cate and developing brain. These infants suffer signif-
icant neurological damage and often die as a result of
the brain injury and swelling.
The toddler and preschool years provide new
challenges as children are growing and developing
new physical skills. These physical skills enable chil-
dren to run, climb, and openly explore in areas they
previously could not, so caregiver supervision be-
comes increasingly important. A neglectful caregiver
will not make the environment safe or provide appro-
priate boundaries. Verbal skills increase and children
vocalize their emerging independence. A parent un-
prepared for the typical use of the word ‘‘no’’ may in-
terpret this as defiant behavior and resort to harsh
physical punishment that becomes abusive, not recog-
nizing the appropriateness of the child’s behavior
for this developmental stage. Toilet training during
these years is one of the more common parental stres-
sors and precipitant of abuse.
School-age children and adolescents have a lower
overall risk of maltreatment. They spend less time in
the presence of caregivers because of school, after-
school activities, and peer interactions. They are also
less dependent as their physical and cognitive devel-
opment allows them to do many things for them-
selves. Physically they are larger in size, stature, and
strength, and it takes more force to cause injury. Sex-
ual abuse, however, is more prevalent among school-
age children and teens, particularly girls. The reason
for this increase is related in part to the physical de-
velopmental changes that occur in both boys and girls
as they enter puberty.
Treatment and System Responses
When it is determined that a child has been
abused or neglected, the system will intervene. The
primary state agency responsible for children is social
services, but children are first identified in any num-
ber of ways: by neighbors, relatives, day-care staff,
teachers, or medical professionals. Medical profes-
sionals and day-care staff often identify young chil-
dren, because the doctor’s office and the day-care
center are common places for children to be seen on
a regular basis. School personnel frequently identify
older children when changes in behavior, attendance,
or school performance are noticed. Suspicions of
abuse or neglect are then referred to the appropriate
social services agency for a more thorough investiga-
tion.
One of the first concerns for social services is the
safety of the child. The agency’s primary purpose is
to ensure that no further harm comes to the child. If
the perpetrator of maltreatment (the person sus-
pected of abusing or neglecting the child) is to contin-
ue to have access to the child, this can be handled in
In August 1954 eleven-year-old Joe Roach was found chained to
his bed in his home in Houston, Texas. Rather than going into the
house to sleep and be mistreated by his parents the night before, the
boy spent the night in a doghouse in the backyard of his home.
(Bettmann/Corbis)several ways. What happens next will depend on the
type and severity of abuse or neglect and the man-
dates of the state. The perpetrator will often contract
with social services and agree not to maltreat the
child. The person can agree to leave the home tempo-
rarily. The child can also be removed from the unsafe
environment and placed in the care of a relative or
foster family.Many times children will require a medical evalu-
ation to determine what harm has been done, docu-
ment the extent of harm, and treat any new or
existing medical conditions. The needs of the whole
child should be addressed during a medical evalua-
tion, although emergent needs are prioritized. In the
case of shaken baby syndrome, for example, the ma-
jority of these children are brought in on an emergen-
cy basis when they stop breathing at home. Obviously
these children require intensive care even before the
determination of abuse is made. For other children,
the medical evaluation may entail treating a broken
bone, tending to lacerations, evaluating bruises, or
examining for sexually transmitted diseases. It canCHILD ABUSE 79