 79% of child maltreatment deaths. Furthermore, children younger than 4 years are at the greatest risk of severe injury or death (Bethea, 1999; CDC, 2003).
• The rate of child abuse and neglect fatalities reported by NCANDS has increased slightly over the last several years—from 1.84 per 100,000 children in 2000 to 1.96 in 2001 and 1.98 in 2002 (NCCANI, 2004).

Fluctuations in Reported Data
The accuracy and reliability of child fatality rates may fluctuate from year to year due to variations in reporting requirements and definitions, variation in state definitions of abuse and neglect, length of time from reporting a fatality to determining cause of death, and miscoding of death certificates (NCCANI, 2004).

Nonetheless, the World Health Organization says that abuse and neglect fatality rates are underreported. Some deaths may be classified as accidents or as sudden infant death syndrome (Bethea, 1999; WHO, 2006). Most child abuse takes place in the home by individuals known and trusted by the child (Bethea, 1999).

National Child Abuse and Prevention Month
On April 2, 2004, George W. Bush signed Proclamation 7766, urging all Americans to safeguard the well-being of children in the United States, by making a commitment to prevent child maltreatment. In a global effort to create child abuse awareness, the WWSF inspired and launched The World Day for Prevention of Child Abuse in 2001, which is commemorated on November 19 in synergy with the annual International Day of the Rights of the Child, November 20—to rally around the issue of child abuse and the need for successful preventive programs.

The Convention on the Rights of the Child is the first legally binding international mechanism incorporated to confer human rights on children aged 0–18—health care, educational, civil, cultural, political, and social rights. The convention comprises 54 articles delineating the basic human rights of children worldwide, namely the right to (a) survival, (b) develop to their fullest capacity, (c) protection from external harmful influences, abuse, and exploitation, and (d) participate fully in family, cultural, and social life (UNICEF, n.d.).

The Limits of Proclamations
However, despite the signing of Proclamation 7766 and efforts of child protection services, child maltreatment fatalities remain a serious issue (NCCANI, 2004).

On Sunday, March 26, 2006, on a rainy, stormy Chicago night, as she lay sleeping, tawny-haired Lauren Lofquist died at the hands of a trusted family member, her biological father. Believing his 8-year-old daughter to be “evil,” Neil Lofquist is accused of first strangling, then stabbing her, and then dunking her head in the family commode to ensure her death (Rozek, 2006).

On March 3, 2006, 14-year-old Starkesia Reed was killed by an AK-47: A stray bullet ripped through her sweet face. Starkesia, a star student, was standing by the window in her home, waiting for her big brother to pick her up for school (Rackl & Pallasch, 2006).

On March 10, 2006, a yellow, blue, and white birthday cake remained uncut, and gifts remained unopened. Siretha White was shot in the head and killed around 8:30 p.m., as she sang and played at her 10th birthday party (Rackl & Pallasch, 2006).

Corollaries of Abuse and Maltreatment
According to Crozier and Barth (2005), cognitive functioning and academic achievement may be associated with child maltreatment. In their 2005 study, the researchers found that maltreated children displayed significantly more aggression, poor social skills, and emotional dysfunction than their non-maltreated peers. For these children, their behavior translates to more school disciplinary referrals and suspensions.

To address child maltreatment at the school level, Crozier and Barth recommended more coordination among social workers, educators, child protection services, and parents. They also suggested that school personnel and social service workers work together to share case information and identify at-risk children, so that preventive and corrective interventions are more effective.

Recognizing Child Abuse and Neglect
The ecological approach to child maltreatment posits that child abuse occurs within a system of risk and protective factors across four levels: (a) the individual, (b) the family, (c) the community, and (d) society (Bethea, 1999; CDC, 2003).

The chart below provides some indicators of possible child abuse and neglect (NCCANI, 2003):

Child Indicators

• Shows sudden changes in behavior or school performance.
• Receives little help for physical or emotional problems.
• Lacks adult supervision.
• Is overly compliant, passive, or withdrawn.

Parental Indicators

• Shows little concern for the child’s welfare or well-being.
• Sees the child as bad, worthless, evil, or burdensome.
• Looks primarily to the child for care, attention, and satisfaction for emotional needs.

A partial list of risk factors associated with child maltreatment and their loci (Bethea, 1999; CDC, 2003; WHO, 2006) is provided in the following chart:

Public Education, Prevention, and Action

All of society (e.g., hospitals, schools, community agencies) plays a role in preventing child maltreatment, globally and locally. Educational campaigns foster dialogue to develop strategies that increase awareness and make a difference at every community level.

• On December 2–3, 2006, the Women’s World Summit Foundation will host the second annual Circles of Compassion summit in Geneva, Switzerland. Employing ancient circle methodology, the summit will train women as leaders on how to develop circles of compassion in their communities. The circle acts a powerful tool to help teach people how to communicate more openly and honestly, bridge differences, increase tolerance, and use compassion to resolve community issues such as child maltreatment (WWSF, 2006).
• Public health nurses (PHN) who conduct home visitations offer a clever and holistic approach to support new mothers. For example, the Chicago Department of Public Health employs PHNs who train at-risk (e.g., poor, low-income) families on infant growth and development. They are trained to recognize signs of child maltreatment, observe mothers for signs of postpartum depression, and examine the home for potential health and safety concerns (Shu, 2004). A key function of home visitations is to promote social networks for new parents and link them to the Medical Home. This goes a long way toward breaking down social isolation, a risk factor for child abuse.
• Prevent Child Abuse America listed three national programs that target at-risk families: Parent Effectiveness Training, the Parent Nurturing Program, and Systemic Training for Effective Parenting. Each parent-focused intervention is aimed at improving child-rearing skills and stress reduction. Empirical findings suggested that these are effective programs for reducing factors associated with physical child abuse.

Here are seven action steps to help prevent child maltreatment, based on recommendations from Prevent Child Abuse America:

• Become a nurturing parent.
• Babysit for a new mom.
• Ask relatives and friends for a time-out.
• Monitor yourself for depression or exhaustion.
• Monitor who spends time with your young child.
• Report suspected child abuse and neglect.
• Ask for help; educate yourself about child development and maltreatment.

References

Bethea, L. (1999, March 15). Primary prevention of child abuse. American Family Physician, 59(6), 1577–85, 1591–2 [Electronic version]. Retrieved April 16, 2006, from http://www.aafp.org/afp/990315ap/1577.html

Centers for Disease Control and Prevention. (2003). Child maltreatment: Fact sheet. Retrieved April 16, 2006, from http://www.cdc.gov/ncipc/factsheets/cmfacts.htm

Crozier, J. C., & Barth, R. P. (2005). Cognitive and academic functioning in maltreated children. Children & Schools, 27, 197–206.

Dieckman, R., Brownstein, D., & Gausche-Hill, M. (2000). Pediatric education for prehospital professionals. American Academy of Pediatrics. MA: Jones and Bartlett.

The National Clearinghouse on Child Abuse and Neglect Information. (2003). Recognizing child abuse and neglect: Signs and symptoms. Retrieved April 16, 2006, from
http://nccanch.acf.hhs.gov/pubs/factsheets/signs.cfm

The National Clearinghouse on Child Abuse and Neglect Information. (2004). Child abuse and neglect fatalities: Statistics and interventions. Retrieved April 16, 2006, from
http://nccanch.acf.hhs.gov/pubs/factsheets/fatality.cfm

Prevent Child Abuse America. (n.d.). Fact sheet: An approach to preventing child
abuse. Retrieved April 16, 2006, from
http://member.preventchildabuse.org/site/DocServer
/an_approach_to_prevention.pdf?docID=121

Prevent Child Abuse America. (n.d.). Ten ways to help prevent child abuse. Retrieved
April 17, 2006, from
http://www.preventchildabuse.org/publications/
parents/downloads/ten_ways_to_prevent.pdf

Rackl, L, & Pallasch, A. M. (2006, March 13). Slaying of 2nd girl stuns Englewood. Chicago Sun-Times, p. 3 [Electronic version]. Retrieved April 17, 2006, from
http://www.suntimes.com/

Rozek, D. (2006, April 4). Attorney: Dad likely to claim insanity. Chicago Sun-Times, p. 9 [Electronic version]. Retrieved April 17, 2006, from
http://www.suntimes.com/

Shu, J. (Ed.). (2004). Baby and child health. American Academy of Pediatrics. NY: DK.

UNICEF. (n.d.). Convention on the Rights of the Child. Retrieved April 16, 2006, from
http://www.unicef.org/crc/

World Health Organization. (2006). Child abuse & neglect. Retrieved April 16, 2006, from
http://www.who.int/violence_injury_prevention/
violence/neglect/en/print.html

Women’s World Summit Foundation. (2006). Open letter to 2005 WWSF coalition members and partners: A global coalition for the creation of a culture of prevention. Retrieved April 16, 2006, from
http://www.woman.ch/children/1-openletter.asp