Battered Child Syndrome - Term Paper Example

Battered Child Syndrome Introduction The battered child syndrome is a type of abuse in which children are physically abused by caregivers. In 1962, physician C. Henry Kempe and his colleagues, in an article in the Journal of the American Medical Association, coined the term "Battered Child Syndrome" (Reid, 2010). The article shed light on the reality and potential of caretakers who abuse their children, and that in some cases the abuse can lead to the death of a child. Kempe and his colleagues also highlighted for the first time the impact that abuse has on the development and mental health of children. Their work was among the first attempts at understanding the psychological trauma that is inflicted upon children who have suffered abuse (Reid, 2010). Once Battered child syndrome is identified, ensuring the child's wellbeing is of vital importance. Despite the large number of reports that are being made, there is an abundance of research demonstrating that mandated reporters fail to report child abuse even when required, and that there is considerable variability of reporting rates among professionals. The research indicates that there is a range of factors influencing reporting. Factors such as gender and education level of the reporter, fear of damaging the therapeutic relationship, the wording of reporting laws, and incomplete descriptions of what defines abuse have all contributed to discrepancies in reporting. Moreover, professionals often believe that the legal standard of reasonable suspicion is insufficient to demonstrate that abuse has occurred and therefore refrain from reporting (Levi & Loeben, 2004). Federal guidelines on child abuse By 1967, almost all states had adopted some type of mandated child abuse reporting laws. These early laws were aimed primarily at physicians who came in contact with children in their medical practices. They served to help physicians identify possible abuse victims and established reporting procedures. These early laws were later expanded to include a variety of other professionals who have contact with children. The adoption of mandated reporting laws by the states was seen as one of the major contributors to the increase in identifying cases of child maltreatment. It also increased public awareness of the gravity and magnitude of child abuse (NACC, 2011). In 1974, the Child Abuse Prevention and Treatment Act (CAPTA) was passed by Congress, which established national definitions of child abuse and neglect. Under this act, individual states had to adopt the CAPT A definitions in order to receive federal funding for their child welfare programs. The funding provided states with new resources for investigation and prevention of child abuse. One significant part of the act was the creation of the National Center on Child Abuse and Neglect (NCCAN). This organization compiled data on child abuse as well as providing information about child maltreatment and prevention (NACC, 2011). In 1991, the Victims of Child Abuse Act of 1990 was passed by Congress, and served to advance efforts to investigate and prosecute cases involving child maltreatment. This act has been amended over the years (NACC, 2011). Following the initial enactment of this statute, in 1997 the Adoption and Safe Families Act (AFSA) was passed in an effort to provide more timely and focused assessment and services for children and families. AFSA set the time limit for reunification of children removed from their families to one year in an effort to protect children and promote attachment with caregivers. Reporting Behavior Research has addressed a number of criticisms professionals have made regarding challenges to reporting child maltreatment. Research reported that, the vagueness of statutes, although legally permissible, decreases professionals' ability to make consistent determinations about whether or not abuse has occurred. This inconsistency and uncertainty contributes to a subsequent lack of confidence about whether to report suspected maltreatment. This point is examined in a review of literature compiled by Alvarez, Kenny, Donohue, and Carpin (2004). They reviewed studies that focused on the reasons professionals gave for failing to report child maltreatment. One of the reasons identified across many studies was the concern that professionals did not feel they had enough evidence to be certain that abuse was occurring. This was true even when the participants in the study were aware that the professional need not investigate child abuse and that one need only have reasonable suspicion to justify a report. Research findings, although varied in approach, imply that training in identifying a range of symptoms associated with abuse is needed (e.g., Hawkins and McCallum, 2001). Knowledge of such symptoms could help mandated reporters identify presence of abuse and may minimize discrepancies in reporting practices. The following section helps to outline some of the physical, psychological and behavioral symptoms that may be exhibited by a child who has been physically abused. Characteristics of Physical Abuse Physical symptoms Since the coining of the term battered child syndrome in 1962, there has been a surge of awareness regarding child maltreatment. It was becoming clear that "empirical and clinical literature demonstrates that child victims of physical abuse may suffer a wide array of psychological, behavioral, and interpersonal difficulties as a result of their victimization" (Runyan, DeBlinger, Ryan, & Thakkar-Kolar, 2004, p. 65). Doctors and other medical staff were beginning to recognize injuries that were often incongruent with a child's developmental age, which may have been the result of maltreatment by the caregivers. These injuries often were not better explained by accidents or other medical causes (Mulryan, 2004). Physicians were finding that often the explanations for these injuries did not match up with the nature ofthe injury, that the child's account of the accident did not match that of the parents, or that a sibling or other witness would offer a different recollection of what had occurred (Mulryan, 2004). It is important to remember that the symptoms mentioned in this section, particularly behavioral symptoms, may not be specific to physical abuse and may be indicative of other forms of abuse. The following will outline the symptoms that are recognized in the research as most frequently found in children who have been victims of physical abuse. Certain types of injuries are viewed as suspicious and may be a result of physical abuse. Being aware of suspicious injuries and taking note of the severity of the injury can assist professionals in decision-making with respect to reporting. Bruising on a child's knees, elbows, arms, shins, etcetera, are more common and can generally be explained by play and other normal activity. Bruising or welts on children's buttocks, backs of their legs, top of hands or both hands, ears, or abdomen tend to suggest an intentional injury. Human bites often look like bruising on a child's skin. Closer inspection of a possible bite mark may reveal imprints of the teeth or may be combined with darker areas in the center of the bite that may indicate sucking. A bite from an adult will be obviously larger than a bite inflicted by a peer or playmate. Bite marks on infants found on the genitalia may be due to punishment. On older children bite marks are more likely due to an assault, and are often numerous and well defined (Monteleone, 1996). Injuries to the ears and eyes also may leave distinct bruising and discoloration. If a child receives a blow to an ear, the result may be swelling that causes the ear to puff up like a balloon. Bilateral black eyes without the presence of a broken nose are indicative of two blows to the child's face. Both of these injuries require significant force to be applied, and are generally not accidental. Injuries that a child may sustain from falling down stairs, off of a bike, or from a moving vehicle generally have similar characteristics. A child who falls down a flight of stairs may have bruising on various parts of the body, but these injuries are rarely life threatening. Similarly a child who falls off of a bicycle may sustain scrapes and bruising on one side of their body and face, and there will be the presence of dirt or gravel from the contact with the ground. This is also true of children who fall from a moving vehicle. Depending on the speed of the vehicle, the child may have scrapes and bruising on many parts of the body as he or she rolled out of the car. Again, with this type of injury, dirt and gravel are present in the wounds, and the child's clothes will reflect similar damage (Monteleone, 1996). Burning is also a common injury related to abuse. Imprint burns may appear on the child's body in the shape of a common object such as an iron or cigarette. Burns to the feet, buttocks, genitalia and arms may suggest a child was submerged or dipped into scalding water in a bathtub or sink (Mulryan, 2004). A parent or caretakers response to any of the above injuries is also important in identifying suspected abuse (Monteleone, 1996). A parent who significantly delays seeking medical attention may adversely affect the outcome and extent ofthe injury. They may seek no medical attention at all, or may wait to see if the injury will heal itself. A parent's affect in relation to the child's injury may also lead to suspicion, such as a parent who does not show appropriate concern regarding the child's injuries, or makes excessive excuses as to their cause, may have abused the child. Behavioral and psychological symptoms Although physical signs of abuse provide professionals with more obvious markers, behavioral changes in children may be another indicator to the presence of abuse. Behavioral changes will vary from child to child, and will be influenced by age, developmental level, gender, and severity of the abuse. Behavioral and emotional markers also seem to be the most difficult to interpret because of the multiple sources of causation (Runyan et al., 2004). Professionals should be acutely aware of reports indicating sudden and persistent changes in the functional behaviors and uncharacteristic changes in behavior for the child. Children who consistently display disruptive patterns of behavior may be alerting professionals to possible abuse. Other considerations When addressing possible physical abuse, it is important to note that victims and perpetrators of abuse come from all types of backgrounds that include varying socioeconomic class, race, and culture. The research indicates that there are factors that may increase the potential for abuse. Some of these factors may include children with "complex medical problems, developmental delays, those that are unwanted, as well as caregivers under significant life stress" (Pressel, 2000, p. 3057). Twins or multiple birth siblings may also be at higher risk for abuse due to the demanding and often simultaneous needs of each child. A child's developmental task also relates to the potential for abuse; for example, when a child is being toilet-trained risks for abuse may be higher. These periods of high stress in child rearing can lead to methods of discipline by parents that are considered abuse (Pressel, 2000). Conclusion This paper provided a brief history of battered child syndrome in the United States and a review of reporting practices of professionals, how the issue of reporting threshold and the presence of evidence factors into reporting and the various behavioral and physical symptoms associated with battered child syndrome. It was felt that there is a need of further research to ascertain professionals' abilities to agree upon incremental rankings of the severity of symptoms that may indicate possible abuse. The considerable variability in the ability to identify incremental symptoms of abuse, and the debate regarding the effectiveness of mandated reporting, do not negate the need for increased professional competency. Developing clear definitions can help to provide clarity in the identification of abuse. This clarity will help place professionals one step closer to establishing competency and, importantly, identifying appropriate services for children and their families. References Alvarez, KM, Kenny, M.C., Donohue, B., Carpin, K.M., (2004). Why are professionals failing to initiate mandated reports of child maltreatment, and are there any empirically based training programs to assist professionals in the reporting process? Aggressive and Violent Behavior, 9, 563-578. Hawkins, R., McCallum, C. (2001). Effects of mandatory notification training on the tendency to report hypothetical cases of child abuse and neglect. Child Abuse Review, 10, 301-322. Levi, B.H., & Loeben, G. (2004) Index of suspicion: Feeling not believing. Theoretical Medicine and Bioethics, 25(4), 1-34. Monteleone, A. (1996). Recognition of child abuse for the mandated reporter. Second Edition. G.W. Medical Publishing, Inc., New York. Mulryan, K., Cathers, P., & Fagin, A. (2004) How to recognize and respond to child abuse. Nursing, 34(10), 52-55. National Association of Counsel for Children. Information Retrieved November 16, 2011 from www.NACCchildlaw.org Pressel, D.M. (2000). Evaluation of physical abuse in children. American Family Physician, 61 (1 0), 3057-3064. Reid, Joan A. (2010). Battered-Child Syndrome. Encyclopedia of Victimology and Crime Prevention. SAGE Publications. Runyan, M.K., DeBlinger E., Ryan, KE., & Thakker-Kolar, R. (2004). An overview of child physical abuse; Developing a integrated parent-child cognitive behavioral treatment approach. Trauma, Violence, and Abuse, 5 (1), 65-85. Read More