According to the Iowa Department of Human Services, child abuse is defined as a child suffering one or more of the following categories:
- Physical abuse
- Mental injury
- Sexual abuse
- Denial of critical care
- Child prostitution
- Presence of illegal drugs
- Manufacturing or possession of a dangerous substance
Resmiye Oral, M.D., University of Iowa Children's Hospital pediatrician and clinical director of the Child Protection Program, said that neglect is the most common form of child abuse, both in Iowa and the United States. (70 percent of all confirmed cases in Iowa). Physical abuse, drug exposure, sexual abuse, and emotional abuse follow in decreasing order of frequency.
In Iowa Oral said there is an increase in child abuse associated with the increase of meth labs.
"The categories of abuse directly related to illicit drugs make up more than 10 percent of all confirmed cases last year. Additionally, two-thirds of neglect cases have underlying parental drug use in the background. Based on these factors within the last two years confirmed cases of abuse have increased by more than 20 percent," she said.
Oral said it varies on who is more likely to abuse a child depending on the type of maltreatment.
"For sexual abuse, shaken baby syndrome and other deadly forms of physical abuse, the overwhelming majority of perpetrators (70 to 90 percent) are males. In other forms of physical abuse and neglect, females are as responsible for the abuse as well as males." She said that in Munchausen Syndrome by Proxy, in which a parent uses a child as a sick subject to constantly request medical care for secondary gains, 95 percent of the time the perpetrator is a female.
"If parents feel like they are at the end of the rope with their children, I urge them to take a ride or a walk with your child," said Oral. "If that doesn't calm the child down, place her in a safe environment, leave the room, take deep breaths, count to 10, call someone you trust, either invite that person to come over and attend to your child for a while until you calm down, or at least vent your frustration.
"If you are under chronic stress and taking care of your child is becoming increasingly risky for abuse, call your local Department of Human Services office and ask for help! We always prefer providing help before abuse occurs rather than after."
The signs of child abuse vary according to the type of maltreatment, Oral says. "In neglect, the child may have frequent injuries, failure to thrive, hunger, stereotypical body movements due to inattention, and abandonment.
"Physically abused children may have unexplained fractures, bruises, burns, skin tears, brain and internal organ injuries.
"Sexually abused children may have genital injuries in acute assault situations, and may also have sleep disorders, unexplained fear of people and places, abdominal pain, depression, substance abuse, truancy, or delinquency," Oral says.
When a child is taken out of an abusive situation, the new caregivers should be aware of the consequences of the specific maltreatment the child has gone through and should be trained on how to manage these problems, Oral says.
"The child should be given play therapy, individual therapy and family therapy according to age and chronicity of the abuse. The non-offending parent should obtain counseling and family therapy as well to be able to support the child.
"In drug exposure situations, the parents should go through drug rehab programs, and children should be referred for both mental health and developmental assessment," she says.
Medicine gets involved with abused children in two stages Oral says. The first involvement is during the diagnostic phase.
"The better job physicians do during this phase the better the assessment and intervention program to follow. If physicians do not do a good job, a missed diagnosis may cause the child further abuse and/or death in the future, which is not uncommon.
"The second phase involves the treatment. Medical and mental health professionals provide cures for physical, emotional, behavioral, and developmental problems that arise from abuse and neglect," Oral says.
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