6.6 Child Maltreatment

We have reserved the most disturbing topic, child maltreatment, for the end of this chapter. The assumption throughout has been that parents and other adults seek the best for young children, and that their disagreements (e.g., what to feed them, how to discipline, what kind of early education to provide) arise from contrasting ideas about what is best.

However, the sad fact is that not everyone seeks the best for children. Sometimes parents harm their own offspring. Often the rest of society ignores the preventive and protective measures that could stop much maltreatment. Lest we become part of the problem, not part of the solution, we first need to recognize child neglect and abuse.

Maltreatment Noticed and Defined

Until about 1960, people thought child maltreatment was a rare, sudden attack by a disturbed stranger. Today we know better, thanks to a pioneering study based on careful observation of the “battered child syndrome” in one Boston hospital (Kempe & Kempe, 1978). Maltreatment is neither rare nor sudden, and the perpetrators are usually one or both of the child’s parents. In these instances, maltreatment is often ongoing, and the child has no protector, which may make the maltreatment more damaging than a single incident, however injurious.

With this recognition came a broader definition: Child maltreatment now refers to all intentional harm to, or avoidable endangerment of, anyone under 18 years of age. Thus, child maltreatment includes both child abuse, which is deliberate action that is harmful to a child’s physical, emotional, or sexual well-being, and child neglect, which is failure to meet a child’s basic physical or emotional needs. Reported maltreatment means that the authorities have been informed. In Canada, the provinces and territories are responsible for protecting and supporting children at risk of abuse and neglect. Substantiated maltreatment means that a reported case has been investigated and verified.

Frequency of Maltreatment

How common is maltreatment? No one knows. Not all cases are noticed; not all noted cases are reported and not all reports are substantiated. The number of investigations for reported cases of child maltreatment in Canada rose sharply in the five-year period between 1998 and 2003, from 135 261 to 235 315. In 2008, it is estimated that about 235 842 investigations were reported in Canada (see Figure 6.1). Of those, about 36 percent were substantiated and 26 percent of the cases had children at risk (see Figure 6.2) (PHAC, 2010).

FIGURE 6.1 Levelling Off Though the number of investigations for child maltreatment in Canada rose dramatically between 1998 and 2003, since then they seem to have levelled off.

FIGURE 6.2 Still Far Too Many Although these rates are estimates and there have been changes in practices with how investigations are conducted, the number of children who have been maltreated is alarming.

How maltreatment is defined by legislation and the level of public and professional awareness of the problem can influence the level of reporting. For example, the Canadian Incidence Study of Reported Child Abuse and Neglect reported that the average annual caseload in 2008 varied among provinces and territories. Based on the child population of 15 years or younger, the territories together had the highest level of reporting (11.67 percent), with British Columbia having the second highest rate (4 percent). The Atlantic provinces had the lowest level of reporting, at 1.54 percent. Generally, Aboriginal children were at greater risk of maltreatment (18 percent) as compared to their non-Aboriginal peers (2.31 percent) (PHAC, 2010).

The number of substantiated victims is much lower than the number of reported victims primarily because the same child is often reported several times, leading to one substantiated case. Also, substantiation requires proof—obvious evidence (broken bones, severe malnutrition) or reliable witnesses.

Often the first sign of maltreatment is delayed development, such as slow growth, immature communication, lack of curiosity, or unusual social interactions. Anyone familiar with child development can observe a young child and notice such problems. Maltreated children often seem fearful, startled by noise, defensive and quick to attack, and confused between fantasy and reality. TABLE 6.3 lists signs of child maltreatment, both neglect and abuse. None of these signs are proof that a child has been abused, but whenever any of them occurs, it signifies trouble.

Noticing children who are maltreated is only part of the task; we also need to notice the conditions and contexts that make abuse or neglect more likely (Daro, 2009). Poverty, social isolation, and inadequate support (public and private) for caregivers are among them. From a developmental perspective, immaturity of the caregiver is a risk factor: Maltreatment is more common if parents are younger than 20 or if families have several children under age 6.

Consequences of Maltreatment

Abuse Victim? Anna (shown here), age 5, told the school nurse she was sunburned because her mother, Patricia, took her to a tanning salon. Patricia said Anna was gardening in the sun; Anna’s father and brother (also shown here) said all three waited outside the salon while Patricia tanned inside. The story led to an arrest for child endangerment, a court trial, and a media frenzy.

CHRISTOPHER SADOWSKI/SPLASH NEWS/NEWSCOM

The impact of any child-rearing practice is affected by the cultural context. Certain customs (such as circumcision, pierced ears, and spanking) are considered abusive in some cultures but not in others; their effects on children vary accordingly. Children suffer most if their parents seem to love them less when compared with the love they witness in neighbourhood families. For example, if a parent forbids something other children have (from candy to cellphones) or punishes more severely or not at all, children might feel unloved.

Although culture is always relevant, as more longitudinal research is published, the effects of maltreatment are proving to be devastating and long lasting. The physical and academic impairment from maltreatment is relatively easy to notice—a nurse sees that a child is bruised and broken, a teacher sees that a child is hungry, sleepy, or failing despite ability. However, when researchers follow maltreated children over the years, enduring deficits in social skills seem even more crippling than physical or academic ones. To be specific, many studies have found that mistreated children typically regard other people as hostile and exploitative; hence, these children are less friendly, more aggressive, and more isolated than other children. The earlier abuse starts and the longer it continues, the worse children’s peer relationships become (Scannapieco & Connell-Carrick, 2005).

Child neglect is three times more common than overt abuse. Research shows that children who were neglected experience even greater social deficits than abused ones because they were unable to relate to anyone, even in infancy (Stevenson, 2007). The best cure for a mistreated child is a warm and enduring friendship, but maltreatment makes this unlikely.

Adults who were severely maltreated (physically sexually or emotionally) often engage in self-destructive behaviours such as drug or alcohol abuse, eating disorders, or violence. They also may repeatedly enter unhealthy relationships, or sabotage their own careers. In addition, they have a much higher risk of emotional disorders and suicide attempts, even after other risk factors (e.g., poverty) are taken into account (Afifi et al., 2008).

Finding and keeping a job is a critical aspect of adult well-being; adults who were maltreated suffer in this way as well. One study (Currie & Widom, 2010) matched 807 children who had experienced substantiated abuse with other children from the same neighbourhood, and of the same sex, ethnicity, and SES. About 35 years later, the employment rate for those who had been mistreated was 14 percent lower than the rate for those who had not been abused. The researchers concluded that abused and neglected children experience large and enduring economic consequences (Currie & Widom, 2010). In this study, the women were more impaired than the men: It may be that self-esteem, emotional stability, and social skills are even more important for female than for male employees.

Three Levels of Prevention, Revisited

Learning to Trust Owen, adopted from India, laughs and plays with his parents in Toronto, Ontario. Amy, his mother, spent eight months in Bangalore, India, with her husband Trevor’s family while the adoption was being processed. Amy spent weeks holding Owen, until finally, after seven months, he responded by holding on to her too.

STEVE RUSSELL/TORONTO STAR VIA GETTY IMAGES

Just as with injury control, there are three levels of prevention of maltreatment. The ultimate goal is primary prevention, which focuses on the macrosystem and exosystem. Examples of primary prevention include increasing stable neighbourhoods and family cohesion, and decreasing financial instability, family isolation, and adolescent parenthood.

Secondary prevention involves spotting warning signs and intervening to keep a risky situation from getting worse (Giardino & Alexander, 2011). For example, insecure attachment, especially of the disorganized type (described in Chapter 4), is a sign of a disrupted parent–child relationship. Secondary prevention includes home visits by helpful nurses or social workers, as well as high-quality daycare that gives vulnerable parents a break while teaching children how to make friends and resolve conflicts.

Tertiary prevention includes everything that limits harm after maltreatment has already occurred. Reporting and substantiating abuse are only the first steps. Often the caregiver needs help to provide better care. Sometimes the child needs another home. If hospitalization is required, that signifies failure: Intervention should have begun much earlier. At that point, treatment is very expensive, harm has already been done, and hospitalization itself further strains the parent–child bond (Rovi et al., 2004).

Children need caregivers they trust, in safe and stable homes, whether they live with their biological parents, a foster family, or an adoptive family. Whenever a child is legally removed from an abusive or neglectful home and placed in foster care, permanency planning must begin, to find a family to nurture the child until adulthood. Permanency planning is a complex task. Parents are reluctant to give up their rights to the child; foster parents hesitate to take a child who is hostile and frightened; maltreated children need intensive medical and psychological help but foster care agencies are slow to pay for such services.

The most common type of foster care in North America is kinship care (see Chapter 4), in which a relative (most often the grandmother) takes over child-rearing from parents who are either abusive or simply unable to give their children the care they need. Unfortunately, kinship care typically receives fewer services and adds stress to the lives of the adults involved, a topic further discussed in Chapter 15 (Sakai et al., 2011). While adults argue about parental rights, criminal charges, and cultural differences, the immediate needs of the child may be ignored. A good treatment plan requires cooperation among social workers, judges, and psychologists, as well as the caregivers themselves (Edwards, 2007). Governments have to ensure that children who are taken from their parents’ care—for whatever reason—do not get lost in the bureaucracy.

One tragic case in point involved a young First Nations boy from Norway House in Manitoba. Jordan River Anderson was born with a rare muscular disorder that meant he had very complex medical needs. Realizing they couldn’t care for him themselves, Jordan’s parents placed him with a child welfare agency shortly after his birth, and he was immediately admitted into a Winnipeg hospital. In the meantime, his family and the welfare agency worked to find him a foster home that could meet both his medical needs and give him the benefits of growing up in a positive family environment.

Shortly after his second birthday, the doctors were ready to release Jordan from hospital, but at that point the provincial and federal governments, who share jurisdiction for First Nations people, began a dispute over who should pay for Jordan’s foster care. The dispute dragged on for more than two years as officials argued over the cost of installing a special ramp and the price of a showerhead. Shortly after Jordan’s fifth birthday, he accidently pulled out his breathing tube and died in hospital (Lavallee, 2005).

This tragedy led to the establishment of Jordan’s Principle, a measure meant to resolve jurisdictional disputes between the federal and provincial/territorial governments that involve services provided to First Nations children. Under this principle, whenever a dispute arises between two levels of government or between two departments of the same government over which should pay for services for a First Nations child, the government or department of first contact is required to pay until the dispute has been resolved. Under a private member’s motion, Jordan’s Principle was unanimously supported by the House of Commons in 2007 (Aboriginal Affairs and Northern Development Canada, 2013).

As detailed many times in this chapter, caring for young children—from making sure they brush their teeth to guiding their emotions—is not easy. Parents shoulder most of the burden, and their love and protection usually result in strong and happy children. Sadly, parents do not always get the help they need, and children sometimes suffer.