Parents or others who care for the child are the abusers in more than 80 percent of the cases of neglect and abuse which result in physical or developmental trauma.

As mentioned before, parents themselves are most often the ones who have abused a child. Social scientists are not really sure why parents in some circumstances abuse their children while other parents in the same circumstances do not resort to child abuse. Recent studies reveal these findings about the abused child, the abusive parent, and the family unit itself.

a. The Abused Child.

(1) Age. The abused child is usually under 4 years of age.

(2) Handicapped, retarded, hyperactive, or birth defects. A child with any of these problems will add stress to the family’s daily life, stress the parents may not be able to handle. Parents of such children may also be disappointed and feel guilty, resentful, and angry that the child is not normal.

(3) Premature birth or neonatal separation. Premature babies, being smaller at birth, needing to be fed more often, and sleeping shorter periods of time, also place stress on a family unit. Some parents cannot cope with that stress. Also, if a newborn baby, premature or not, must stay in the hospital for a period of time after birth to overcome physical problems, proper bonding between the baby and the parents may not take place.

b. The Abusive Parent. As social scientists are not sure how many children are abused, these researchers are not exactly sure why some parents are child abusers. The following characteristics, however, have been identified in parents who abuse their children:

(1) Low self-esteem. A parent who is insecure himself may build his self-esteem by abusing his children. He can control his own children through abuse, but he may not be able to control his boss or others with whom he comes in contact in everyday life.

(2) Unhappy, depressed, and/or frustrated. The parent with any or all of these feelings often feels guilty about the past and self-hatred for the way his life is going in the present. Believing himself to be useless, no good, and unlovable, this parent sees his child as useless, unlovable, etc. He takes out his own feelings of worthlessness by abusing his children.

(3) Substance abuser. Parents who misuse alcohol or drugs have a limited ability to deal with their children.

(4) Violent temper. Parents who do not control a violent temper often direct that violence at their children. Also, parents who are violent with each other are usually violent toward their children.

(5) Abused child, himself. Parents who were mistreated as children frequently abuse their own children.

(6) History of mental illness or criminal activity. Although not all child abusers are mentally ill, those who are mentally ill do sometimes abuse their children. Individuals engaged in criminal activity may have been abused as children themselves. Additionally, the force of laws against child abuse is no deterrent to the child abuser who is involved in criminal activity.

(7) Rigid/unrealistic expectations of the child. Some parents expect children to behave perfectly at all times. Toilet training accidents, for example, frequently trigger child abuse incidents.

(8) Young/immature parent. There is no specific training for parenthood. Very young, immature parents do not always understand that caring for a child is a 24 hour a day, 20 year task. The frustration of constant child care can lead to child abuse.

c. The Family Unit. Characteristics of the family unit of an abused child include some of the following:

(1) Money problems, often including unemployment.

(2) Adult family members who are isolated with very few friends.

(3) Family which moves frequently, living in many different places.

(4) Marital problems.

(5) Pattern of husband or wife abuse in the family.

(6) Poor parent-child relationships.

(7) Unwanted pregnancies, illegitimate children, youthful marriage.

d. Situations Triggering Child Abuse. Usually, something triggers an incident of child abuse. Situations which bring about child abuse include the following:

(1) A family argument.

(2) A discipline problem.

(3) Substance abuse (alcohol or drugs).

(4) Loss of a job.

(5) Eviction notice.

(6) Illness.

(7) Other stresses to a family member or to the family unit.

NOTE: These profiles of the abusive parent and the abused child’s family unit paint a picture of child abuse in only one segment of American society (the lower end of the socioeconomic structure).

Remember that child abuse occurs in all parts of society in the United States. The abuser may be rich or poor, educated or uneducated, socially prominent or virtually unknown in a town, immaculately dressed in the latest style or slovenly and dirty, etc. People are very good at concealing what they really do and how they really act from outsiders.

It is, therefore, doubly important that you as a health care provider be observant and thorough in examining an injured child and that you report to the proper authorities according to local standing operating procedure (SOP) any suspicions of child abuse.