Abuse and neglect are important causes of illness, injury, and death in children. However, child abuse and neglect are inconsistently defined, difficult to track, and may be underreported. According to the National Child Abuse and Neglect Data System (NCANDS), an estimated 896,000 children were victims of child abuse or neglect in the Unites States in 2002, which translates to a rate of 12.3 per 1,000 children. (Here, “child abuse or neglect” refers to physical, sexual, or emotional abuse or neglect.)
Abuse and neglect are not only more dangerous in infants and young children, they are more common: NCANDS data indicate that children age three and under have the highest rates of victimization—at 16 per 1,000 children in 2002.
A myriad of risk factors are typically associated with child maltreatment. These include: low socioeconomic status, a cultural background permissive to violence, family breakdown, social isolation, child illness, parental mental illness or substance abuse, and parents own history of being abused as a child.
A new study in the October 2004 issue of
examined how a group of parents in the Netherlands reacted to their young infants’
—a pervasive infant behavior, which, according to case reports, often provokes abuse. The researchers ultimately found that risk of crying-associated infant abuse was highest among those parents who had immigrated to the Netherlands from non-industrialized countries, those with either no job or a job with short working hours, and those who judged their infant’s crying to be excessive.
About the Study
In 1997 and 1998, doctors and nurses interviewed the parents of 3,345 infants aged 1-6 months old from the Netherlands. They asked parents about infant crying habits as well as personal characteristics such as sex, immigration status, family composition, number of children, daily hours of employment (before pregnancy leave), degree of urbanization (based on how crowded their neighborhood was), and lifestyle. Parents also filled out an anonymous questionnaire about specific actions taken to stop infant crying—slapping, shaking, and smothering being three out of over 20 items listed. At the same time, the researchers collected information on after-birth hospitalization of these infants.
In six-month old infants, nearly 6% of parents reported either smothering, slapping, or shaking their infant at least once since birth in order to stop them from crying. Of this 6%, one-fifth reported more than one of these actions, and shaking was reported most often. Logically, the younger that infants were, the less likely it was for parents to report these actions.
Rates of potential abuse (i.e., having been shaken, smothered, or slapped) were significantly higher for infants not living with their biological parents, those living in urbanized areas, those born in non-industrialized country, those with unemployed parents, and, finally, those whose parents worried about the crying or had judged it to be excessive at one time or another. Neither the sex of the parent, nor the number of hours that the baby cried (measured as either less than or more than three hours per day on more than three days of the week) significantly influenced the likelihood of a violent parental reaction.
How Does This Affect You?
This study shows how frequently and under what circumstances parents react to infant crying in potentially harmful ways. Furthermore, the 6% rate is quite likely to represent an underestimation, since many parents would understandably be reluctant to report abusive behavior, even on an anonymous questionnaire.
A related editorial points out that this study did not examine crying as a cause of abuse. Rather, it looked at caregiver characteristics that influence why they may
to crying in an abusive manner. As with all cases of abuse at any age, maltreatment stems from the abuser’s emotional state, certainly not the actions of the victims he or she abuses.
Overall, this study does illuminate a few characteristics that increase parents’ chances of committing infant abuse. And while most of these cannot be modified at an individual level (e.g., widespread immigration, unemployment, and urbanization), health professionals who are aware of these characteristics may be able to recognize a potentially dangerous environment and intervene before serious harm is done.
The study also raises the issue of parental expectation when it comes to their infants' crying. Doctors need to inform parents of what to expect from the innocent-appearing bundle they have just brought home. A typical, healthy infant will cry on average from 2-3 hours a day, and 20% to 30% of infants exceed that. Parents who know this may be more patient and tolerant compared to those who are surprised and dismayed at what they perceive as an unreasonable level of discontent.
Please be aware that this information is provided to supplement the care
provided by your physician. It is neither intended nor implied to be a
substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER
IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the
advice of your physician or other qualified health provider prior to
starting any new treatment or with any questions you may have regarding a