Abuse of a child is a behavior toward a child that is outside the norm and present a considerable risk of physical or psychological damage to the child. There are four types of child abuse: physical abuse, sexual abuse, emotional abuse and neglect. The causes of child abuse are different and not yet clear. Abuse and neglect often occur with physical injuries, growth and developmental delay, and mental disorders. Diagnosis is based on medical history, physical examination findings, and sometimes laboratory tests and diagnostic imaging. The supply includes the documentation and treatment of any injury and the physical and mental health, as well as a mandatory reporting to the relevant authorities and sometimes hospitalization and / or placement in a nursing home, to bring the child to safety.
In 2012 were the Child Protective Services in the United States reported 3.4 million reports of alleged child abuse, affecting 6.3 million children. 62% (2.1 million) of these reports were examined in detail and over 686,000 abused children have been identified. Both sexes are equally affected, is also considered that the younger the child is, the likelihood of being a victim, the greater.
Abuse of a child is a behavior toward a child that is outside the norm and present a considerable risk of physical or psychological damage to the child. There are four types of child abuse: physical abuse, sexual abuse, emotional abuse and neglect. The causes of child abuse are different and not yet clear. Abuse and neglect often occur with physical injuries, growth and developmental delay, and mental disorders. Diagnosis is based on medical history, physical examination findings, and sometimes laboratory tests and diagnostic imaging. The supply includes the documentation and treatment of any injury and the physical and mental health, as well as a mandatory reporting to the relevant authorities and sometimes hospitalization and / or placement in a nursing home, to bring the child to safety. In 2012 were the Child Protective Services in the United States reported 3.4 million reports of alleged child abuse, affecting 6.3 million children. 62% (2.1 million) of these reports were examined in detail and over 686,000 abused children have been identified. Both sexes are equally affected, is also considered that the younger the child is, the likelihood of being a victim, the greater. About two-thirds of all reports made to the Child Protective Services came from people who are obliged by profession to report abuse (z. B. educators, police officers, social workers, lawyers, childminders, medical personnel, healthcare workers, caregivers). Of the 2,012 confirmed cases in the US of child abuse were 78.3% cases of neglect (including medical neglect), 8.3% to physical abuse, 9.3% due to sexual abuse and 8.5% to psychological abuse. Many children were victims verschiedenster forms of violence. Approximately 1,640 children died in 2012 in the US by abuse. About three-quarters of the children were <3 years old. Nearly 70% of these children were victims of neglect and 44% victims of physical abuse with or without other forms of ill-treatment. About 80% of perpetrators were parents who acted alone or with another parent, and> 25% of deaths from ill-treatment were carried out by the mother alone. Classification The various forms of mistreatment coexist and overlap considerably. Physical abuse physical abuse is the infliction of physical damage or joining operations which have a high risk of injury, by a caregiver. Special forms are shaking, dropping, striking, biting and burns Add (z. B. scalding or touching with a cigarette). Abuse of power is the most common cause of severe head injuries in infants. In infants are often found abdominal injuries. Infants and young children are particularly vulnerable because the development stages that they go through can be frustrating (eg. As colic, inconsistent sleep patterns, tantrums, toilet training) caregivers. This age group also has a higher risk because they may not report their abuse. The risk increases in the early school years and then increases again in Jugendalter.Sexueller abuse Any act with a child, to be held as a sexual reward for an adult or a significantly older child is sexual abuse (pedophiles disorder). The following types of sexual abuse: sexual intercourse with oral, anal or vaginal penetration; Discomfort caused by contact of the genital organs without intercourse and shapes that do not involve physical contact, such. to perform as exhibition of the genitals of the offender, the showing of materials with sexually explicit content and determining a child, sexual activity with another child or attend to produce materials (photos, films etc.) sexual content. Sexual abuse has nothing to do with the child’s sexual curiosity, in which to look at the children of the appropriate age each other or touching of another without force or coercion genital area. The guidelines that distinguish sexual abuse from the game, vary between US states, but usually is an age difference of> 4 years (in chronological order or in the mental and physical development) as abuse angesehen.Psychische abuse the psychological abuse is the adding mental harm through words and actions. Special shapes are the scare of a child by bellowing and screaming, rejecting by narrowing the skills and achievements of the child, the intimidation and terrorizing with threats and the exploitation or corruption of the child by encouraging deviant and criminal behavior. A psychological abuse may also be present if refrain linguistic or physical affection or are denied, so essentially an emotional neglect is (z. B. ignore the child or reject or discourage interactions with other children or adults) .Missbrauch in a medical environment child abuse in a medical setting (formerly by as Munchausen syndrome proxy, now known as others added factitious disorder) occurs when caregivers intentionally produce or falsify physical or psychological symptoms or signs in a child. The caregivers can harm the baby with drugs or other agents or enclose urine sample blood or bacterial contaminants in order to simulate diseases. Many children receive unnecessary and harmful or potentially harmful tests and Behandlungen.Vernachlässigung Neglect is the failure to provide for the physical, emotional, educational and medical basic needs of a child. Neglect is different from abuse by not normally deliberately harm. Physical neglect includes the failure to provide adequate food, clothing, shelter, supervision and protection from potential harm, one. The emotional neglect is the failure to let the child get affection, love or other forms of emotional support. Educational neglect is the inability to enroll a child in a school, ensuring the school or to provide a home education. Of medical neglect occurs when there is no guarantee that the child receives appropriate medical care, for example. As the withholding of vaccinations or necessary treatments for injuries, physical or psychological factors Störungen.Kulturelle Severe corporal punishment (eg. As flogging, burning, scalding) are clearly physical abuse. However, certain penalties move depending on the cultural background within or outside the boundaries of socially accepted, behavior and abuse. Also, certain cultural practices (eg. As female genital mutilation [FGM]) are so extreme as to constitute an abuse. Certain traditional medical rituals folk medicine care (z. B. embossing, Pate Chien, cupping, envelopes) often for lesions (z. B. bruises, minor burns), so that the boundary between acceptable cultural practice and abuse may be blurred. Members of certain religious and cultural groups have sometimes failed to receive a life-saving treatment (z. B. in diabetic ketoacidosis or meningitis), which resulted in the death of a child. Such a failure is considered neglect in general, regardless of the intent of the parents or caregivers. In addition, in the United States certain people and cultural groups have increasingly reservations about vaccinating their children, citing security concerns (anti-vaccination movement). It is not clear whether this rejection of vaccination is a real medical neglect. If the children are sick, however, a denial of scientific and medically recognized treatment is reason to investigate, if necessary, followed by legal consequences. Etiology abuse generally occurs abuse by a loss of self-control by parents or caregivers. Several factors contribute to this. Character and personality of the parents can play a role. In childhood, the parents may have lack of affection and warmth. Perhaps his parents were not encouraged to develop a self-esteem or emotional maturity and suffered in most cases, even other forms of ill-treatment. Abusive parents see their children as a source of unlimited and unconditional affection and support that they themselves have never received. As a result, they sometimes have unrealistic expectations of the child, as this should help them; they are then easily frustrated and have poor impulse control; and they may be unable to give what they themselves have never experienced. Drug or alcohol abuse can provoke impulsive and uncontrolled behavior towards their children. increase parental mental disorders also the risk of abuse. Irritable, demanding, or hyperactive children can cause outbursts of anger among parents; the same is true for the mentally or physically disabled children who need more care than a normally developed child. Sometimes no strong emotional bonds develop between parents and children. This lack of loyalty is more common in premature infants or sick babies, which were separated in early childhood from parents, or between parents and not biologically related children (z. B. stepchildren). This can increase the risk of abuse. Situation Bound stress may precede an abuse, especially when emotional support is missing by relatives, friends, neighbors and peers. Physical abuse, emotional abuse and neglect are often associated with poverty and low social status. All forms of abuse, including sexual abuse, are found in all social classes. The risk of sexual abuse is increased in children who have different manager or supervisor with multiple sexual partners haben.Vernachlässigung neglect arises usually from a combination of factors such as poor education, poor coping strategies, unsupportive family systems and stressful life circumstances. Neglect often occurs in impoverished families in which the parents also have a mental disorder (typically depression, bipolar disorder or schizophrenia), drug or alcohol abuse or a diminished mental capacity exists. In children of single parents at risk of neglect due to lower income and less available resources can be made. Symptoms and signs The symptoms and discomfort depend on the duration and type of abuse or neglect. Physical abuse skin lesions are common and can include palm prints or oval fingertip impressions caused by hitting or gripping and shaking Long band-shaped ecchymosis caused by hitting with a belt narrow arcuate bruises, caused by the beating with an extension cable Several small round burns caused by cigarette Symmetrical scalding the upper or lower limbs or the buttocks, which were caused by intentional immersion bite marks thickened skin or scar to the mouth edges caused by gagging Fleckige alopecia with different hair lengths caused by the tearing of was caused hair, but the skin findings often subtle (eg. as are a small be ule, petechiae on the face and / or neck). Fractures that often occur in a physical abuse are: rib fractures, vertebral fractures, fractures of the long bones and fingers from non-ambulatory children and metaphyseal fractures. In children aging for <1 year 75% of the fractures are externally induced. Confusion and localized neurological disorders may occur in CNS injuries. The absence of visible lesions on the head can not rule out traumatic brain injury, particularly in infants not have been shaken violently. These children may become unconscious or stuporous as a result of brain injury, although they lack any outward signs of injury (with the exception of retinal hemorrhage), or they can present with non-specific signs such as restlessness and vomiting. Traumatic injuries to organs in the chest, abdomen or pelvis may also be present with no visible signs. Children who are often abused, are timid, irritable and sleep poorly. You may have symptoms of depression (Depression in Children and Adolescents), post-traumatic stress reactions (acute and post-traumatic stress disorder (ASD and PTSD) in children and adolescents) or anxiety (overview of anxiety disorders in children and adolescents). Violent or suicidal behavior may occur. Tips and Risks The absence of visible lesions on the head can not rule out traumatic brain injury. Sexual abuse in most cases do not speak the children spontaneously about sexual abuse and rarely show behavioral or physical signs of sexual abuse. If sexual abuse is revealed, this generally happens too late, sometimes days to years later. In some cases it may lead to sudden or extreme changes in behavior. Aggressiveness, withdrawal such as phobias and insomnia also may develop. Some sexually abused children react sexually in an age-appropriate way. Physical signs of sexual abuse, the penetration includes may include difficulty walking or sitting bruising or cracks around the genitals, anus or mouth vaginal discharge, vaginal bleeding or itching Other manifestations have a sexually transmitted infection and pregnancy. Within a few days after the abuse investigation of the genitalia, anus and mouth may appear normal or healed lesions or subtle changes zeigen.Psychische abuse in early childhood may have a mental abuse blunt the emotional expressiveness and reduce the interest in the environment , Mental abuse often leads to failure to thrive and is often misinterpreted as mental retardation or physical illness. The failure to parental stimulation and interaction resulting in a developmental delay of social and language skills. Emotionally abused children are insecure, fearful, suspicious, superficial interpersonal relationships, passive and of their way to please adults. Children who have been spurned, sometimes develop low self-esteem. Children who have been terrorized and threatened to appear timid and withdrawn. The emotional effects in children are visible when school starts normally when faced with problems in building relationships with teachers and peers. Often, the emotional impact can only be appreciated when the child is placed in a different environment or deviant behavior reduced and replaced with an acceptable behavior. Children who are exploited, may commit crimes and drive Abuse of drugs and Alkohol.Vernachlässigung malnutrition, overwork, poor hygiene and lack of proper clothing and failure to thrive (failure to thrive (GS)) are common signs of an inadequate supply of food, clothing and shelter. Growth arrest and death by starvation or exposure to extreme temperatures or weather may occur. Neglect, including inadequate supervision can lead to preventable illnesses or injuries. Diagnostics High index of suspicion (z. B. with a history that does not coincide with physical findings or atypical injury patterns) Supporting openly asked questions Sometimes imaging and laboratory studies reporting to the authorities for further investigation, the investigation of injuries and food deficits is elsewhere in the MSD Manual treated. As a reason to recognize an abuse can be difficult; but you should always keep in mind it. Due to social prejudices abuse is rare in children pulled consider living in a two-parent household with an average income. While child abuse occurs independently in front of the composition of the family or socioeconomic status. Sometimes direct questions can lead to an answer. Children who have been abused, the events and the cause can describe. However, some children, especially sexually abused, are bound to secrecy were threatened or are so traumatized that they are reluctant to talk about the abuse (sometimes they fight the abuse from even when asked directly). A medical history, including a history of the events should be included in a relaxed environment of the children and their caregivers. ( "Can you tell me what happened," z. B.) Open questions are especially important in these cases because yes / no questions ( "Did daddy do that?" "Did he touch you there?") For small can lead to a false story children very easily. close the investigation if possible observations of the interactions between the child and the caregivers a. The documentation of the history and physical examination should be as clear and accurate as possible, and include, among other things, direct quotations in the history and pictures of the injuries. Often it is unclear after the first evaluation, whether it is at all dealing with abuse. In such cases, the mandatory reporting of abuse vermutlichem allows to the competent authorities and social services, investigations. If these confirm the abuse, followed by appropriate legal and social interventions. Physical abuse Both the history and the clinical examination give indications of possible abuse. to report Parental reluctance or inability as to the injuries a report that does not (with the injury, for example, came bruises on the backs of the legs, the result of a fall: features that are suggesting an abuse of history. should be), or to reconcile with the apparent healing progress (z. B. old injuries are described as if they were only just) happened a report, which is depending on the person they told, or different time a report that does not match the level of development of the child (eg. as injuries attributed to roll down from the bed in an infant who is too young to roll, or a fall from the stairs are attributed if the child still can not even crawl) Inappropriate reaction of parents to the severity of injuries - either overly concerned or indifferent delay in the use of care in case of injury Key indicators of abuse in the investigation are atypical injuries injuries that are with the report do not match childhood injuries, which are caused by a fall typically only at locations on the forehead , located on the chin or around the mouth, on the surfaces of Extremitätenextensoren, and particularly on the elbows, knees, shins and forearms. Bruises on the back, buttocks and the backs of the legs rarely come from a fall. Fractures - except Klavikula-, tibial and radial fractures (Colles fracture) - relatively rarely occur during a fall while playing or stair falls. There are no pathognomonic fracture in abuse. The classic metaphyseal fracture, rib fractures (especially the posterior approach and the first rib), depressed fractures or multiple skull fractures in a small trauma, Skapulafrakturen, Sternalfrakturen and fractures of the spinous processes should awaken in every case of suspected abuse. Physical abuse should be considered when a child who is not running, has a serious injury. Infants with facial injuries should be investigated further. Younger children may appear normal despite a massive brain injury. At each lethargic child one inflicted brain injury should be considered as differential diagnosis into consideration. Further information can many injuries in different Abheilungsstadien be skin lesions, show the characteristics that indicate a particular type of injury (Physical abuse), and repeated violations that may indicate abuse or inadequate supervision. A pupil dilation control and neuroimaging are to have been for all children <1 year old and are suspected abused recommended. Retinal hemorrhages are seen in 85-90% of shaken babies and very often with a random head injury with an incidence of <10% of cases. They may have been caused by the birth and persist for 4 weeks. If retinal hemorrhages are the result of an accident trauma, the mechanism is usually clear and life-threatening (eg. As worse car accident), and the bleeding are usually few in number and limited to the rear Poland. In children under 36 months (previous recommendation: 24 months) in which the suspected physical abuse is, the entire skeleton should be X-rayed to detect prior fractures (fractures in various Abheilungsstadien or subperiosteal withdrawals of long bones). Similar studies are carried out in children aged between 3 and 5 years, but not in children> 5 years useful. The standard survey contains images of appendicular skeleton: upper arm bone, forearms, hands, thighs, legs and feet axial skeleton: thorax (including oblique views), pelvis, lumbosacral spine, cervical spine and skull Physical diseases causing multiple fractures are a Osteogenesis imperfecta (osteogenesis imperfecta) and congenital syphilis (congenital syphilis) .Sexueller abuse Sexually transmitted infections in a child <12 years of age should trigger a serious suspicion of the possibility of sexual abuse among doctors. Was a child molester, at the beginning, a change in behavior the only indication (e. As irritability, anxiety, insomnia). If a suspected sexual abuse, perioral and anal areas and the external genitalia should be examined for injuries. If it is suspected that sexual abuse has occurred recently (? 96 hours) should be collected forensic evidence by using the appropriate equipment and the procedure is in accordance with the necessary legal standards (medical examination after rape: Tests and gathering of evidence). A test in which a camera with a magnification can be used as a specially equipped colposcope can be used for the evaluator as well as a forensic medical documentation helpful sein.Seelische abuse and neglect The investigation focuses on the overall appearance and behavior to to decide whether the child is able to develop normally. Teachers or social workers notice a neglect the first. The doctor can carefully a number of missed appointments and preventive an incomplete vaccination status. A medical neglect of life-threatening, chronic diseases such as asthma or diabetes can consequently lead to increased exploration for emergency rooms, sometimes in poor compliance with the recommended treatment schedule. Treatment Treatment of injuries a safety plan family counseling and support are worried Sometimes a separation from home First need for the treatment of urgent medical problems (including possible sexually transmitted infections) and the immediate safety of the child. A referral to a pediatrician who specializes in child abuse should be considered. In both situations, abuse or neglect, is recommended over rather a helpful than a punitive approach to the families concerned. Immediate safety doctors or other professionals (eg. As nurses, teachers, cribs supervisors, police officers) have to deal with children, arranged rapporteur who are required by law, any suspicion of abuse, mistreatment or neglect must be reported (see US Dept of Health and Human Services, mandated reporting). Each state has its own laws. The population is encouraged, but not compelled to report any suspected abuse. Any person who shall report on an abuse of a reasonable cause or good faith, are protected in the United States prior criminal or civil prosecution. Someone who is committed to such a message and fails it can be displayed. The ads should be addressed to the competent authorities. In most cases, it is advisable for the professionals to educate caregivers about that complaint was filed and that she probably contacted, interviewed and visited at home. In some cases, the actors may decide that it itself is too dangerous for the child and / or to inform the parents or caregivers before the arrival of the police or the relevant relief organizations. Under these circumstances, parents and caregivers will be notified later. Representatives of youth services and social workers can help the doctor to assess the likelihood of further injury and to arrange the best possible placement of the child. Options include hospitalization as a protective measure placements with relatives or in shelters (sometimes a whole family of an abusive partner brought out of the house) Temporary foster families send home, but with a time-based mental health and medical follow-up appointment, the doctor plays in working with public authorities an important role to ensure the best and safest accommodation for the child. Healthcare professionals in the US are often asked, about a child, in which it is suspected that it has become a victim of abuse, to leave a "Impact Letter", which is addressed generally to a representative of Child Protective Services (which can then refer the case to the legal system). The letter should include a clear explanation of the history and physical examination findings (in legal terminology) and a judgment as to the likelihood that the child has been abused, enthalten.Nachsorge A primary medical care is important. However, the families of abused or neglected children move frequently to thereby complicating the continuation of treatment. Frequently scheduled meetings to be canceled. Missed deadlines are common; possibly home visits by a social worker and / or sister may be helpful. A child protection center on site can be applied to a child-friendly and effective way help to bring together a team mutidisziplinären community facilities, doctors and legal system. A review of the family situation, the earlier contacts with various community agencies and the needs of caregivers are important. A social worker can perform these checks and help by interviewing and counseling of parents. Social workers can also support them in a public assistance, child care and recreational services (which can reduce the stress of caregivers) to obtain the caregivers actively. You can also help to coordinate mental health services for caregivers. Periodisch wiederkehrende oder kontinuierliche Betreuung durch den Sozialdienst ist erforderlich. In einigen Gemeinden gibt es Hilfsprogramme für Eltern, in deren Rahmen ausgebildete, nichtprofessionelle Helfer misshandelnde und vernachlässigende Eltern unterstützen und ein Beispiel für angemessenes Elternverhalten geben können. Andere Formen von Elternunterstützung waren ebenfalls erfolgreich. Sexuelle Belästigungen können vor allem bei älteren Kindern und Jugendlichen eine dauerhafte Auswirkung auf die Entwicklung und sexuelle Anpassung des Kindes haben. Beratung und Psychotherapie für das betroffene Kind und den Erwachsenen kann diese Auswirkungen vermindern. Körperliche Misshandlung, insbesondere signifikantes Kopftrauma, kann auch langfristige Auswirkungen auf die Entwicklung haben. Wenn Ärzte oder Pflegepersonal besorgt sind, dass die Kinder eine Behinderung oder verzögerte Entwicklung haben, können sie eine Bewertung vom Early Intervention System ihres Bundesstaates einfordern (s. National Dissemination Center for Children with Disabilities), das ein Programm zur Bewertung und Behandlung von Kindern mit Verdacht auf Behinderungen oder Entwicklungsverzögerungen darstellt.Trennung von zu Hause Obwohl eine notfallmäßige zeitweilige Trennung von zu Hause, bis die Untersuchungen abgeschlossen sind und die Sicherheit des Kindes gewährleistet