Physician: Prevalence of Child Abuse

By definition, child abuse does not discriminate by race, culture, or the social status of the perpetrator. A child abuser can be any person– a coworker, friend, or neighbor, any of whom may or may not have a criminal record.

People who abuse children often have something in common: many have either repeatedly witnessed or have been victims of child abuse themselves. The assumption that a caregiver is nice person or the ideal community leader should never exclude the possibility of child abuse if the suspicion is warranted.

Failure to investigate concerns can be hazardous, if not fatal, to a child who is not immediately removed from a hostile living environment.

The recent attention that the media has given to cases of child abuse at the hands of their adopted parents has raised the question:  “Are children being placed in imminent danger of physical and sexual abuse by being slated for international adoption?” This question has caused many countries, like Russia, to shut down all international adoptions, and other countries to suspend them.

Because of this politically initiated knee-jerk response, orphan children are now condemned to a life of institutional care living, and are thus being exposed to all the health hazards that are associated with it. These children are now at even higher risk of physical and sexual abuse. Orphan children now are confined to a closed community, with little supervision. The perpetrator may be the one in charge of the child’s well-being, thus making the reporting of these actions highly unlikely.

Institutions are filled with unwanted children, and they are magnets for sexual predators. Child abuse is also common within the confines of the orphanage walls by the older children from the same orphanage. This, too, occurs because of lack of supervision, reporting, and the easy accessibility to children. Fear of reporting incidents makes orphans prime candidates for all types of abuse. These types of stories are rerely reported upon; they often remain forever concealed behind closed doors.

Over the years, I have met many adoptive parents and I have observed one similar common characteristic. They are the most wonderful and caring people that I have ever met.

Adoptive parents are very attuned to the health care of their children and want only what is best for their child. It is the rare case when an adoptive parent abuses the child, though sadly it does occur. Statistically speaking, however, the incidence of child abuse is exponentially higher in the environment the child has left.

Headline news: “Local child from a small town in Russia is beaten by his biological parents.” This type of headline just does not make for a good story. But “Internationally Adopted child from Russia beaten by his adoptive parents in New York”– this make for a great headline news story that will increase viewer ratings.

In a case of child abuse, there are numerous historical features that are universally encountered, regardless of the country where the abuse occurred:

1. A discrepancy in the reported history that is given by the parent, or an injury that has a mechanism that is physically impossible to have occured within the described sequence of events (e.g., A severe Intracranial head bleed secondary to a fall after an 11-month-old child “tripped.”)
2. Frequent changes in the history of events related to the injury.
3. Delay in seeking medical attention.
4. History of violence or child abuse in the caregiver as a child.
5. Inappropriate affect of the caregiver.
6. Social isolation of the child or caregiver from friends or family.
7. Stress or crisis in a family.
8. Unrealistic expectations of the caregiver for the child.

Once a case is officially being investigated for child abuse, many of these features become easily recognizable. When a television station reports on such cases, they usually add the question, “Why didn’t anyone see these clues before the child was beaten to death?” The answer is not so simple. When the media reports on a child abuse story, they generally have a timeline of events as they unfolded. In the real world, it does not occur that way. The signs appear slowly, but if one is given this data piecemeal, the case may not be so obvious.

The medical and behavioral problems associated with international adoption can cause a great deal of stress on the family, causing a momentary lack of reason that can drive one to physically harm their child. While it is not always the case, an astute medical professional should always entertain the possibility of child abuse in their differential diagnosis if presented with suspicious clinical evidence. Child abuse should always be reported and investigated. It should never be dismissed because “the parents look too nice” or “are not capable of hurting a child.”

The international adoption community as a whole– from agencies, social workers, and medical professionals– have the responsibility to educate adoptive parents on how to deal with the problems associated with internationally adopted children. By better preparing the families with education, support services, and resources, we as a group may be able to prevent some of the devastating cases of child abuse that occur within the adoption community.