Infancy is a critical period in a child’s development. During infancy, the brain, which is approximately one-quarter of the size of the adult brain, is one of the most undeveloped organs and it is highly susceptible to both the positive and the negative effects of the external environment. For instance, shaken baby syndrome, a result of physical abuse,14 damages the brain structure, which can have severe consequences for the health of an infant—namely mental retardation, hearing problems, visual problems, learning disabilities, and cognitive dysfunction.11 Some studies show that physically abused children have structural brain changes, including “smaller intracranial and cerebral volume,” smaller lateral ventricles, and smaller corpora callosa.15 The consequences of abuse might not manifest clinically until later in life. For example, the outcomes for infants who suffer brain damage from shaking can range from no apparent effects to permanent disability, including developmental delay, seizures or paralysis, blindness, and even death. Survivors might have substantially delayed effects of neurologic injury resulting in a range of impairments seen over the course of their lives, including cognitive deficits and behavioural problems. Recent Canadian data on children hospitalized for shaken baby syndrome showed that 19% died; 59% had neurologic deficits, visual impairment, or other health effects; and only 22% appeared well at the time of discharge. Data also indicate that babies who appear well when discharged from hospital might show evidence of cognitive or behavioural difficulties later on, possibly by school age.14
High cortisol and catecholamine levels, which increase as a response to stress that results from abuse, have been linked to the destruction of brain cells and the disruption of normal brain connections, consequently affecting children’s behavioural development. Sleep disturbances, night terrors, and nightmares can be signs of infant abuse.5
By the second year, a child will usually react to stress with a display of angry and emotional expression. Stress accompanying any kind of abuse causes children to feel distress and frustration.16 The excessive anger is displayed in the form of aggressive behaviour and fighting with caregivers or peers. This form of response is intensified more with physical abuse.
At this stage, children have similar reactions to the different types of abuse as younger children do. However, by ages 4 and 5, children might express their reaction to abuse through different behaviour. Boys tend to externalize their emotion through expression of anger, aggression, and verbal bullying.17 Girls are more likely to internalize their behavioural attitudes by being depressed and socially withdrawn, and having somatic symptoms such as headache and abdominal pain.18
Primary school age:
At this age, children develop through peer interaction. Abused children often have difficulties with school, including poor academic performance, a lack of interest in school, poor concentration during classes, and limited friendships.9 They are often absent from school.
Adolescents who have experienced abuse might suffer from depression, anxiety, or social withdrawal. In addition, adolescents who live in violent situations tend to run away to what they perceive to be safer environments.19,20 They engage in risky behaviour such as smoking, drinking alcohol, early sexual activity, using drugs, prostitution, homelessness, gang involvement, and carrying guns.17,21,22 Psychiatric disorders are often seen in adolescents who have been abused.18,23,24 In one long-term study, 80% of young adults who had been abused met the diagnostic criteria for at least 1 psychiatric disorder by the age of 21.24
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