Child Abuse: The Unspoken Truth, By Dr. C. Farquharson-Deveaux,MD

Dr. Farquharson is a Family Medicine Specialist at Holistic Family Medicine Center, Tonique Williams-Darling Hwy (West) , Nassau, N.P. Bahamas. P.O. Box S.P. 60568, Tel: 242-326-1665/6. Office Hours 9a.m. to 5p.m. (Registration is FREE to access this document - published in The Eleutheran in Your Health on Page 6)

April is recognized as National Child Abuse Prevention Month by the Centre for Disease Control in the United States and was started as a way of increasing public awareness of the need to ensure the safety and welfare of children.  Child abuse or maltreatment is recognized worldwide as a significant health issue and it is alarming the rate at which children continue to be abused and neglected.  Here in the Bahamas the prevalence of this crime is significant but even though child protection legislation has been canvassed it will take time to see how effective enforcing them will improve statistics. 

Child maltreatment refers to "the physical and emotional mistreatment, sexual abuse, neglect and negligent treatment of children, as well as to their commercial or other exploitation."  It can occur in any setting or environment and the perpetrators may be parents or other family members, caregivers, friends, acquaintances, strangers, authoritative figures like school teachers and pastors, employers, healthcare workers and even other children.  The World
Health Organization (WHO) recognizes four types:

1. Physical Abuse is the intentional use of physical force against a child resulting in harm for the child's health, survival, development or dignity.  It includes hitting, beating, kicking, shaking, biting, strangling, scalding, burning, poisoning and suffocating.  Much of this physical violence occurs within the home and is done with the object of punishing.

2. Sexual abuse is the involvement of a child in sexual activity that he or she does not fully understand, is unable to give informed consent to, or for which the child is not developmentally prepared.  This can be carried out by both adults and other children who are in a position of responsibility, trust or power over the victim.

3. Emotional and psychological abuse involves a pattern of failure over time on part of the parent or caregiver to provide a developmentally appropriate and supportive environment which is likely to damage the child's physical or mental health, or its physical, mental, spiritual, moral or social development.  It includes belittling, blaming, threatening, frightening, discriminating against or ridiculing; and other non-physical forms of rejection or hostile treatment.
4. Neglect includes both isolated incidents, as well as a pattern of failure over time on the part of a parent or other family member to provide for the development and well-being of the child - where the parent is in a position to do so - in one or more of health, education, emotional development, nutrition, shelter and safe living conditions.  The parents of neglected children are not necessarily poor.

Children are not to blame for the harm others inflict on them, however, there are certain factors when present that can increase the chances of a child being abused.  Children under 4 years (infants and preschoolers) are at the greatest risk for severe injury or death; the most common forms being head trauma, abdominal injuries, intentional suffocation, being beaten, kicked or tied up by parents.  This is due primarily to their dependence, vulnerability and relative social invisibility.  Generally, 1 out of every 5 girls is likely to be a victim of sexual abuse and boys are more likely to suffer harsh physical punishment.  Other factors which predispose a child to abuse include being an unwanted child or not meeting the parent(s) expectations, having a physical or mental disability, being premature or having a chronic illness, being an 'inconsolable' child, or being in a setting where dangerous criminal behaviour exists including intimate partner violence.

When we consider the persons who are committing abuse, worldwide statistics suggest that parents and other family members are responsible for the majority of deaths and injury suffered by children, particularly in the 0-4 year age group.  Females tend to commit the greatest proportion (58%) of all forms of child abuse, and most often are young mothers.  The male perpetrators (42%), most often fathers, are also often young.  Other factors that predispose a person to become a child abuser include failure to bond with or be nurturing to the newborn, having unrealistic expectations that make it difficult to understand the child's needs, using alcohol or drugs, lack of education, being socially isolated, being abused as a child, having financial difficulties, being involved in criminal activity and lacking self-control when angry or upset.  Family and community factors also help to contribute to the risk of abuse within any society.  These include family breakdown like marital or intimate partner relationship problems, violence between family members, lack of extended family help with raising children, lack of social support and resources to assist with stressful or difficult situations, tolerance of violence within the community, high levels of unemployment, lack of adequate housing with transient communities and presence of a local drug trade.  Based on the above information, the Bahamas certainly falls within a range of being a high risk community.

The consequence of child maltreatment goes beyond just death or physical injury and includes major harm to the mental health and development of the victims.  Physical abuse in early age group can cause stress that can interfere with brain development and affect the nervous and immune systems resulting in learning and behavioral issues.  Also children who are abused or neglected have a higher chance of becoming involved in criminal behaviour, teen pregnancy, delinquency, have low academic achievement, drug use, mental health problems including depression, panic disorder, anxiety and eating disorders, smoking, alcohol and illicit drug use, especially marijuana.  This in turn can lead to some of the principal causes of death, disease and disability in adulthood such as obesity, heart disease, sexually transmitted diseases, cancer and suicide.  Finally a history of early child maltreatment makes it difficult for both men and women to establish and maintain healthy intimate partner relationships in adulthood and the vicious cycle is perpetuated.
So what can be done to detect and 'treat' child abuse and neglect?  The ultimate goal should really be to stop it before it starts.  However, the solutions are complex and difficult because violence against children in the home is one of the most difficult to detect as much of it takes place in the privacy of the home and is done by parents and caregivers, who are also the source of nurture for the child.  However, intervention contributes to prevention of a much broader range of non-communicable diseases and should definitely be implemented.  Essentially, addressing the underlying risk factors and cultivating protective factors will significantly decrease the occurrence of any kind of abuse or neglect.  It is also essential that this intervention include not just the child and perpetrator, but also the community and society as a whole for it to be effective.  These include reducing unintended pregnancies, assisting high-risk adolescents to complete schooling, reducing alcohol and illicit drug use during pregnancy and availability within the community, improving access to high quality pre- and post-natal care, providing social service resources to families where children are at high-risk for maltreatment,  providing parents with child development and problem-solving skills, having a supportive family environment and stable family relationships and providing adequate housing and employment. 

Children are the future of any nation; however, their innocence and dependability unfortunately make them easy targets.  As individual members of a greater society it is incumbent upon each of us to protect these children.  If you know you are guilty of committing any form of abuse then decide within yourself to make a change.  If you are aware of any child being abused, the law requires that this is reported to the relevant authorities.  In the Bahamas, we tend to ignore a lot of social ills going on before our eyes   as an accepted norm or with the attitude that it is someone else's problem.  However, realizing the far reaching consequences on the society as a whole should help you to see that it is everyone's problem.  Please do not knowingly allow another child to suffer at the hand of an abuser.  Take the initiative to be a part of the solution and give this country a brighter future.