Child Abuse, Neglect, and Foster Care

Child abuse takes many forms.  Children can be physically or sexually assaulted, and they may also suffer from emotional abuse and neglect of many different forms. Whatever form it takes, child abuse is a serious problem.

It is especially difficult to know how much child abuse occurs.  Infants obviously cannot talk, and toddlers and older children who are abused usually do not tell anyone about the abuse. They might not define it as abuse, they might be scared to tell a trusted adult, they might blame themselves for being abused, or they might not know with whom they could talk about their abuse.  Whatever the reason, children usually remain silent, thus making it very difficult to know how much abuse takes place. Up-to-date statistics on the different types of child abuse in the United States can be found at the U.S. Children’s Bureau website.

Abuse

Abuse can occur in multiple forms and across all family relationships. Breiding, Basile, Smith, Black, and Mahendra^[1] define the forms of abuse as:

• Physical abuse, the use of intentional physical force to cause harm. Scratching, pushing, shoving, throwing, grabbing, biting, choking, shaking, slapping, punching, and hitting are common forms of physical abuse;
• Sexual abuse, the act of forcing someone to participate in a sex act against the person’s will. Such abuse is often referred to as sexual assault or rape.
• Psychological abuse, aggressive behavior that is intended to control someone else.  Such abuse can include threats of physical or sexual abuse, manipulation, bullying, and stalking.

Abuse between partners is referred to as intimate partner violence; however, such abuse can also occur between a parent and child (child abuse), adult children and their aging parents (elder abuse), and between siblings.^[2]

The most common form of child abuse is neglect.  Child neglect is a deficit in meeting a child’s basic needs, such as failure to provide adequate nutrition, supervision, health care, clothing, or housing, as well as other physical, emotional, social, educational, and safety needs. All societies have established necessary behaviors a caregiver must provide in order for a child to develop well within the domains of physical, social, and emotional development. Causes of neglect may result from caregivers experiencing problems associated with mental disorders, unplanned pregnancy, substance abuse, unemployment, over-employment, domestic violence, and, in special cases, poverty.

Child neglect depends on how a child and society perceives the caregivers’ behaviors; it is not how parents or caregivers believe they are behaving toward their child.^[3] Caregiver’s failure to provide for a child, when options are available, is different from failure to provide when options are not available. Poverty and lack of resources are often contributing factors that may prevent caregivers from meeting children’s needs, when they otherwise would be able to meet those needs.^[4]

There are various types of child neglect which include:

• Physical neglect is the failure to provide a child with basic necessities of life such as adequate food, shelter, and clothing.
• Medical neglect is the failure of caregivers to meet a child’s basic health care needs. Examples include not brushing teeth on a daily basis, not bathing a child, and/or taking children to doctor visits when needed.
• Emotional neglect is the failure to provide emotional support such as emotional security and encouragement (love, nurturance, etc.).
• Educational and developmental neglect include the failure to provide children with experiences necessary for normative growth and development. These may include failing to ensure children receive adequate education or experiences that help foster normative, developmental standards.
• Depending on the laws and child protective policies in one’s area, leaving a young child unsupervised may be considered neglect, especially if doing so places the child in danger.

All types of abuse are complex issues, especially within families. There are many reasons people may become abusers, such as poverty, stress, and substance abuse are common characteristics shared by abusers, although abuse can happen in any family.

Children who experience any type of abuse may “act out” or respond in a variety of unhealthful ways. These may include acts of self-destruction, withdrawal, and aggression, and struggles with depression, anxiety, and academic performance.  Researchers have found that abused children’s brains may produce higher levels of stress hormones.  These hormones can lead to decreased brain development, lower stress thresholds, suppressed immune responses, and lifelong difficulties with learning and memory. ^[5] Abused children are much more likely than children who are not abused to end up with various developmental, psychological, and behavioral problems throughout their life course. In particular, they are more likely to be aggressive, to use alcohol and other drugs, to be anxious and depressed, and to get divorced if they marry.^[6]

Children who experience abuse or neglect are at risk of developing lifelong social, emotional, and health problems, particularly if neglected before the age of two years. This is consistent with what we learned about ACEs.  However, it is important to note that not all children who experience abuse and neglect will have the same outcomes.  As we learned, there are many ways in which we can foster stable, permanent, safe, secure, nurturing, loving care for children who have been associated with reduced effects of ACEs.

It is extremely important to understand the ways in which child abuse and neglect can be prevented, such as those listed in this infographic from the CDC. For more information, visit cdc.gov/violenceprevention/childabuseandneglect.

Corporal Punishment

Worldwide initiatives have recommended banning the use of corporal punishment with or in children of all ages.  According to the Global Initiative to End all Corporal Punishment of Children, corporal punishment is defined as “any punishment in which physical force issued and intended to cause some degree of pain or discomfort, however light”.^[7]  Examples include shaking, kicking, forcing ingestion (e.g., soap, hot sauce), and “smacking,” “slapping,” or “spanking” with any object or a hand.  Nonphysical forms of punishment (e.g., verbal and emotional abuse) include activities that are intended to cause shame to a person such as humiliation, threats, ridicules, etc.

Vast amounts of research have consistently demonstrated strong correlations between youth who experienced harsh punishment (e.g., spanking) by their parents and increased risks of:

• changes in brain physiology that show on MRI studies,
• mental health disorders such as depression or anxiety,
• elevated cortisol levels,
• cognitive problems,
• aggressive behaviors,
• unhealthy caregiver-child relationships,
• suicide attempts,
• moderate-to-heavy drinking,
• substance use disorders,
• misconduct, and
• adverse outcomes that extend into adulthood.

Foster Care

In the United States and in some other countries, another way to immediately protect children from further abuse is to remove them from their primary caregivers and place them into foster care or with family members. Foster care is a system in which a minor is placed into a group home (residential child care community, treatment center, etc.), or private home of a state-certified caregiver, referred to as a “foster parent,” or with a family member approved by the state. The placement of the child is normally arranged through the government or a social service agency. The institution, group home, or foster parent is typically compensated for expenses unless the child is placed with a family member.^[8]

In the United States, on any given day, there are more than 400,000 youth living in foster care (out-of-home care) primarily due to abuse and/or neglect.  And, more than 100,000 of these youth are waiting to be adopted from foster care.  This means that these parents have lost permanent legal rights and custody of their children, leaving their children without any permanently legal caregivers (the government assumes this responsibility until someone adopts the children).  The average age of youth waiting to be adopted from foster care is eight years old.  Contrary to popular belief, it typically does not cost any money to adopt a child from foster care.  For more information about becoming a foster parent or adopting from foster care, visit: www.adoptuskids.org.  For additional statistics about adoption and foster care visit the Adoption and Foster Care Statistics website.