Monahans-Wickett-Pyote ISD

Sexual Abuse & Other Maltreatment of Children: Consequences of Maltreatment 

Child maltreatment has often severe short- and long-term physical, sexual, and mental health consequences. These include injuries, including head injuries and severe disability (in particular in young children), post-traumatic stress, anxiety, depression, and sexually transmitted infections (STIs), including HIV. Adolescent girls may face additional health issues, including gynecological disorders and unwanted pregnancy. Child maltreatment can affect cognitive and academic performance and is strongly associated with alcohol and drug abuse and smoking, key risk factors for noncommunicable diseases (NCDs) such as cardiovascular diseases and cancer. Maltreatment causes stress that is associated with disruption in early brain development. Extreme stress can impair the development of the nervous and immune systems. Consequently, as adults, maltreated children are at increased risk for behavioral, physical, and mental health problems such as: 
• perpetrating or being a victim of violence
• depression
• smoking
• obesity
• high-risk sexual behaviors
• unintended pregnancy
• alcohol and drug misuse. 

Violence against children is also a contributor to inequalities in education. Children who experienced any form of violence in childhood have a 13% greater likelihood of not graduating from school. Beyond the health, social, and educational consequences of child maltreatment, there is an economic impact, including costs of hospitalization, mental health treatment, child welfare, and longer-term health costs. 

Risk factors 

Several risk factors for child maltreatment have been identified. Not all risk factors are present in all social and cultural contexts, and the list here provides an overview when attempting to understand the causes of child maltreatment. 
Child 

It is important to emphasize that children are the victims and are never to blame for maltreatment. Characteristics of an individual child that may increase the likelihood of being maltreated include:
• being either under 4 years old or an adolescent
• being unwanted, or failing to fulfil the expectations of parents
• having special needs, crying persistently or having abnormal physical features
• having an intellectual disability or neurological disorder
• identifying as or being identified as lesbian, gay, bisexual or transgender. 

Parent or caregiver 

Characteristics of a parent or caregiver that may increase the risk of child maltreatment include:
• difficulty bonding with a newborn
• not nurturing the child
• having been maltreated themselves as a child
• lacking awareness of child development or having unrealistic expectations
• misusing alcohol or drugs, including during pregnancy
• having low self-esteem • suffering from poor impulse control
• having a mental or neurological disorder • being involved in criminal activity
• experiencing financial difficulties.

Relationship 

Characteristics of the relationships within families or among intimate partners, friends and peers that may increase the risk of child maltreatment include:
• family breakdown or violence between other family members
• being isolated in the community or lacking a support network
• a breakdown of support in child rearing from the extended family. 

Community and societal factors 

Characteristics of communities and societies that may increase the risk of child maltreatment include: • gender and social inequality; • lack of adequate housing or services to support families and institutions;
• high levels of unemployment or poverty;
• the easy availability of alcohol and drugs;
• inadequate policies and programs to prevent child maltreatment, child pornography, child prostitution, and child labor;
• social and cultural norms that promote or glorify violence towards others, support the use of corporal punishment, demand rigid gender roles, or diminish the status of the child in parent–child relationships, social, economic, health and education policies that lead to poor living standards, or to socioeconomic inequality or instability. 

Prevention 

Preventing and responding to child maltreatment requires a multisectoral approach. The earlier such interventions occur in children's lives, the greater the benefits to the child (e.g. cognitive development, behavioral and social competence, educational attainment) and to society (e.g. reduced delinquency and crime). Effective and promising interventions include:
• Parent and caregiver support: Information and skill-building sessions to support the development of nurturing, non-violent parenting delivered by nurses, social workers, or trained lay workers through a series of home visits or in a community setting.
• Education and life skills approaches: 

• increasing enrolment in quality education to allow children to acquire knowledge, skills, and experiences that build resilience and reduce risk factors for violence;
•  programs to prevent sexual abuse that build awareness and teach skills to help children and adolescents understand consent, avoid and prevent sexual abuse and exploitation, and to seek help and support; and
•  interventions to build a positive school climate and violence-free environment, and strengthening relationships between students, teachers, and administrators. 

Norms and values approaches: Programs to transform restrictive and harmful gender and social norms around child-rearing, child discipline, and gender equality, and promote the nurturing role of fathers.
Implementation and enforcement of laws: laws to prohibit violent punishment and to protect children from sexual abuse and exploitation • Response and support services: Early case recognition coupled with ongoing care of child victims and families to help reduce reoccurrence of maltreatment and lessen its consequences. 

To maximize the effects of prevention and care, WHO recommends that interventions are delivered as part of a four-step public health approach:
• defining the problem;
• identifying causes and risk factors;
• designing and testing interventions aimed at minimizing the risk factors; and
• disseminating information about the effectiveness of interventions and increasing the scale of proven effective interventions.