Did you know? An abused child will suffer the consequences all his life. The prevalence of child abuse and neglect is a worldwide problem, and its physical and psychosocial effects are felt by abused children, their families, and their communities. It has been associated with changes in the mental and behavioral development of victims throughout their lives, putting them at risk for potentially dangerous behaviors later on.

Child abuse refers to abuse and neglect of anyone under 18 years of age. It includes all forms of physical and/or emotional abuse, sexual abuse, neglect or negligent treatment, or commercial or other exploitation that results in actual or potential harm to the health of the child, survival, development, or dignity in the context of a relationship of responsibility, trust or power. Sometimes, it is also considered a form of abuse to expose the child to the spectacle of violence between intimate partners.

The Prevalence of Child Abuse and Neglect

Child abuse is a universal problem with serious consequences for life for those who are victims. Despite the existence of several studies in low- and middle-income countries, data is still lacking for many countries.

It is estimated that every year 34,000 children under the age of 15 are victims of homicide. This figure does not capture the true magnitude of the problem as a significant proportion of deaths due to abuse are mistakenly attributed to falls, burns, drowning, or other causes.

In situations of armed conflict and in contexts where there are refugees, girls and girls are particularly vulnerable to sexual violence, exploitation, and abuse by soldiers, security forces, their communities, humanitarian staff, and other categories of people.

I – Five Types of Child Abuse

– Physical Violence

It refers to any deliberate use of physical force against a child that poses a threat to the health, development, and/or self-respect of the child. The range of physical violence ranges from milder forms of violence (eg, pushing and shoving) to more severe forms (eg, strangling and hitting).

– Sexual Abuse of Children

This refers to any sexual act committed against a child by a person who is responsible for it. The act can only be attempted or completed and there may or may not be contacted during the interaction.

– Neglect

It occurs when the responsible adult child does not meet their primary needs, be they physical, emotional, medical/dental or educational. Neglect is also involved when the child does not have access to adequate nutrition, hygiene, and housing, or if his or her safety is not ensured.

– Psychological Violence

It refers to actions that cause or have the potential to cause adverse effects on the emotional health and development of the child. The behavior of the responsible adult can take various forms: rejecting the child, isolating, ignoring, terrorizing, corrupting or exploiting him.

Domestic violence (also called domestic violence)

It is also considered a form of abuse because the children who are exposed to it present problems similar to those who are direct victims of physical violence.

II – Consequences of Child Abuse

The prevalence of child abuse needs to be taken seriously because abuse causes suffering for children and their families and can have long-term consequences. It causes stress that is associated with the disruption of early brain development. Extreme stress can affect the development of the nervous and immune systems. As a result, abused children who have become adults are more exposed to various behavioral, physical, or psychological disorders, such as:

– the propensity to commit or to suffer violence;

– depression;

– smoking;

– obesity;

– risky sexual behavior;

– unwanted pregnancy;

– alcoholism and drug addiction.

Through these behavioral and psychological consequences, abuse can promote heart disease, cancer, suicide, and sexually transmitted infections.

Beyond its impact on health and society, child maltreatment has an economic cost, including hospitalization, mental health treatment, child protection, and longer-term health care costs.

III – Risk Factors

Several risk factors for child abuse have been identified, although the prevalence of child abuse and neglect are the risk factors per se. They are not present in all social and cultural contexts but they can give a general light when one tries to understand the causes of the phenomenon.

*** Factors Affecting the Child

Children are the victims of abuse and they are never to blame for the abuse they are subjected to. Several factors can predispose the child to be abused:

– he is less than 4 years old, or is a teenager;

– is an unwanted child or who does not meet the expectations of his parents;

– He has special needs or is having persistent crying or a physical abnormality.

*** Factors Related to Parent or Caregiver

Several factors in the child’s parent or caretaker may increase the risk of abuse:

– the difficulty of establishing a relationship with a newborn;

– lack of attention for the child;

– having yourself been abused in childhood;

– lack of knowledge about child development or unrealistic expectations;

– the abuse of alcohol or drugs, including during pregnancy;

– involvement in criminal activities;

– experiencing financial difficulties.

*** Relational Factors

A number of factors related to relationships within families, or between intimate partners, friends and peers may increase the risk of child abuse:

– physical or psychological problems or developmental problems in a family member;

– the break-up of the family unit or violence between other family members;

– isolation from the community or lack of a support network;

– a loss of support from the extended family for the education of the child.

*** Community and Societal Factors

Among the characteristics of the community or social environment associated with increased risk of child abuse include:

– sexual or social inequalities;

– lack of adequate housing or support services for families and institutions;

– high unemployment rates or poverty;

– ease of access to alcohol and drugs;

– inappropriate policies and programs to prevent child abuse, child pornography, prostitution, and child labor;

– social and cultural norms that encourage or glorify violence against others, including the use of corporal punishment, require absolute respect for the gendered social roles or undermine the child’s status in parent-child relationships;

– social, economic, health and education policies leading to low standards of living, or socio-economic inequalities or precariousness.

IV – The Effects of Child Abuse and Neglect on Attachment and Brain Development

The development of resilience and a healthy personality is based primarily on establishing a strong and secure bond of attachment with a person who primarily provides care.

The child experiences the world as a safe place to explore and develop self-reliance. He finds comfort and support from his caregiver when he experiences stress. When children are abused, they may experience disturbed forms of attachment and abnormal emotional responses to their caregivers.

Poor interactions between caregiver and infant compromise the formation of circuits and neural pathways. Children are more likely to have learning and behavioral problems when living with parents with mental health or addiction issues.

Maternal depression is a key determinant in a child’s initial deficient development.

Witnessing scenes of verbal or physical abuse and arguments has direct deleterious effects that have lasting consequences. Similarly, children who are victims of abuse or parental neglect are more likely to have negative outcomes that extend into their adult lives, including ongoing problems with emotional regulation, self-image, social skills, and emotional deprivation. motivation in studies, as well as serious learning and adjustment problems, including academic failure, severe depression, aggressive behavior, peer difficulties, alcoholism, substance abuse, and delinquency.

*** As in the War

A study, published by British researchers in the journal Current Biology, in 2011, concludes that domestic violence would have effects similar to war. According to the researchers, abused children had brain activities similar to those of soldiers who were exposed to combat situations.

It is true that when there is domestic violence, the house is compared to a battlefield. Growing up in an atmosphere where anger, cries, and blows are part of everyday life, has a big impact on the mental and emotional health of the little ones.

To reach this conclusion, the researchers studied brain images made to children to evaluate the impact of violence on their emotional development. They found that domestic abuse was linked to an increase in activity in two areas of the brain that “lit up” after seeing pictures of expressions of rage on their faces.

The results were compared to other studies in which soldiers in combat experienced brain activity in the same areas, which experts say indicate how they should respond to a possible threat.

These results could be explained by the fact that the two target groups would have the ability to adapt to become “hyper-conscious” of their environment. This is positive since the brain is prepared for dangerous situations.

However, this ability to respond to danger may hide a neuro-biological risk factor that increases children’s susceptibility to mental illness, such as depression and anxiety disturbance.

*** Abuse Affects the Child’s Brain and Depresses the Teenager

The study conducted by researchers at the University of Texas and published in the journal Neuropsychopharmacology, in August 2012, compared the brains of abused adolescents in their childhood with those of non-abused adolescents and followed subjects before a diagnosis of the mental illness.

Child abuse affects the white matter of the brain, causing a certain susceptibility, later in life, to certain mental disorders, such as depression or drug use.

Previous studies have already shown that child abuse leads to behavioral, cognitive, and social disorders, but the underlying mechanisms that lead to these disorders have never been fully elucidated.

Animal studies have also shown that exposure to stress during brain development can lead to changes in brain structure due to disrupted hormone levels.

The researchers examined the white matter bundles in the brains of 19 adolescents with no personal history of psychiatric disorders mistreated during childhood, and 13 adolescent controls, who also had no history of psychiatric disorders, using diffusion tensor imaging (DTI).

Participants were followed at 6-month intervals for 5 years to monitor the onset of mood disorders and the potential use of drugs.

The associations between fractional anisotropy (FA), a measure of standard signal deviation on MRI, and psychopathology were noted.

Initially, adolescents exposed to child maltreatment had significantly lower AF values in some areas of the brain, such as the hippocampus, compared to control participants, suggesting disturbances of the white matter of the brain.

This same association is also found in adolescents who developed a major depressive disorder or substance abuse during follow-up, suggesting that white matter disturbances observed in adolescents exposed to child abuse may be associated with a vulnerability mental disorders, particularly depression and addiction.

In conclusion, abuse makes it more vulnerable to major depressive disorder and substance abuse and this vulnerability can now be identified even before the development of psychiatric disorders.

This study will help identify children at high risk of developing mental disorders and better understand these mechanisms in order to develop effective prevention interventions.

*** Abuse Affects the Gray Matter of Children

According to a study published in the American Journal of Psychiatry in June 2014, physical or emotional abuse affects various areas of the brain, which develops late.

The authors point out that child abuse acts as a stressor and produces a cascade of physiological and neurobiological changes that result in lasting changes in brain structure. Comparing 3D brain imaging with more than 3,000 mistreated individuals to 360 non-abused individuals, significant differences emerged.

Very diverse areas of the brain are affected by abused children, even in adulthood. The gray matter has abnormalities in several regions with various functions, some of which govern sensory perception, emotions, and dependence. Others, decision-making, language comprehension. In some cases, the anomalies of the gray matter affect the recognition of known faces, the identification of a social context. In one region – the parahippocampal gyrus – an abnormality is associated with an increased risk of schizophrenia.

These abnormalities are found in all people abused during childhood, even those who have not received medication. This means that they are well linked to abuse, not to the drug treatment that can follow. In abused children, the most affected areas are those that develop late.

These results provide a better understanding of affective and cognitive deficits in patients maltreated during childhood and will help reduce environmental risks during childhood and develop treatments that stabilize these morphological changes.

V – Prevention of the Prevalence of Child Abuse and Neglect

Preventing child abuse requires a multisectoral approach. Effective programs are those that support parents and teach them to be good parents.

– Nursing home visits to provide parents with support, advice, and information.

– Parental training programs, generally offered in groups, to improve parents’ educational skills, instill in them a better knowledge of child development and promote positive child behavior management strategies.

– Multi-faceted interventions, usually with support and parenting components, pre-school education, and childcare.

Other Prevention Programs Have Been Quite Promising

Prevention programs for head trauma attributable to abuse, including shaken baby syndrome, shaken infant syndrome, and traumatic brain injury. These are usually hospital-based programs for new parents who will leave the hospital or clinic to inform them of the dangers of the shaken baby syndrome, and to advise them of what to do about a crying baby. we know how to calm him down.

Programs to prevent child sexual abuse. Usually organized in schools, these programs are designed to teach children:

– that they are masters of their bodies;

– what is the difference between appropriate physical contact and inappropriate gestures;

– how to recognize situations of violence;

– how to say “no”;

– how to talk to a trusted adult about the abuse.

Such programs effectively reinforce protective factors against sexual violence. Thanks to them, the child is informed of the existence of sexual abuse and knows how to protect himself from it.

The earlier these interventions take place in the child’s life, the more they will benefit the child himself, regarding cognitive development, behavioral and social skills, academic success. Also for society: a decrease in delinquency and crime.

In addition, early detection of cases associated with the care of child victims and their families over time can help reduce the repetition of ill-treatment and mitigate the consequences.

Common Behavioral Indicators of Abuse

It is usually difficult to identify the signs of child abuse. Family members and family physicians should be alert to children who complain of unusual psychosomatic problems or change their behavior. In such cases, a more in-depth assessment of the child and family may be indicated.

The child could:

– be afraid to return home, hesitate to do so or run away;

– show unusual aggression, rabies, or seizures;

– have a reflex of apprehension when touched;

– poor performance at school and poor attendance;

– to stand back from the family, friends, and activities that he loved before;

– have poor self-esteem (eg describe yourself as being mean, say that you deserve to be punished, be very self-centered);

– Suicidal thoughts or self-destructive behavior (eg, self-injury, suicide attempt, extreme risk-taking).

The child could also:

– have a hyperactive or unusual behavior;

– cling to foreign adults;

– be apathetic and withdrawn into oneself;

– not to react to painful treatments;

– do not appear to flourish;

– show signs of general negligence;

– being afraid of physical contact;

– adopt manipulative behavior to attract attention.

Professionals working with children can help make the reduction of abuse a priority. They should always check for violence when assessing children with injuries or mental health issues. Qualified professionals should also be familiar with the cultural context in which children grow up to ensure that their safety, care, and protection needs are met, regardless of cultural practices.

Interventions for abused children and careless families should also be guided by a common set of standards:

– Identify who and what contributes to the problems;

– To build a therapeutic alliance with the family;

– Set reasonable and concrete goals in collaboration with the family;

– Carefully supervise the situation and modify the plan if necessary;

– Ensure that the needs of children are met;

– Collaborate with the other professionals involved.

Child abuse has serious implications for child development and family health throughout the lifecycle and could be detected in family practice.

Family physicians play an important role in identifying cases of child abuse in their practice by reporting them to youth protection agencies, preventing further harm to identified children and other children’s family and providing constant additional support and education to families.