abuser may offer gifts or be very loving and attentive. At this stage, the abuser and victim may both believe that the abuser can change. If specific measures are not taken to stop the cycle of abuse, it continues. There may be days, weeks, months, or years between abusive events. Usually, the time between episodes gradually shortens, and the abuse becomes more frequent and more intense. It is important for the victim and abuser to recognize the problem and get help to stop the cycle. Child Abuse Child abuse occurs when a parent, guardian, or caregiver mistreats or neglects a child, which may result in the following: * Significant emotional or psychological harm * Serious risk of harm to the child Child abuse is a gross misuse of a caregiver's position of trust and authority over a child. Children who are abused tend to experience more social problems and perform less well in school than other children. As a result, as adults, they can remain poorly adjusted socially and lack success in life. Additionally, victims of childhood abuse are at greater risk for becoming violent abusers and criminals themselves. Child abuse can take many different forms: * Physical abuse —the deliberate application of force on any part of a child’s body, which may result in a nonaccidental injury. Physical abuse also includes behaviours such as shaking, choking, biting, kicking, burning, or poisoning a child; holding a child under water; or any other harmful or dangerous use of force or restraint. Some people confuse punishment with physical abuse.* Emotional abuse —sce general description of emotional abuse on page 180. Other forms of emotionally abusive treatment include forcing a child into social isolation or intimidating, exploiting, terrorizing, or routinely making unreasonable demands on a child. Emotional abuse is often part of a pattern of family stress and dysfunctional parenting. In fact, some provinces in Canada now include exposure of a child to violence between the parents as a form of emotional abuse. ‘ A recent study of wife assault found that children witness violence against their mothers in almost 40% of violent marriages. > Children who are both emotionally and physically abused exhibit the greatest degree of aggression, delinquency, and interpersonal problems. Women who were abused in childhood are more likely to suffer from depression, low self-esteem, and suicidal thoughts. While physical abuse will put a child in immediate danger of injury, psychological or emotional abuse can have even more negative and long-term consequences for the child. * Sexual abuse —the use of a child for sexual purposes by an adult or adolescent. Exposing a child to any sexual activity or behaviour constitutes sexual abuse. It may involve fondling, inviting a child to touch or be touched sexually, or even engaging the child in sexual intercourse, juvenile prostitution, or sexual exploitation through pornography. Sexual abuse is also considered a form of emotional abuse. * Child neglect — failure by a parent or other caregiver to meet a child’s basic needs for emotional, psychological, and physical development. Physical neglect occurs when a child’s needs for food, clothing, shelter, cleanliness, medical care, and protection from harm are not adequately met. Emotional neglect occurs when a child’s need to feel loved, wanted, safe, and worthy is not met. Emotional neglect can range from the context of the abuser’s simplybeing unavailable, to the abuser’s open rejection of the child: Physical assaults are more likely to be reported, but neglect can have equally serious consequences for a child. * If you witness or suspect child abuse, you are legally required to report it! Situations That Increase the Risk for Child Abuse * Family crisis. Divorce, unemployment, moving, poverty, and crowded living conditions all cause stress. Stress can lead to abuse (see the Supporting Taylor: Understanding Contributing Abuse Factors box). * Nonbiological or transient caregivers in the home. Children are more likely to be abused if they live in a household in which the biological parent shares parenting responsibilities with a partner (or partners) who does not have a committed and loving relationship with the children. The risk increases if either the partner or parent was abused or neglected as a child. 6 * Isolation. Parents who mistreat or abuse their children are more likely to experience feelings of isolation, loneliness, and less social support as compared to other parents. 7 * Caring for children with special needs. Children living with physical or mental disabilities or chronic illness are especially at risk for abuse. Children with personalities or behaviours that the abuser considers “different” or unacceptable also face greater risk. Supporting Taylor: Understanding Factors Contributing to Abuse 4 Taylor is a 6-year-old boy who was born with fetal alcohol syndrome (see Chapter 36). His weight is below the average for a child his age, and he has hearing and vision difficulties as well as behavioural problems. You have been assigned to Taylor as his support worker, to assist him with bathing, toileting, and eating.Because of Taylor’s frequent verbal outbursts and his tendency to bite, kick, and scratch, his mother has decided to home-school Taylor. You arrive for your first visit with Taylor in his home, and his mother, a nicely dressed woman, greets you at the door. The house is clean, neat, and stylishly furnished. Her breath smells of alcohol, and there is an open bottle of vodka on the kitchen counter. In the course of your conversation, Taylor’s mother tells you that she is a lawyer, and because of Taylor's situation, she plans on practising law from her home. During this initial visit, while she is showing you around the house, she repeatedly blames her ex-husband for Taylor’s condition; she says her ex-husband had a “terrible drinking problem.” When you meet Taylor, he gives you a big hug and asks you if you can stay all day. He then turns on the television; because of his hearing and vision difficulties, he needs to sit very close to it, with the volume turned up. Taylor’s mother yells at Taylor, telling him, “Turn the (uses a swear word) TV down!” Taylor does so but begins to cry. His mother then asks you to make sure that Taylor keeps quiet while you are with him. Can you identify the factors that might contribute to Taylor’s possible mistreatment at home? Failure to Thrive Failure to thrive is a term that is often used to describe infants, babies, or children who are below the norms for body weight, growth, or cognitive development. It is also used when referring to older persons who are losing weight and experiencing a health decline for no apparent reason. One of the many known causes of failure to thrive is caregiver neglect. In extreme cases, it can lead to permanent developmental delays and even the death of the client. Unfortunately, many of the mothers of infants described with failure to thrive were themselves likely also abused in the past. What Can Be Done to Prevent Child Abuse?Most abusive parents do not consciously set out to harm their children. If there are more and better efforts to assist troubled families, parents at risk for abusing may be reached and helped before they resort to violence. Prevention is a good investment, in terms of both personal and social costs to individuals. There are many ways to prevent abuse, including the following: § * Parenting education. With education, parents can better understand normal child development and how to have a more nurturing and enjoyable relationship with their children. Positive approaches to parenting can help parents deal with children of any age. Child abuse prevention programs. Abused children tend to repeat the pattern of abuse when they become adults, so identification of potential abusers and prevention are the most effective means to stop the cycle of violence. * Supportiveness. If a child tells you, the support worker, about an abusive situation or experience, you need to show the child that you believe them and ensure that the information is promptly reported to the appropriate authorities. Education. Children should know how to recognize and say no to abusive or exploitative behaviour and be taught that they have the right to be free from abuse. As a support worker, you can help children and adults find information and assistance to prevent an abusive or neglectful pattern from developing. Abuse of Older Persons Older people are at risk for all types of abuse— physical, sexual, emotional, and financial—as well as neglect. Financial and emotional abuses are most commonly reported by older people. Abusers are usually family members, such as adult children or grandchildren. Often, the abuser is the older person’s primary caregiver. Most abusers of older people depend on their victims for