Punishment or child abuse? How to practice safer discipline

“I want to kill myself. … My mom has hit me too many times with belts, metal spatulas, and sticks,” the 10-year-old girl told me, as she tearfully showed me fresh bruises on her body. I informed her mother that I would need to report concerns of child abuse to Child Protective Services. Her response was she was “disciplining her” and did not find fault in her actions.

Unfortunately, this is not an uncommon scenario. The U.S. Centers for Disease Control and Prevention notes at least 1 in 7 children have experienced child abuse and/or neglect in the last year, and this is likely an underestimate.

The Pennsylvania Child Protective Services Law defines child abuse and neglect as “when an individual acts or fails to prevent something that causes serious harm to a child under the age of 18.” Harm can take many forms, such as serious physical injury, serious mental injury, or sexual abuse or exploitation.

Parents were the group most responsible for abuse of their children, according to an annual report by the Pennsylvania Department of Human Services (DHS).

Child abuse and neglect can have broad effects on the child. From the stress of abuse or neglect, the body increases the release of stress hormones, which can impair sleep and memory, increase irritability, and make it difficult for the child to control his or her emotions. A key consequence of abuse is aggressive behavior from the abused as they start to model their behavior after the ways in which they have been abused. Victims of abuse are more likely to abuse drugs and alcohol, develop depression or anxiety, and have higher rates of suicidal thoughts and suicide attempts. Victims can often have impaired relationships and decline in school performance.

Some children develop post traumatic stress disorder (PTSD), a psychiatric condition that can occur when someone witnesses or experiences a traumatic event, and subsequently relives the event or avoids reminders or places of the event. Children with PTSD resulting from abuse or neglect might develop disturbing thoughts and feelings associated with the event and become easily startled, irritable, or watchful of their surroundings.

What increases the risk for child abuse or neglect? Families with a history of mental illness or substance abuse, who live in poverty, with a single-parent household with fewer resources, or have a greater number of children in the home are at an increased risk. Children born to adolescent parents or parents that have been abused, were born prematurely, or have physical or intellectual disabilities are also at a higher risk.

What mental-health treatment is available for youth who have suffered from abuse and neglect? Consultation with a pediatrician, child and adolescent psychiatrist, psychologist, or social worker would help determine whether the child and/or family would benefit from therapy. A psychiatrist could advise whether medications would be helpful for psychiatric symptoms that could result.

What are resources for more effective and safer ways to discipline? Generally, discipline works best when it involves clear, consistent, age-appropriate, and reasonable expectations that are nonpunitive and involve consequences that are delivered soon after rules are broken. For example, a 10-year-old girl who enjoys screen time can have a consistent consequence of not being allowed to play on an iPad until she clears the table after dinner, following three reminders. The parent does not argue with or raise her/his voice at their daughter. Once the table is cleared, the child is then promptly allowed to play.

The American Academy of Pediatrics and American Academy of Child and Adolescent Psychiatry offer more specific resources for parents to use in guiding discipline. Philadelphia’s DHS offers Parent Cafes to help support parents, and free classes can be found by calling 215-PARENTS (215-727-3687). Caring parents and families are the best resource for children.

Helping children who are abused or neglected. If you think you know a child who is being abused, the most crucial first step is to make a report of suspected child abuse or neglect to ChildLine by calling 1-800-932-0313. Sources who report abuse are kept anonymous.

Philadelphia DHS operations director Samuel B. Harrison III offered this advice: “I would encourage individuals whether they are mandated or not to report any suspected child abuse, and not worry about the possibility of being wrong. There is a formal process that occurs once referrals are received and specific criteria that has to be met before reports of child abuse are generated and child abuse investigations occur. The confidentiality of reporters is taken very seriously.”

Julie Furst, M.D., is a child and adolescent psychiatry fellow under the guidance of James Luebbert, M.D., a child and adolescent psychiatry attending at Thomas Jefferson University Hospitals. The Philadelphia DHS contributed information for this article.