The physical abuse of children has a long history (Radbill, 1968; Breiner, 1990). From time immemorial new-borns, infants and children have been beaten, mutilated, sold into slavery and killed, primarily by their parents. Historians of child abuse assess previous cultures by how they cared for their children, the respective roles, responsibilities and rights within families, and the available laws against the killing or abuse of children. Within cultures there were periodic concerns about the plight of children as demonstrated by the enactment of various laws against the killing of children.
In England this was shown by the establishment of the NSPCC in 1884 in response to the appalling scenes of deprivation and cruelty to children seen by liberal minded reformers. Its remit was to protect children from cruelty and neglect and to support vulnerable families. It lobbied Parliament strenuously to pass a law governing the treatment of children and in 1889 the first Act of Parliament for the Prevention of Cruelty to Children was passed, popularly known as the "Children's Charter".
The current procedures for the protection of children from physical abuse stem from the work of Henry Kempe in the U.S.A. in the 1960's, drawing attention to the 'battered child syndrome' (Kempe et al, 1962). In the U.K., the report by Skinner and Castle (1969), on 78 battered children referred to the NSPCC, led to widespread consultation with concerned professionals within local authorities about the problem. The death of Maria Colwell at the hands of her stepfather in 1973 and the subsequent Government Inquiry report crystallised this concern. In 1974 the Department of Health and Social Security issued guidelines to all local authorities on the management of "non-accidental injury to children" in their area (DHSS, 1974). These management guidelines were revised in 1980 (DHSS, 1980) to cover additional forms of abuse to non-accidental injury. Specifically these were physical neglect, non-organic failure to thrive and emotional abuse. Sexual abuse was not included at this time, due to definitional problems, but was included in the 1988 circular (DHSS, 1988).
In order to provide any measure of extent it is necessary to first offer a definition of what is meant by physical abuse. This briefing will look at three methods used in the United Kingdom, including the definitions they use, and one further from the U.S.A.
The first definition is that used for placing a child's name in the physical abuse category on a Child Protection Register in England (DoH, 2001):
"Physical abuse may involve hitting, shaking, throwing, poisoning, burning or scalding, drowning, suffocating, or otherwise causing physical harm to a child. Physical harm may also be caused when a parent or carer feigns the symptoms of, or deliberately causes, ill health to a child whom they are looking after. This situation is commonly known as factitious illness by proxy or Munchausen syndrome by proxy." (p.41)
Using this definition some 8000 children's names were registered in the physical abuse category in England during the year ended 31 March 2001, a recorded incidence of 7 per 10,000 children, or 0.07%.
Children placed on registers are those who have come to the attention of concerned professionals. The U.S. national incidence study (NIS-3) (U.S. Dept. of Health and Human Services, 1996) also looked at all cases reported to Child Protection Services, as well as those reported by a variety of professionals in other agencies, who served as 'sentinels'.
The definition of physical abuse they used was:
"Physical abuse includes hitting with a hand, stick, strap, or other object; punching; kicking; shaking; throwing; burning; stabbing; or choking a child, where the child has suffered demonstrable harm as a result of the maltreatment" (p.2-9 - 2-10).
They reported a national incidence of physical abuse of 5.7 per 1,000 children in 1993, or 0.57%.
Both these studies involved reports from professionals. The other two studies in this section involve reports from the victims themselves or their perpetrators. The first was a national survey of the childhood experiences of some 2869 young adults aged between 18 and 24 in the UK (Cawson et al., 2000). The young adults were defined as having suffered serious physical abuse if they had experienced:
Some 7% of the young adults had experienced this serious physical abuse during their childhood. A further 14% had experienced intermediate physical abuse, where the treatment and physical effects were not so regular as for the serious category. These percentages represent a lifetime prevalence rather than annual incidence as in the two previous studies.
The final study (Ghate et al) provided both an incidence and prevalence rate for parental behaviours to their 0 - 12 year old children that were assessed as physically abusive. These included "hitting with an implement, punching, kicking, beating up orburned or scalded on purpose". Some 6% of parents in Britain had used physically abusive methods with their child in the last year and 11% during the child's lifetime.
Boys, young and premature children are over-represented among children registered for physical abuse in England (Creighton, 1992). The rate of physical injury to registered children is highest among the under one year olds (DoH, 2001) and boys. Studies of hospitalised young children have shown that children injured by physical abuse were significantly younger than those who had been injured unintentionally (DiScala et al, 2000). For those hospitalised children who had sustained head injuries, subdural haematoma's, subarachnoid and retinal haemorrhages were significantly more common among the abused group (Reece and Sege, 2000). Boys were over-represented in both groups of injured children.
Among older, teenage children registered for physical abuse, there were more girls than boys (DoH, 2000). Young women were also more likely to have experienced serious physical abuse in their childhood than young men (Cawson et al, 2000), though young men had experienced more intermediate physical abuse. The majority of physically abused children who come to the notice of child protection services are moderately, rather than severely injured (Creighton, 1992).
The parents of the physically abused registered children were distinguished from parents nationally by their youth, low socio-economic status, high unemployment and high criminality (Creighton, 1992). Marital problems were thought to be the most significant stress factor which may have led to the abuse, as evidenced by the atypical parental situation of the physically abused children. Just over a third of those registered as having been physically abused were living with both their natural parents at the time of the abuse, whilst a quarter were living with their natural mother and a father substitute (Creighton, 1992). The families of the physically abused children were distinguished from families of similar social class by their large size, early parenthood, high mobility and low income (Cappelleri et al, 1993; Creighton, 1992). Gillham (1996) has argued that all these distinguishing features are highly correlated with poverty and other forms of social disadvantage. Whilst poverty is not a sufficient explanation of physical abuse (most poor people do not abuse their children) it is likely to be a contributor in many cases.
Natural mothers and fathers were equally implicated as the suspected perpetrator of the physical abuse. This makes no allowance for the fact that many fewer physically abused children were living with their natural father than with their natural mother. When the position is adjusted for who the child was living with at the time, natural fathers, stepfathers and father substitutes were twice as likely to be implicated in the abuse as natural mothers (Creighton, 1992).
Follow -up studies of physically abused children have shown poorer physical and intellectual development, more difficult and aggressive behaviour, poorer relations with peers and more arrests for juvenile and adult crimes, particularly violent ones than their non-abused peers (see Gibbons et al, 1995 for summary of studies; Fergusson and Lynskey, 1997). Dodge et al (1990) have suggested that abused children are more likely to acquire deviant patterns of processing social information (e.g. ascribing hostile intent, evaluating aggressive acts positively etc.) through their abusive experiences. It is this deviant mode of social interaction which leads to the poorer outcomes described rather than the abuse itself. Other researchers (De Bellis & Putnam, 1994) have suggested that the abuse creates changes in the neuroendocrine systems that influence arousal, pain thresholds, learning and growth.
A history of abuse has been thought to be a major risk factor for becoming an abusive parent in turn (Egeland, 1993). Early studies of abusive parents (Spinetta & Rigler, 1972) found a high proportion of them had been abused themselves. More recent research (Kaufman & Zigler, 1993; Tomison, 1996; Zuravin et al, 1996) has argued that the rate of intergenerational transmission of abuse is overstated. Using prospective studies of abused children, rather than retrospective studies of abusing parents, Kauffman and Zigler (1993) suggested that the best estimate for the rate of intergenerational transmission of abuse was approximately 30%.
The treatment of physical abuse can be divided into primary and secondary prevention. Primary prevention stops the abuse occurring in the first place and secondary prevention is aimed at stopping any re-abuse after the original physical abuse is identified.
Primary prevention operates at either a general or specific level. General public education programmes are aimed at discouraging parental behaviours that might lead to abuse, such as corporal punishment, and providing alternative positive parenting practices. They are also aimed at alerting the general public to the possibility of abuse and giving guidance on whom to turn to. Specific primary prevention is aimed at individuals or families thought to be at high risk of physical or other abuse. Evidence from the follow-up studies of high risk individuals who did not go on to abuse their children (Egeland et al, 1988) has shown a number of protective factors. These included an emotionally supportive adult when they were a child, a stable satisfying marital relationship when an adult, and involvement in psychotherapy when an adolescent or young adult.
Secondary prevention involves the treatment of abusive parents, and, to a lesser extent, the treatment of abused children. Gough (1993) reviewed the various interventions being used. Behavioural approaches to physical abuse, some special projects and multi-component interventions were found to have beneficial effects. Gibbons et al (1995), in their follow-up study of physically abused children, found that psychiatric treatment of a parent, prolonged support or therapeutic attendance at a family centre were associated with better outcomes.
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Cawson, P., Wattam, C., Brooker, S., and Kelly, G. (2000) Child maltreatment in the United Kingdom: a study of the prevalence of child abuse and neglect. London: NSPCC.
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This research briefing is based on a review of research and literature. It reports the findings and views of a range of authors. These views are not necessarily the views of the NSPCC.
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