Child abuse can be divided into several categories. In this lesson, the types of child abuse are physical abuse, neglect and emotional abuse, and sexual abuse.

a. Physical Abuse.

(1) Definition. Physical abuse to a child can be defined as non accidental injury to a child. Such abuse is usually inflicted by someone taking care of the child (parent or other caretaker), not by a total stranger. The abuse can be triggered by an angry attempt on the adult’s part to punish the child for misbehavior. Or, the physical abuse can be the result of furious adult lashing out at a child who just happens to be around when the adult has some crisis. The physical abuse may be mild (a few bruises, welts, scratches, cuts, scars), moderate (numerous bruises, minor burns, a single fracture), or severe (large burn, central nervous system injury, abdominal injury, multiple fractures, other life-threatening injury). All of these forms of physical child abuse (even mild abuse) are unnecessary and damaging to the child.

(2) Signs and symptoms of physical child abuse. Included are the following:

(a) Bruises. Typical bruises are caused by a forceful slap on the face, upper arms, or buttocks.

(b) Distinctive marks. Rectangular, linear, or round marks which might have been caused by blunt instruments are common. Choke marks on the neck may be evident. There may be circumferential bruises from restraints on the ankles or wrists as well as bruises at the corners of the mouth from gags.

(c) Human bite marks. Human bite marks may be found on any part of the child’s body but are most frequently found on the cheeks and arms. A physically abused child may have healed, healing, and/or fresh bite marks.

(d) Burn injuries. Cigarette burns on hands, feet, or buttocks indicate physical abuse. Burn injuries may be in the shape of a household appliance such as an iron, or burn injuries may be the result of scalding from boiling liquid poured on the child.

(e) Facial injuries. There may be trauma to the eyes, ears, nose, or mouth.

(f) Bald patches. Bald patches on the child’s scalp interspersed with normal hair growth often indicate physical abuse.

(g) Chest injuries. A radiological bone survey can reveal unusual fractures of the ribs, lateral clavicle, scapula, and sternum. Such fractures should arouse suspicion of child abuse.

(h) Abdominal injuries. Physical findings of abdominal injuries include ruptured liver, spleen, or pancreas as well as intramural hematoma of the bowel. Children with these injuries may have recurrent vomiting, abdominal distention, absent bowel sounds, local tenderness, or shock. A ruptured liver or spleen is the most common finding.

Intramural hematomas can occur at the sites of ligamental support such as the duodenum and the proximal jejunum. Intramural hematomas are caused by the whipping force of a punch or blow. This injury is different from a ruptured spleen or ruptured kidney injury, both of which can be caused by the crushing or compressing forces of a traffic accident or a fall.

Adults with a child who has an intramural hematoma routinely deny that the child has had a blow to the abdomen. Therefore, in any case in which a child has sustained an abdominal injury without a reasonable explanation, the medical examiner should suspect child abuse.

b. Neglect and Emotional Abuse.

(1) Definition. Neglect involves failure to provide the necessities of life for a child.

There are many types of neglect: medical, educational, nutritional, psychosocial, physical, and emotional neglect. Abandonment is also classified as a form of neglect. The child who is under weight and malnourished may be a victim of nutritional neglect. Children under two years old are most frequent sufferers from this type of neglect because they are still dependent on adults for food and because the first two years are the years of most rapid growth.

Medical (or health care) neglect exists when a child with a treatable chronic disease does not receive medical treatment despite recommendations to the parents or caretakers.

Physical neglect occurs when those responsible for caring for the child don’t take care of him. Included in physical neglect are dirty hair, dirty or inadequate clothing, incomplete immunizations, unsanitary home environments, unstimulating environments, inadequate after school supervision, and excessive work. Such children should also be evaluated for the presence or absence of severe emotional disturbances. Often, their parents are very depressed and withdrawn. The failure to thrive syndrome (FTT) is part of this type of child abuse. All of these forms of neglect have an emotionally damaging impact on the child.

(2) Signs and symptoms of neglect and emotional abuse. Included are the following:

(a) Stage of development less than other children of the same age.

(b) Evidence of various problems in learning.

(c) Frequently very depressed.

(d) Fearful.

(e) Aggressive behavior.

(f) Socially withdrawn.

(g) Sometimes behaves in more adult manner than other children of the same age.

c. Sexual Abuse of a Child.

(1) Definition. Any sexual activity between an adult and a child (child = a person under the age of 18) is defined as sexual abuse.

Types of sexual abuse of a child include rape (rape of a child, formerly called statutory rape, = sexual intercourse with a girl, not the offender’s wife, under the age of consent), incest, indecent assault, child pornography, and child prostitution. Included are child molestation (fondling or masturbation of the child by another person), intercourse (vaginal, anal, or oral intercourse even though not forced on the child), and family-related rape.

Usually, the child victim is a girl (in 90 percent of the cases), and half of these child victims are under the age of 12. The person committing the abuse is male 99 percent of the time.

(2) Signs and symptoms of sexual abuse. Included are the following:

(a) Lacerations, bruises, or injuries to the genitals, injuries that cannot be explained logically as accidental.

(b) Venereal disease.

(c) Poor sphincter tone.

(3) Reasons victims of sexual abuse participate in the abuse. A variety of factors are responsible for the sexually molested victim to cooperate. Included are the following:

(a) Rewards or bribes may be used to encourage the victim to go along. The offender may treat the abuse as a game, little by little encouraging the victim to engage in sexual play.

(b) The offender may use fear. While force and violence are not usually used directly, the offender may tell the child he will hurt other family members if the child does not cooperate.

(c) The offender may place blame on the victim. Many adults blame the child for not resisting the abuser. Remember, children are taught early in life to obey adults and to do as adults tell them. Particularly among children under 13, sexual activity is beyond their understanding and far beyond the child’s capacity for moral judgment. The adult offender is totally responsible, but the child may bear life-long guilt feelings that he is a “bad” person. The adult abuser often encourages such feelings.

(d) Many victims believe that others know what is going on. He (the victim) may even think that he is sending signals inviting the abuse. When sexual advances are made by strangers, the victims often believe more strongly and incorrectly that they have brought the abuse on themselves.

(e) A different kind of fear is present if the offender is a member of the victim’s family. The victim sometimes is afraid that telling about the abuse will disrupt or destroy his family, and the child cares about his family very much.

(f) The sexually abused child may not realize that anything is wrong if the abuse is committed by someone the child loves and trusts.

(g) The victim may believe that ending the sexual activity will mean the loss of the love of the abuser.

(h) Sometimes victims think no one will believe them and so do not tell anyone.

(i) Victims may feel that sex is bad and be too ashamed and guilty to tell anybody about what has happened.