● Eating disorders. ● Sleep disturbances. ● Diabetes. ● Lung disease. ● Malnutrition. ● Vision problems. ● Heart attack. ● Back problems. ● Arthritis. ● High blood pressure. ● Migraines. ● Chronic lung disease.
● Impaired psychological health: Posttraumatic stress disorder, depression, heightened anxiety. ● Impaired relational skills: Aggression, poor peer relations, difficulty at work. ● Impaired executive functioning and cognitive skills: Difficulties with memory, self-control, cognitive flexibility, learning, and paying attention. ● Emotional difficulties: Low self-esteem, difficulty establishing or maintaining relationships, challenges with intimacy and trust, an unhealthy view of parenthood. ● Inability to cope with stress and frustrations. ● Attachment disorders. Behavioral health consequences (Child Welfare, 2021): ● Increased risky behaviors: Early sexual activity, alcoholism, drug use. ● Juvenile delinquency leading to adult criminality. ● Future perpetration of maltreatment.
● Cancer. ● Stroke. ● Bowel disease. ● Chronic fatigue syndrome. Psychological health consequences (Mayo Clinic, 2019; National Academy of Sciences, 2018):
EXCLUSIONS FROM CHILD ABUSE, PER THE CPSL
● All correspondence with a subject of the report and the records of the department and the county agency shall not reference child abuse and shall acknowledge the religious basis for the child's condition. ● The family shall be referred for general protective services, if appropriate. ● This shall not apply if the failure to provide needed medical or surgical care causes the death of the child. This shall not apply to any childcare service as defined in this chapter, excluding an adoptive parent. Healthcare consideration: If an individual’s religion promotes not seeking medical attention for a child who has an upper respiratory infection, then not seeking care in this circumstance would not be considered child abuse unless it resulted in the child’s death. Use of force for supervision, control, and safety The use of reasonable force on or against a child by the child’s own parent or person responsible for the child’s welfare shall not be considered child abuse if any of the following conditions apply (Juvenile Court Judges’ Commission, 2014): ● The use of reasonable force constitutes incidental, minor, or reasonable physical contact with the child or other actions that are designed to maintain order and control. ● The use of reasonable force is necessary for the following reasons (Juvenile Court Judges’ Commission, 2014). ○ To quell a disturbance or remove the child from the scene of a disturbance that threatens bodily injury to persons or damage to property. ○ To prevent the child from self-inflicted physical harm. ○ For self-defense or the defense of another individual. ○ To obtain possession of weapons or other dangerous objects or controlled substances or paraphernalia that are on the child or within the control of the child. Healthcare consideration: In the grocery store, you witness a woman (parent) who is upset with her child for climbing on a half-empty shelf. The parent grabs the child’s arm, she pulls the child down, and the child falls to the floor and sprains his ankle. This is not child abuse, as the parent or caregiver is using reasonable force to prevent the child from several actions, including the self- inflicted harm of the child falling.
Pennsylvania has identified scenarios that should not be considered child abuse. Pennsylvania statute § 6304 (exclusions from child abuse) details the following scenarios that have been excused from such a determination. Restatement of culpability Conduct that causes injury or harm to a child or creates a risk of injury or harm to a child shall not be considered child abuse if there is no evidence that the person acted intentionally, knowingly, or recklessly when causing the injury or harm to the child or creating a risk of injury or harm to the child. Child abuse exclusions The term “child abuse” does not include any conduct for which an exclusion is provided in section 6304 of the PA CPSL (relating to exclusions from child abuse). Environmental factors No child shall be deemed physically or mentally abused based on injuries that result solely from environmental factors such as inadequate housing, furnishings, income, clothing, and medical care, which are beyond the control of the parent or person responsible for the child’s welfare with whom the child resides (Juvenile Court Judges’ Commission, 2014). This does not apply to any childcare service, excluding an adoptive parent (Juvenile Court Judges’ Commission, 2014). Healthcare consideration: If a family lives at the poverty level through no fault of the parents, it is not considered child abuse. Practice of religious beliefs If, upon investigation, a county agency determines that a child has not been provided needed medical or surgical care because of religious beliefs of the child’s parents or relative within the third degree of consanguinity with whom the child resides, which beliefs are consistent with those of a bona fide religion, the child shall not be deemed to be physically or mentally abused (Juvenile Court Judges’ Commission, 2014). This does not apply to childcare services or if the failure to provide care results in the death of a child (Juvenile Court Judges’ Commission, 2014). In such cases the following shall apply (Juvenile Court Judges’ Commission, 2014): ● The county agency shall closely monitor the child and the child's family and shall seek court-ordered medical intervention when the lack of medical or surgical care threatens the child's life or long-term health.
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