Keywords
Bullying, cyber bullying, intimate partner violence, delinquency, dating violence
The 2014 National Survey of Children’s Exposure to Violence found that close to two thirds of children experienced at least one self- or parent-reported direct exposure to violence in the preceding year. Forms of violence include physical assault, sexual assault, child maltreatment (see Chapter 22 ), and property crime. Witnessing violence in the family and/or community was also prevalent (approximately one quarter of children). Violence is an important individual and public health concern given its prevalence and impact on well-being.
Intimate Partner Violence and Children
Intimate partner violence (IPV) is a pattern of purposeful coercive behaviors aimed at establishing control of one partner over the other that may include inflicted physical injury, psychological abuse, sexual assault, progressive social isolation, stalking, deprivation, intimidation, and threats. Although partner violence often occurs between male perpetrators and female victims, it may also occur bidirectionally and may be better conceptualized as family or interpersonal violence. Violence may escalate during the perinatal period.
IPV affects the lives of millions of children each year. Children experience IPV by seeing or hearing the violence and its aftermath. Children may be injured during violent outbursts, sometimes while attempting to intervene on behalf of a parent. Many children are victims of abuse themselves. It is estimated that there is at least a 50% concurrence rate between IPV and child abuse. Exposure to IPV can also impact child development, emotional health, and behavior. There is no particular behavioral consequence or disturbance that is specific to children who witness IPV. Some children are traumatized by fear for their caregiver’s safety and feel helpless. Others may blame themselves for the violence. Children may have symptoms of post-traumatic stress disorder , depression, anxiety, aggression, or hypervigilance. Older children may have conduct disorders, poor school performance, low self-esteem, or other nonspecific behaviors. Infants and young toddlers are at risk for disrupted attachment and routines around eating and sleeping. Preschoolers may show signs of regression, irritable behavior, or temper tantrums. During school-age years, children may show both externalizing (aggressive or disruptive) and internalizing (withdrawn and passive) behaviors. Because of family isolation, some children have no opportunity to participate in extracurricular activities at school and do not form friendships. Adolescents in homes where IPV is present have higher rates of school failure, substance abuse, and risky sexual behaviors. These adolescents are more likely than their peers to enter into a violent dating relationship.
Because of the high concurrence of IPV and child abuse, asking about IPV is part of the screening for violence against children. Recognizing the importance of IPV screening in pediatric practice, the American Academy of Pediatrics has endorsed screening in this setting and suggests that intervening on behalf of battered women may be one of the most effective means of preventing child abuse. Without standardized screening, pediatricians may underestimate the IPV prevalence in their practices. Parents should not be screened together. Questions about family violence should be direct, nonjudgmental, and done in the context of child safety and anticipatory guidance ( Table 25.1 ).
| FOR THE CHILD |
| How are things at home and at school? |
| Who lives with you? |
| How do you get along with your family members? |
| What do you like to do with them? |
| What do you do if something is bothering you? |
| Do you feel safe at home? |
| Do people fight at home? What do they fight about? How do they fight? |
| ADDITIONAL QUESTIONS FOR THE ADOLESCENT |
| Do your friends get into fights often? How about you? |
| When was your last physical fight? |
| Have you ever been injured during a fight? |
| Has anyone you know been injured or killed? |
| Have you ever been forced to have sex against your will? |
| Have you ever been threatened with a gun or a knife? |
| How do you avoid getting in fights? |
| Do you carry a weapon for self-defense? |
| FOR THE PARENT |
| Do you have any concerns about your child? |
| Who helps with your children? |
| How do you feel about your neighborhood? |
| Do you feel safe at home? |
| Is there any fighting or violence at home? |
| Does anyone at home use drugs? |
| Have you been frightened by your partner? |
| Does your partner ever threaten you or hurt you? |
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