The Concepts On Child Maltreatment
Child abuse, long neglected by society and medicine, is now a focus of not only the United States, but also has become a major point of interest for the Native Indian Nations. Cases of suspected maltreatment of children are often featured in the news media and argued in the American and Tribal Courts. Some cases raise profound questions about the relative rights of parents, children, Tribal and Government authorities, and those charged with child care such as day care and school workers, and guardians, and those charged with child abuse. Additionally, allegations of sexual abuse by American celebrities have raised questions of privacy for those charged for abuse, and their alleged victims. There has also been an increase of concern given towards fetal abuse among The American economic middle-class. Some of the results and investigations of child abuse has brought into fruition recent legal cases prompting legislative recourses against alcohol and drug abuse during pregnancies. American families have challenged the stereotype that violence in the home occurs only among the poor or disadvantaged. The real facts coming to public attention show that the economic status has afforded the American upper class avenues of public scrutiny escape. While in the Native Indian culture there has been a degree of silence concerning such matters. Such routes of evading publicity and legal prosecution are available to the affluent through the use of private counselors etc.
Physicians and others in the medical community play an important part in identifying possible victims of child abuse. While in the Native Indian community peer confidence and Elders inquiries have been successful to some degree, in some instances. In both cultures, generally medical providers supply what is frequently the only regular contact with people outside the family. This has also been the source for children too young to attend school, and for the estimated 350,000 U.S. teenagers who drop out of secondary school each year. The Indian Health Service Clinics located on most reservations pursues periodic training for their employees in regards to issues of this matter.
Since the 1960s, legislation in the United States and Canada has mandated that virtually any professional (a term that often includes teachers, psychologist, and social workers, as well as physicians and nurses) must make a report to civil authorities if that person suspects that a child has been abused or neglected by a care-taking adult, even if the professional person has not seen the child face to face. In the United States, most child abuse laws specify this requirement for reporting over-rides, or supersedes all professional-client confidentiality privileges. Many of the United States laws prescribe penalties for the failing to report any abuse, while in the same language, grant immunity to those reporting professionals against any charges of violation of professional-client relationships. Providing, the charges or report was made in good faith.
Epidemiological Features and Definitions
The American Medical Association, of which also is recognized and held in esteem by the Native Indian Health Clinics, commonly present the definition of child abuse as child maltreatment. That definition is presented as:
Child maltreatment is intentional harm or threat of harm to a child by someone acting in the role of caretaker. Even if that charge of care is for a short time.
Categories of Child Maltreatment
Maltreatment is commonly divided by the American psychologist into four categories, they being;
Physical abuse:
Physical abuse involves inflicting bodily injury through excessive force or forcing a child to engage in physically harmful activity, such as excessive exercise, or excessive physical labor.
The diagnosis of physical abuse among children relies most heavily on physical evidence. Key findings suggestive of intentional injury include multiple lesions in different stages of healing, lesions in the shape or pattern of an identifiable object, and trauma that seems inconsistent with the explanation given by a parent or caretaker. An alleged history that shifts with re-telling or involves un-witnessed incidents, such as the scalding of the child in a bath while the caretaker "just stepped out to answer the phone' should arouse concern.
The battered child syndrome and its close relative, the shaken baby syndrome, have gained acceptance among professionals and in the courts as signs of diagnostic intentional injury. Generally, these child victims have multiple episodes of trauma including subdural hematomas, fractures, and bruises in various stages of healing, often in combination with failure to grow and chronic malnutrition. In the shaken baby syndrome, the symptoms have commonly been metaphysical long bone fractures and evidence of injury to the cervical spinal cord much like a whiplash type injury. There have been some questions about whether the intracranial injuries found in the shaken baby can occur from shaking alone, or whether some direct, forceful contact with the head is required. Regardless of the precise mechanism, subdural bleeding is an important clue to the occurrence. Subdural bleeding in children is rare and is usually related to congenial malformation of the cerebral vasculature, severe dehydration with the loss of brain volume, or purulent meningitis. Subdural bleeding may occur after serious head trauma but is considered to be an unlikely consequence of a single household fall or a non-penetrating blow to the head. Subdural bleeding with no plausible explanation usually suggest an inflicted injury.
Retinal hemorrhage is another important, but not highly specific, indicator of possible physical maltreatment of young children. Retinal hemorrhage does occur from intentional injury, particularly blows to the chest or abdomen, but it can also result from other causes of increased central venous and intercranial pressure. Other causes to be considered would be compression of the chest and head during delivery, automobile accidents, or cardiopulmonary resuscitation. Therefore, the discovery of a retinal hemorrhage should prompt a diligent search for other signs of intentional injury but is not in and of itself proof that a child has been abused.
Sexual Abuse:
Sexual abuse is defined as the inappropriate exposure of a child to sexual acts or sexually pornographic materials, the passive use of children as sexual stimuli for adults, and actual sexual conduct between children and other people.
It should be noted that children thought to have been sexually abused or assaulted within the past 48 to 72 hours still exhibit forensic evidence. Thus they should be evaluated at a rape crisis center capable of processing such evidence. Other children of this abuse should be screened for medical and emotional problems. Many local law enforcement agencies extend multidisciplinary social services for such events. The inner-agency training seminars and sessions can be attended by a Clan counselor as those sessions are publicly funded. Therefore in the Native American application it is strongly suggested that each Clan leader designate a specific person to be trained by the law enforcement in regards to these matters.
In recent years the most substantial development in the physical diagnosis of sexual abuse in children has concerned the interpretation of changes in genital anatomy among prebubertal girls. Children who have recently experienced a serious sexual assault often have obvious injuries such as lacerations, edema, or distortion of the normal genital anatomy. It must also be remembered that sexual abuse may involve genital contact that is less physically traumatic. In regards to girls. The the pathological anatomy of the hymen should be closely scrutinized for signs of sexual abuse. The disclosure by the victim should indicate the depth of the examination. The reason being is that many sexually abused children do not have any definitive lesions because they are examined long after healing has occurred or because maltreatment did not result in genital or rectal injury. Finally, a diagnosis of a sexually transmitted decease should be thoroughly examined. This is due to facts that not all VDs are transmitted through sexual behavior. Some are fostered through the living conditions and environment of the victim.
Child Neglect:
Child neglect is thought to be the most common of the four and probably the most life-threatening. Most instances of neglect have in common the failure of the child's caretaker to provide basic shelter, nutrition, supervision, medical care, or parental financial support. Unfortunately, neglect is often the result of many sociological issues of which commonly affect our Native American families and communities. Such problems as alcoholism, unemployment depression, oppressive discrimination by the American culture, Tribal Government problems, lack of education opportunities, and the feeling of loneliness all contribute to the emotional stability needed as fuel to create child maltreatment instances. As was presented in the opening of this writing. As the American studies continue it is seen that economical differences are not exactly the single cause for maltreatment. Repeating again, this is presented in the plethora of cases being made public concerning their abusive politicians, and other rather wealthy families of who have been publicly disclosed. Thus, the actual causes for maltreatment are far from being identified. It would be ludicrous to suggest this is due to lack of Christian values. Every week we see a different parishioner or priest facing public scrutiny or prosecution for committing these acts. Actually, in the American views of neglect, we see that those parameters apply to our entire families concerning matters of food, health care, etc. Can we ever understand how, before the cultural invasion, in our old ways and traditions, we did not have child maltreatment as it is today?
In our Native American community each individual case has to be analyzed.
As we struggle during this seventh generation to alleviate these problems
through the control of our own destiny. Perhaps we will be more successful
in identifying the causes of child maltreatment. We have no choice to do
otherwise. For these children of ours are to continue our race, they are
the future leaders of or sovereign nations. Therefore, we must now, not
later, not on Indian time, but now attack this problem. If not, we are showing
the Great Mystery, during this time of the seventh generation cleansing,
that we are contributing to our own annihilation. It is wise to issue caution
not to try and face the Creator in prayers with an excuse as to why you
let Child Abuse happen when you have knowledge of such. Asking forgiveness
from the Creator for someone else involved in this, is never going to be
granted. The seed of love, and innocence is found in our children.
