The term child abuse refers to the multiple ways in which children are victimized by the willful or negligent actions of adults. The abusive victimization of children includes three broad categories of harm: (1) caretaker neglect of children’s health and well-being, (2) acts of physical violence by adults against children, and (3) sexual violations of young people’s psychic and physical boundaries before “the age of consent” to sex, established by the cultural and legal norms of a given society.
Child abuse is commonly viewed today as a troubling social problem. It is combated by legal punishments, therapeutic interventions, and social reforms. But, from a historical perspective, it is important to recognize that for centuries Western societies ignored, and even authorized and defended, routine assaults by adults upon children. This was particularly the case for harm done to children by their “God given” or legal guardians. Indeed, until recently, according to the patriarchal precepts of ancient Roman law and the common law traditions of Britain and the
United States, parents and legal guardians were granted almost limitless power over children placed under their authority. This meant that legal guardians had the right to impose any punishment deemed necessary for a child’s upbringing. At the same time, children— even those targeted by severe acts of physical violence—had virtually no rights to protect them against harsh and excessive sanctions of abusive caretakers. As late as the early 19th century, despite a proliferation of all kinds of punishment against alleged social wrongdoings, there existed no formal laws aimed at stemming the caretaker abuse of children. During this time, a major North Carolina court ruled, in the case of State v. Pendergrass, that a parent’s judgment concerning a child’s “need for punishment” was presumed to be correct and that criminal liability was limited to cases resulting in “permanent injury.”
Despite the “child saving” efforts of several generations of 19th- and early 20th-century reformers, the precarious legal position of children changed little until the early 1960s. Noteworthy among the relative failures of child reform efforts were the House of Refuge Movement, the Society for the Prevention of Cruelty to Children (an organization occasioned by the widely publicized 1875 case of “Mary Ellen,” a 9-year-old girl viciously assaulted by her foster parents), and the early years of the juvenile court. Despite an abundance of pro-child rhetoric, these early attempts at “child saving” contributed more to strategies of “preventive penology” than to actually curtailing the abusive power of adults over children. As a strategy of social control, preventive penology sought to reduce crime and social unrest by removing delinquency-prone youths from corrupt urban environments and improper homes. Those removed from their homes were placed in public or privately funded child reformatories. Public intervention against abusive adults lagged by comparison. In truth, it was not until the early 1960s that laws were placed on the books against caretaker assaults upon children. These laws resulted from publicity surrounding the “discovery” of the so-called child battering syndrome by pediatric radiologists and their medical allies, pediatricians and child mental health specialists.
The historical “discovery” of child abuse by mid-20th-century pediatric radiologists is a complex and contradictory matter. It suggests as much about the power dynamics of organized medical interests as it does about social concerns for child welfare. Before child abuse was labeled as an illness by pediatric radiologists, numerous factors may have prevented physicians from both “seeing” and reporting child abuse. Of particular significance were (a) the lack of an available diagnostic category to guide physician judgments; (b) doctors’ complicity with dominant cultural norms that paired parental power with images of benevolence, making it difficult for physicians to believe that parents could be responsible for deliberate injuries to their children; (c) fears of legal liability for violating physician-patient relations; and (d) reluctance on the part of the medical establishment to subordinate its clinical expertise to the power of police officers, lawyers, judges, and other agents of the criminal justice system.
Pediatric radiologists were less constrained than other medical professionals by such obstacles. Radiologists were research oriented and gained prominence by discovering new categories of pathology and disease. Unlike clinicians, they were less hampered in their observations of childhood injuries by a lack of existing diagnostic classifications. Removed from direct clinical contact with battered children and their parents, radiologists studied black-and-white X-rays. This made pediatric radiologists less susceptible to denials of parental responsibility rooted in normative or emotional identification with parents. Because their primary clients were doctor colleagues requesting their services, radiologists were also less afraid of betraying patient confidentiality. In addition, until “discovering” child battering, pediatric radiology represented a relatively low-ranking specialty within the medical profession. High-ranking medical specialties were characterized by hands-on life-or-death contact with patients. By engaging with the life-or-death exigencies of caretaker violence, while defining abuse as primarily an illness or syndrome in need of medical treatment, pediatric radiologists were able to move upward within the ranks of the medical profession without compromising medical control over an alleged form of sickness.
Beginning in 1946 with Dr. John Caffey’s observations about the “unspecified origins” of various long bone fractures in children, over the next decade pediatric radiologists moved from speculations about the mysterious physiological basis of childhood bone and skeletal traumas to something more troubling. Caffey, like other doctors, had attributed injuries he observed in children to nebulous causes. But by 1957 he had become convinced that parental “misconduct and deliberate injury” lay behind the horrific bone fractures pictured on X-ray screens. Breaking a code of cultural silence concerning violent parental and caretaker behavior, Caffey and other pediatric radiologists joined with pediatricians and child psychiatrists in drawing attention to a new public health menace—the child-battering syndrome.
Public response to the medical “discovery” of child abuse was swift and far-reaching. Over the following 10 years, a multitude of professional conferences, newspaper and magazine articles, and sensational media reports directed attention to this new social problem. As a result, between 1962 and 1966 all 50 U.S. states passed laws aimed against caretaker violence. Many laws included mandatory reporting requirements for doctors, educators, and others in regular contact with children. Researchers also labored to survey the scope and causes of child battering. Although plagued by methodological problems concerning the reliability of reports and how to best measure degrees of abuse, studies estimated that more than 1.5 million U.S. children were seriously abused by adult caretakers each year. Data presented by the U.S. Department of Health and Human Services for 2004 indicate 3 million alleged and 872,000 confirmed incidents of serious abuse. This includes an estimated 1,490 deaths of children at the hands of caretakers.
Researchers have identified a number of factors that appear to increase the likelihood of a child being abused. It is important to recognize that what is known today about child abuse is, for the most part, based on relatively small samples of known offenders. As such, while providing a suggestive picture of conditions contributing to the likelihood of abuse, current knowledge remains tentative and awaits refinement. Moreover, while no single factor is viewed as causative by itself, one thing appears clear: There is little empirical support for the medicalized image of parental violence as a supposed disease or “syndrome.” More important are sociological factors affecting the caretaker-child relationship. Of these, the most consistently recognized are (a) stressful social, economic, and emotional situations; (b) the relative powerlessness of the family unit involved (a factor that may lead disadvantaged adults to search for distorted forms of power in violent relations with children); and (c) the prevalence of powerful cultural norms legitimizing the authoritative use of violence as a means of childrearing.
Stress is particularly important in creating a social environment conducive to abuse. Stressful living situations also amplify the impact of other conditions associated with a higher likelihood of abuse. These include low family income; the presence of premature, unwanted, or handicapped children; families with four or more children; and families headed by single mothers employed in low-paying jobs outside the home. Other factors identified as amplifying the likelihood of abuse are the social isolation of abusive families, unrealistic parental expectations for a child’s performance, a parent’s own experience of having been abused as a child, and inconsistencies in caretaker approaches to discipline. Together, these factors combine with situations of stress, powerlessness, and cultural support for authoritarian childrearing in making caretaker violence against children more likely.
To combat the routine abuse of children by adults, it is necessary to go beyond existing legal and therapeutic efforts to punish or rehabilitate known offenders. It is important to also uproot deeply entrenched ways of living that amplify stress and reinforce social inequality and to lessen cultural support for violence as a solution to everyday feelings of frustration. Without realizing far-reaching social changes in these areas, it is likely that the tragedy of child abuse will continue to haunt society long into the future.
- Caffey, John. 1957. “Traumatic Lesions in Growing Bones Other Than Fractures and Lesions.” British Journal of Radiology 30(May):225-38.
- Dailey, T. B. 1979. “Parental Power Breeds Violence against Children.” Sociological Focus 12(October):311-22.
- Gelles, Richard J. and Murray A. Straus. 1988. Intimate Violence. New York: Simon & Schuster.
- Gil, David. 1970. Violence against Children. Cambridge, MA: Harvard University Press.
- McCaghy, Charles H., Timothy A. Capron, J. Jamieson, and Sandra Harley Carey. 2006. “Assaults against Children and Spouses.” Pp. 167-204 in Deviant Behavior: Crime, Conflict and Interest Groups. 7th ed. Boston: Pearson.
- Pfohl, Stephen J. 1977. “The ‘Discovery’ of Child Abuse.” Social Problems 24(3):310-23.
- Straus, Murray A., Richard J. Gelles, and Suzanne K. Steinmetz. 1980. Behind Closed Doors: Violence in the American Family. Garden City, NY: Anchor Press.
- S. Department of Health and Human Services, Administration of Children, Youth and Families. 2006. “Child Maltreatment 2004.” Washington, DC: U.S. Government Printing Office.
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