Definition
Battered child syndrome (BCS) refers to non-accidental injuries sustained
by a child as a result of physical abuse, usually inflicted by an adult
caregiver.
Description
Internal injuries, cuts,
burns
,
bruises
, and broken or fractured bones are all possible results of battered child
syndrome. Because adults are so much larger and stronger than children
are, an abused can suffer severe injury or death without the abuser
intentionally causing such an injury. Shaking an infant can cause bleeding
in the brain (
subdural hematoma
), resulting in permanent brain damage or death. Emotional damage to a
child is also often the byproduct of
child abuse
, which can result in the child exhibiting serious behavioral problems
such as substance abuse or the physical abuse of others.
BCS is alternatively referred to as child physical abuse or non-accidental
trauma (NAT).
Demographics
The total abuse rate of children is 25.2 per 1,000 children, with physical
abuse accounting for 5.7 per 1,000, sexual abuse 2.5 per 1,000, emotional
abuse 3.4
per 1,000, and neglect accounting for 15.9 per 1,000 children. These
categories overlap, with sexual and physical abuse often occurring
together; physical abuse or neglect seldom occur without emotional abuse.
These numbers may be underestimates due to underreporting of the problem
or failure of diagnosis by medical personnel.
In 1996, more than 3 million victims of alleged abuse were reported to
child protective services in the United States; reports were substantiated
in more than one million cases. Parents were abusers in 77 percent of the
confirmed cases; other relatives in 11 percent. More than 1,000 children
died from abuse in 1996.
Causes and symptoms
Battered child syndrome (BCS) is found at every level of society, although
the incidence may be higher in lower-income households, where adult
caregivers may suffer greater stress and social difficulties and have a
greater lack of control over stressful situations. Other risk factors
include lack of education, single parenthood, and
alcoholism
or other drug addictions. The child abuser most often injures a child in
the heat of anger or during moments of stress. Common trigger events that
may occur before assaults include incessant crying or whining of infants
or children; perceived excessive "fussiness" of an infant or
child; a toddler's failed
toilet training
; and exaggerated perceptions of acts of "disobedience" by a
child. Sometimes cultural traditions may lead to abuse, including beliefs
that a child is property, that parents (especially males) have the right
to control their children any way they wish, and that children need to be
toughened up to face the hardships of life. Child abusers were often
abused as children themselves and do not realize that abuse is not an
appropriate disciplinary technique. Abusers also often have poor impulse
control and do not understand the consequences of their actions.
Symptoms may include a delayed visit to the emergency room with an injured
child; an implausible explanation of the cause of a child's injury;
bruises that match the shape of a hand, fist or belt; cigarette burns;
scald marks; bite marks; black eyes; unconsciousness; lash marks; bruises
or choke marks around the neck; circle marks around wrists or ankles
(indicating twisting); separated sutures; unexplained unconsciousness; and
a bulging fontanel in small infants.
Emotional trauma may remain after physical injuries have healed. Early
recognition and treatment of these emotional "bruises" is
important to minimize the long-term effects of physical abuse. Abused
children may exhibit:
Sometimes emotional damage of abused children does not appear until
adolescence
or even later, when abused children become abusing parents who may have
trouble with physical closeness, intimacy, and trust. They are also at
risk for anxiety, depression, substance abuse, medical illnesses, and
problems at school or work. Without proper treatment, abused children can
be adversely affected throughout their life.
Anyone should call a health care provider or child protective services if
they suspect or know that a child is being abused. Reporting child abuse
to authorities is mandatory for doctors, teachers, and childcare workers
in most states as a means to prevent continued abuse.
Diagnosis
Battered child syndrome is most often diagnosed by an emergency room
physician or pediatrician, or by teachers or social workers. Physical
examination will detect injuries such as bruises, burns, swelling, retinal
hemorrhages (bleeding in the back of the eye), internal damage such as
bleeding or rupture of an organ,
fractures
of long bones ore spiral-type fractures that result from twisting, and
fractured ribs or skull.
X rays
, and other imaging techniques, such as MRI or scans, may confirm or
reveal other internal injuries. The presence of injuries at different
stages of healing (i.e., having occurred at different times) is nearly
always indicative of BCS. Establishing the diagnosis is often hindered
by the excessive cautiousness of caregivers or by actual concealment of
the true origin of the child's injuries, as a result of fear, shame
and avoidance or denial mechanisms.
Treatment
Medical treatment for battered child syndrome will vary according to the
type of injury incurred. Counseling and the implementation of an
intervention plan for the child's parents or guardians are
necessary. The child abuser may be incarcerated, and/or the abused child
removed from the home to prevent further harm. Decisions regarding
placement of the child with an outside caregiver or returning the child to
the home will be determined by an appropriate government agency working
within the court system, based on the severity of the abuse and the
likelihood of recurrence. Both physical and psychological therapy are
often recommended as treatment for the abused child. If the child has
siblings, the authorities should determine where they have also been
abused, for about 20 percent of siblings of abused children are also shown
to exhibit signs of physical abuse.
Prognosis
The prognosis for battered child syndrome will depend on the severity of
injury, actions taken by the authorities to ensure the future
safety
of the injured child, and the willingness of parents or guardians to seek
counseling for themselves as well as for the child.
Prevention
Recognizing the potential for child abuse and the seeking or offering of
intervention, counseling, and training in good parenting skills before
battered child syndrome occurs is the best way to prevent abuse. The use
of educational programs to teach caregivers good parenting skills and to
be aware of abusive behaviors so that they seek help for abusive
tendencies is critical to stopping abuse. Support from the extended
family
, friends, clergy, or other supportive persons or groups may also be
effective in preventing abuse. Signs that physical abuse may occur include
parental alcohol or substance abuse; high stress factors in the family
life; previous abuse of the child or the child's siblings; history
of mental or emotional problems in parents; parents abused as children;
absence of visible parental love or concern for the child; and neglect of
the child's hygiene.
Parental concerns
KEY TERMS
Child protective services (CPS)
—The designated social services agency (in most states) to
receive reports, investigate, and provide intervention and treatment
services to children and families in which child maltreatment has
occurred. Frequently this agency is located within larger public social
service agencies, such as Departments of Social Services.
Fontanelle
—One of several "soft spots" on the skull where the
developing bones of the skull have yet to fuse.
Multiple retinal hemorrhages
—Bleeding in the back of the eye.
Subdural hematoma
—A localized accumulation of blood, sometimes mixed with spinal
fluid, in the space between the middle (arachnoid) and outer (dura
mater) membranes covering the brain. It is caused by an injury to the
head that tears blood vessels.
Resources
Besharov, Douglas J.
Recognizing Child Abuse: A Guide for the Concerned.
New York, NY: Free Press, 1990.
Crosson-Tower, Cynthia.
Understanding Child Abuse and Neglect. 5th Edition.
New York, NY: Allyn & Bacon, 2001.
Feinen, Cynthia, Winifred Coleman, Margaret C. Ciocco, et al., eds.
Child Abuse: A Quick Reference Guide.
Long Branch, New Jersey: Vista Publishing, 1998.
Giardino, Angelo P., and Giardino, Eileen.
Recognition of Child Abuse for the Mandated Reporter,
3rd ed. St. Louis, MO: G.W. Medical Publishing, 2002.
Lukefahr, James L.
Treatment of Child Abuse.
Baltimore, MD: Johns Hopkins University Press, 2000.
Monteleone, James A.
A Parent's & Teacher's Handbook on Identifying and
Preventing Child Abuse: Warning Signs Every Parent and Teacher Should
Know.
St. Louis, MO: G.W. Medical Publishing, 1998.
Reece, Robert, and Stephen Ludwig.
Child Abuse: Medical Diagnosis and Management,
2nd ed. Baltimore, MD: Lippincott, Williams, and Wilkins, 2001.
National Child Abuse Hotline.
800-4-A-Child (800-422-4453).
National Clearinghouse on Child Abuse and Neglect Information.
P.O. Box 1182, Washington, DC 20013-1182. 800-394-3366. Web site:
http:/ccanch.acf.hhs.gov
.
Prevent Child Abuse America.
200 South Michigan Avenue, 17th Floor, Chicago, IL 60604. (312) 663-3520.
Web site:
http://preventchildabuse.org
.
National Parents Anonymous.
675 West Foothill Blvd., Suite 220m Claremont, CA 91711. (909) 621-6184.
Web site:
http://www.parentsanonymous.org/pahtml/paNPLTabout.html
.
Child Abuse: Types, Symptoms, Causes, and Help.
Available online at:
<http://www.helpguide.org/mental/child_abuse_physical_emotional_s
xual_neglect.htm>
.
"State by State Abuse Hotline & Organization
Directory."
The Broken Spirits Network.
Available online at:
http://www.brokenspirits.com/directory
.
