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It is customary, but I think it is a mistake, to speak of happy childhood. Children, however, are often overanxious and acutely sensitive. Man ought to be man and master of his fate; but children are at the mercy of those around them.
SIR JOHN LUBBOCK, BARON AVEBURY (1834–1913)
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Public and medical awareness of child abuse has markedly increased in recent decades, and the possibility of child abuse and neglect has to be kept in mind by the family doctor. It may surface in families from all walks of life and where a good trustful relationship exists between parents or children and doctor.
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While reporting rates continue to increase (at 34 per 1000 Australian children in 20121), the true incidence of child abuse is much greater and also difficult to assess.
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The various types of abuse1 (and their estimated incidence2) are shown in FIGURE 95.1.
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FACTS ON CHILD ABUSE1,4,5
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The younger the child the greater the risk.
The more disabled the more vulnerable.
Indigenous children are 8 times more likely to be the subject of substantiated abuse than non-Aboriginal children.
The number of children who are deemed at risk and placed in out-of-home care (OOHC) has increased in recent years, with the rate in 2012 at 7.7 per 1000 Australian children nationally. Roughly half of these are in foster care, and half in relative/kinship care, with a small (5%) proportion in residential (paid workers) care.
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Child abuse and neglect are collectively referred to as child maltreatment. This refers to any non-accidental behaviour by parents or other adults or adolescents that is outside the norms of conduct and entails a substantial risk of causing physical or emotional harm to a child or young person. Such behaviours may be intentional or unintentional, and can be through omission (i.e. neglect) or commission (i.e. abuse).
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Deciding whether behaviour constitutes maltreatment can depend on:
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cultural issues (e.g. corporal punishment)
developmental age of the child
the severity, frequency and duration of the behaviour
the behaviour itself, or the result of the behaviour (a definition issue)
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Physical abuse (non-accidental injury)
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Physical abuse is defined as the non-accidental use of physical force against a child that results in harm to the child. It include behaviours such as hitting, shoving, slapping, shaking, throwing, punching, kicking, biting, burning, strangling and poisoning. Munchausen syndrome by proxy (see below) is considered physical abuse.