Understanding the risks of child neglect: an exploration of poverty and parenting characteristics

A strong association between poverty and child neglect has been established, but the mechanisms that explain this relationship have not been clearly articulated. This research takes advantage of survey and child maltreatment administrative data about families with young children and assesses the influence of poverty and parenting characteristics on subsequent child neglect. The authors find that indicators of poverty, such as perceived material hardship and infrequent employment, and parenting characteristics, such as low parental warmth, use of physical discipline, and allowing a child to engage in frequent television viewing, are predictive of child neglect. Parenting characteristics do not appear to mediate the link between perceived hardship and neglect, although they suppress the link between employment and neglect. Results from this study provide information that is highly relevant to the approach and design of child maltreatment prevention and intervention strategies.     

Update on child maltreatment

PURPOSE OF REVIEW: The authors discuss the significance of studies published over the previous year regarding assessment and treatment and prevention of child maltreatment, including physical and sexual abuse, inflicted traumatic brain injury, and child neglect. RECENT FINDINGS: The evidence base for many forms of child abuse is growing. As clinicians begin to understand the factors which may increase child vulnerability to abuse, more sophisticated and focused prevention efforts are being implemented. In response to a very public reprimand by the General Medical Council of two child abuse pediatricians, which was felt by many to be unwarranted, the UK government re-emphasized its commitment to the protection of children. In the US, this well-publicized set of events has renewed the medical community's commitment to the recognition of child abuse pediatrics as a formal subspecialty. Several authors detail the short-term and long-term outcome of varying forms of abuse for children as they grow into adults, reinforcing the importance of community efforts to prevent abuse and support families during times of heightened stress such as the current war in Iraq. SUMMARY: The short-term and long-term impact of child maltreatment is significant not only for individuals, but for families and communities where abuse is taking place. General pediatricians have an important role to play with families and in the community as advocates for the protection of children.     

The role of fathers in risk for physical child abuse and neglect: possible pathways and unanswered questions

Despite overrepresentation of fathers as perpetrators in cases of severe physical child abuse and neglect, the role they play in shaping risk for physical child abuse and neglect is not yet well understood. This article reviews the possible father pathways that may contribute to physical child abuse and neglect risk and their existing empirical support. The present empirical base implicates a set of sociodemographic factors in physical maltreatment risk, including fathers' absence, age, employment status, and income they provide to the family. As well, paternal psychosocial factors implicated in physical child maltreatment risk include fathers' abuse of substances, their own childhood experiences of maltreatment, the nature of fathers' relationships with mothers, and the direct care they provide to the child. However, the empirical base presently suffers from significant methodological limitations, preventing more definitive identification of risk factors or causal processes. Given this, the present article offers questions and recommendations for future research and prevention.     

Child maltreatment and substance abuse among U.S. Army soldiers

Although substance abuse has consistently been linked to child maltreatment, no study to date has described the extent of substance abuse among child maltreatment offenders within the military. Analysis of U.S. Army data on all substantiated incidents of parental child maltreatment committed between 2000 and 2004 by active duty soldiers found that 13% of offenders were noted to have been abusing alcohol or illicit drugs at the time of their child maltreatment incident. The odds of substance abuse were increased for offenders who committed child neglect or emotional abuse, but were reduced for child physical abuse. The odds of offender substance abuse nearly tripled in child maltreatment incidents that also involved co-occurring spouse abuse. Findings include a lack of association between offender substance abuse and child maltreatment recurrence, possibly because of the increased likelihood of removal of offenders from the home when either substance abuse or spouse abuse were documented.     

Understanding the ecology of child maltreatment: a review of the literature and directions for future research

Studies examining neighborhood characteristics in relation to social problems, including child maltreatment, have proliferated in the past 25 years. This article reviews the current state of knowledge of ecological studies of child maltreatment. Taken as a whole, these 18 studies document a stable ecological relationship among neighborhood impoverishment, housing stress, and rates of child maltreatment, as well as some evidence that unemployment, child care burden, and alcohol availability may contribute to child abuse and neglect. The authors include a discussion of methodological difficulties in conducting research at the neighborhood level and present a set of recommendations for future research that emphasizes movement from a simple examination of neighborhood-level characteristics toward a theoretically driven explication of processes and mechanisms supported by appropriate multilevel modeling techniques. The final goal of such efforts would be to enable practitioners to develop evidence-based neighborhood interventions that would prevent and reduce child abuse and neglect.     

Relationships between different types of maltreatment during childhood and adjustment in adulthood

There are very few research studies that have evaluated the relationships between multiple forms of childhood maltreatment and psychological adjustment in adulthood. This study evaluates the interrelationships between five different types of child maltreatment (sexual abuse, physical abuse, psychological maltreatment, neglect, witnessing family violence) in a community sample of women and men (N = 175). The relationships between the reported experience of these forms of maltreatment in childhood, family characteristics during childhood, and current psychological adjustment (trauma symptomatology and self-depreciation) were assessed. As hypothesized, family characteristics predicted maltreatment scores and adjustment, and maltreatment scores predicted adjustment after controlling for family environment. There were high correlations between scores on the five maltreatment scales. Results highlight the need to assess all forms of maltreatment when looking at relationships of maltreatment to adjustment and the importance of childhood familial environment for the long-term adjustment of adults.     

Associations between voluntary and involuntary forms of perinatal loss and child maltreatment among low-income mothers

AIM: This study explored maternal history of perinatal loss relative to risk of child physical abuse and neglect. METHODS: The 518 study participants included 118 abusive mothers, 119 neglecting mothers, and 281 mothers with no known history of child maltreatment. Interviews and observations were conducted in the participants' homes, and comparisons were made between women without a history of perinatal loss and women with one and multiple losses relative to risk for child maltreatment. RESULTS: Compared to women with no history of perinatal loss, those with one loss (voluntary or involuntary) had a 99% higher risk for child physical abuse, and women with multiple losses were 189% more likely to physically abuse their children. Compared to women with no history of induced abortion, those with one prior abortion had a 144% higher risk for child physical abuse. Finally, maternal history of multiple miscarriages and/or stillbirths compared to no history was associated with a 1237% increased risk of physical abuse and a 605% increased risk of neglect. CONCLUSION: Perinatal loss may be a marker for elevated risk of child physical abuse, and this information is potentially useful to child maltreatment prevention and intervention efforts.     

Child maltreatment and adulthood violence: the contribution of attachment and drug abuse

This study examined the association between child maltreatment and adult violence in a high-risk sample of women with and without a history of cocaine abuse and the contribution of working models of childhood attachment relationships in understanding this association. Results indicated that whereas childhood physical abuse was associated with adult sexual victimization for cocaine-abusing women, sexual abuse was associated with both partner violence victimization and perpetration for comparison women. Insecure working models of attachment were associated with partner violence victimization for comparison women, independent of the effect of sexual abuse. These findings suggest the importance of research focused on understanding the processes by which child maltreatment may lead to later violence and that examines both childhood and adulthood experiences in understanding pathways to adult violence.     

Estimating the Prevalence Rate of Child Physical and Psychological Maltreatment in South Korea

In Korea, an amendment to the Child Welfare Act was made in 2008 that required a national study estimating the occurrence rate of child abuse and neglect every 5 years. The present study reports the major findings of the first national study conducted after the 2008 amendment. The aim of the study is to estimate the prevalence of child physical and psychological maltreatment (CPPM) in Korea and to explore the basic characteristics associated with such incidents. Household surveys were administered to caregivers and focal children who were school age and older. We estimated the prevalence of CPPM using the Parent–child Conflict Tactic Scale, which was developed by Straus et al. (1998). The occurrence rate of CPPM was 25.3 % in Korea, with instances differing by household income, poverty status, and size of the region. Children who experienced physical and psychological maltreatment were more likely to witness the abuse of their siblings and domestic violence. The implications of the findings are discussed and recommendations made for further research.     

The emerging problem of physical child abuse in South Korea

South Korea has had remarkably high incidence and prevalence rates of physical violence against children, yet the problem has received only limited public and professional attention until very recently. This article represents the first attempt in English to systematically analyze South Korea's recent epidemiological studies on child maltreatment. Discussed are sociocultural factors that have contributed both to delays in child protection laws and a low public awareness of the problem of child abuse. The article highlights methodological issues concerning the definition of physical abuse in South Korea and the complex attitudes toward violence. It also examines the role of the Korean women's movement in the reform of family laws and the recent establishment of new child protection legislation. Suggestions for future directions for the problem of child maltreatment within South Korea are presented.     

An update on child abuse and neglect

PURPOSE OF REVIEW: Nonaccidental trauma and neglect continue to be major problems for children, families, and the providers who care for them. Whereas prevention is the key to ending child abuse and neglect, diagnosis and treatment continue to be the mainstays of practice. This article will briefly review the epidemiology, diagnosis, sequelae, and prevention of abuse and neglect in today's world. RECENT FINDINGS: The latest statistics estimate that more than 900000 children are victims of child maltreatment. Abuse occurs at all ages but is most common in younger children. Child abuse may manifest as skin injuries, skeletal trauma, head injury, or many other forms. Information on abusive head trauma has been published in large amounts in the past year and is reviewed in further depth. The long-term consequences, the keys to prevention, and the role for pediatric providers are also reviewed. SUMMARY: Whereas great strides have been made in diagnosing and treating child abuse, our work has been cut out for us in preventing child abuse. Pediatric clinicians must continue to screen patients and families, recognize signs and symptoms of abuse and neglect, and find time to advocate for home visits, early intervention programs, and education on this very important topic.     

Update on child maltreatment

PURPOSE OF REVIEW: Recent literature regarding assessment, management and prevention of child maltreatment will be considered. Unexplained infant and child death will also be reviewed. RECENT FINDINGS: Controversies in the evaluation of unexpected infant death and inflicted traumatic brain injury are ongoing. Evidence continues to accumulate describing the serious long-term sequelae of child maltreatment. Studies have examined the earliest beginnings of these adverse outcomes commencing in childhood. Despite sustained efforts to develop a variety of training and intervention programs, the deployment of these efforts has been hampered by the lack of evidence that they make any difference in improving recognition of child abuse or in preventing recurrent maltreatment. There is a great need in the child abuse field for more formal, rigorous assessment of all manner of intervention programs. SUMMARY: Efforts to improve the recognition of and management of child abuse need to be sustained. As our understanding of child maltreatment continues to grow, evidence-based interventions will likely improve outcomes for abused children and their families. General pediatricians are often the first to notice signs and symptoms of possible child maltreatment; collaboration with hospital-based Child Protection Teams is critical when considering the possibility of abuse or neglect.     

The cutaneous manifestations of child abuse and neglect.

The most easily recognizable physical manifestations of child abuse and neglect are seen in the skin. The findings may be the result of intentional trauma, neglect to provide adequate child care, alterations in family dynamics, or the emotional problems secondary to the maltreatment.     

The effects of early prevention programs for families with young children at risk for physical child abuse and neglect: a meta-analysis

In this article, a meta-analysis is presented on 40 evaluation studies of early prevention programs for families with young children at risk for physical child abuse and neglect with mostly nonrandomized designs. The main aim of all programs was to prevent physical child abuse and neglect by providing early family support. For the meta-analysis, a multilevel approach was used. A significant overall positive effect was found, pointing to the potential usefulness of these programs. The study demonstrated a significant decrease in the manifestation of abusive and neglectful acts and a significant risk reduction in factors such as child functioning, parent-child interaction, parent functioning, family functioning, and context characteristics.     

Child protective services and domestic violence

Studies estimate that domestic violence is present in at least one-third of the families involved in child protective services (CPS). Yet, until recently, CPS has not directly addressed domestic violence in its handling of child abuse and neglect cases. By the same token, domestic violence programs have historically emphasized services for battered women, with limited understanding of the child safety goals of CPS. Despite these historical differences, collaborative efforts between CPS and domestic violence service programs are emerging based on a common goal of safety from violence for all family members. Innovative strategies include the use of domestic violence specialists in a variety of child protection settings for case consultation and for support to the battered women, direct referrals of battered women from domestic violence programs to family preservation services, and cross-training of CPS workers and domestic violence service providers. A survey of state CPS administrators and domestic violence coalition directors conducted for this article revealed that although there is mutual interest in greater collaboration, such efforts remain limited. New forums, such as CPS citizen review panels and community-based CPS partnerships, hold promise for further collaboration. Critical to successful strategies are supportive agency leadership, greater trust and understanding across systems, a recognition of common goals, and a willingness to change policies and practice.     

Stress and anger as contextual factors and preexisting cognitive schemas: predicting parental child maltreatment risk

Progress in the child maltreatment field depends on refinements in leading models. This study examines aspects of social information processing theory (Milner, 2000) in predicting physical maltreatment risk in a community sample. Consistent with this theory, selected preexisting schema (external locus-of-control orientation, inappropriate developmental expectations, low empathic perspective-taking ability, and low perceived attachment relationship to child) were expected to predict child abuse risk beyond contextual factors (parenting stress and anger expression). Based on 115 parents' self-report, results from this study support cognitive factors that predict abuse risk (with locus of control, perceived attachment, or empathy predicting different abuse risk measures, but not developmental expectations), although the broad contextual factors involving negative affectivity and stress were consistent predictors across abuse risk markers. Findings are discussed with regard to implications for future model evaluations, with indications the model may apply to other forms of maltreatment, such as psychological maltreatment or neglect.     

Child maltreatment among Asian Americans: characteristics and explanatory framework

This article systematically reviews the characteristics of child maltreatment among Asian Americans and provides a theoretical explanatory framework. The reported rate of child maltreatment among Asian Americans is disproportionately low. A high rate of physical abuse and low rates of neglect and sexual abuse are found among Asian American victims. Some protective factors (e.g., the emphasis on family harmony and reputation and the indulgence to infants and toddlers) may lead to low probability of child maltreatment among Asian Americans. Some others (e.g., parental authority and beliefs in physical punishment) may be risk factors of child maltreatment, especially physical abuse. Meanwhile, many other coexisting factors (e.g., children's obedience to parents and families' invisibility to authorities) may prohibit child maltreatment from being disclosed. Therefore, the overall low reported rate of child maltreatment among Asian Americans may be a combination of low incidence and underreporting. Implications for practice and research are discussed.     

Intergenerational continuity of child abuse among adolescent mothers: authoritarian parenting, community violence, and race

Among the negative sequelae of child maltreatment is increased risk for continuity of maltreatment into subsequent generations. Despite acknowledgment in the literature that the pathways toward breaking the cycle of maltreatment are likely the result of dynamic interactions of risk and protective factors across multiple ecological levels, few studies have followed high-risk samples of maltreated and nonmaltreated parents over time to evaluate such processes. In the current investigation, exposure to community violence and authoritarian parenting attitudes were evaluated as predictors of the intergenerational continuity of abuse, and the moderating effect of African American race was examined. The sample included 70 mothers and their 18-year-old children, who have been followed longitudinally since the third trimester of the adolescent mothers' pregnancy. Results revealed that among mothers with a child abuse history, higher exposure to community violence and lower authoritarian parenting attitudes were associated with increased risk for intergenerational continuity of abuse. The relation of authoritarian parenting attitudes to intergenerational continuity was moderated by race; the protective effects of authoritarian parenting were limited to the African American families only. The salience of multiple ecological levels in interrupting the intergenerational continuity of child abuse is discussed, and implications for preventive programs are highlighted.     

Burns as a consequence of child maltreatment

Over 25,000 children a year attend emergency departments in the UK with burns. Scalds predominate, with infants aged one year being 10 times more likely to sustain a burn than any other age group. Identifying which burns result from abuse or neglect is challenging, but inflicted injuries are more likely to have certain characteristics and differences in the causative agent, mechanism and pattern of burns have been observed in children with non-accidental burn injuries. Children have been subjected to every type of burn as a consequence of abuse including scalds, contact, caustic, flame and radiation burns, thus careful scrutiny of all burns cases for possible maltreatment is warranted. Whilst neglectful burns outnumber inflicted burns by 9:1, these are most challenging to discern. A detailed history is vital to determine whether the burn pattern is consistent with the child's developmental stage, and the agent and mechanism offered, in addition to evaluating supervision, and previous or co-existent injuries. Social features such as domestic violence in the home or being previously known to social services are also key indicators. If abuse is suspected, full investigations including skeletal survey in those aged less than 2 years is required, consideration of cranial neuro-imaging in younger infants and possible scene assessment.     

Should child abuse and neglect be considered when a child dies unexpectedly?

Deaths during two years at a pediatric teaching hospital were studied to develop guidelines for clinicians who must decide when to explore the possibility of child abuse or neglect when a child dies unexpectedly. Unexpected deaths were defined as deaths occurring before arrival at the hospital or within ten days of hospitalization in children past the first month of life and unrelated to any previously known congenital anomaly or medical condition. There were 43 such deaths during two years. The majority (27) were due to natural causes. However, nine deaths were related to suspected child abuse or neglect (SCAN) and in three of those cases evidence of injury was found only at autopsy. The SCAN cases were more often mistaken for medical illness than for uninflicted injury, indicating that autopsy and postmortem skeletal survey are warranted whenever a child dies unexpectedly. The two factors "dead on arrival" and "1 year of age or less" had a positive predictive value for SCAN of 89% and a negative predictive value of 94%. The two factors identify a high-risk group requiring at least hospital-based investigation into the possibility of abuse or neglect. Reporting for SCAN is warranted when unsuspected trauma is found post mortem, there is direct physical or social evidence of child abuse or neglect, or the child is in the high-risk group and hospital-based investigation falls to eliminate the possibility that maltreatment contributed to the child's death.