Medicolegal Library 1 Edited by A. Carmi Child Abuse Edited by A.Carmi and H.Zimrin With Contributions by O. Ayalon E. Deutsch B. M. Dickens R. A. Eisikovits Z. Eisikovits H. L. Hirsh J. E. Holloway E. R. Krasna I. H. Krasna G. M. Larkin R. Mayer T. T. Noguchi A. Oren D. Reifen F. A. Rozovsky R. L. Sadoff A. Sagi M. A. Somerville A. Schwartz C. H. Wecht With 39 Figures Springer-Verlag Berlin Heidelberg New York Tokyo 1984 Judge Amnon Carmi P.O.B. 6451 Haifa 31063, Israel Dr. Hanita Zimrin School of Social Work, Tel Aviv University, Tel Aviv 69978, Israel ISBN-13 :978-3-540-12471-9 e-ISBN -13:978-3-642-82063-2 DOl: 10.1007/978-3-642-82063-2 Library of Congress Cataloging in Publication Data. Main entry under title: Child Abuse. (Medicolegal Library; 1). Bibliography: p. 1. Child abuse Addresses, essays, lectures. 2. Child abuse - Law and legislation - Adresses, essays, lectures I. Canni, Amnon. II. Zimrin H. (Hanita) III. Ayalon, Ofra. IV. Series. RC569.5.C55C43 1984 362.7'044 84-1303 This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically those of translation, reprinting, re-use of illustrations, broadcasting, reproduction by photocopying machine or similar means, and storage in data banks. Under § 54 of the Gennan Copyright Law where copies are made for other than private use a fee is payable to 'Verwertungsgesellschaft Wort', Munich. © Springer-Verlag Berlin Heidelberg 1984 The use of registered names, trademarks, etc. in the publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. Product Liability: The publisher can give no guarantee for infonnation about drug dosage and application thereof contained in this book. In every individual case the respective user must check its accuracy by consulting other phannaceuticalliterature. 2119/3140-5 4 3 2 1 0 Introduction The Medicolegal Library is the first and only series of its kind. Its importance is self-evident. During the last decade, science, especial ly medical practice, has become an increasingly complex undertak ing. Recent dramatic developments in medicine have given rise to both theoretical controversies and practical dilemmas. Society is struggling with new scientific, economic, cultural, and legal issues. The establishment of a series such as this appears vital for lawyerr; and physicians, for sociologists and psychologists, and for the pub lic at large. The editorial board of the Medicolegal Library consists of dis tinguish scientists from many different countries and disciplines. Judge Amnon Carmi acts as principal series editor. Judge Carmi is the author of many books and articles on medical law, and is Editor in-Chief of Medicine and Law: An International Journal. The Medicolegal Library will issue two books each year. The first four books, soon to be published, will deal with child abuse, eutha nasia, disability, and psychiatry laws and ethics. It is the wish and intention of Springer-Verlag that the Medicole gal Library play an important role throughout the world in the study and understanding of the field of medicine and law, for the benefit of both professions and of mankind at large. Contents I. The Phenomenon Battering Behavior: One Phenomenon, Many Explanations H.Zimrin. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Abusive Versus "Normal" Child-Rearing Practice: A Cross-Cultural Perspective R.A. Eisikovits . . . . . . . . . . . . . . . . . . . . . . . . . .. 14 Abusing Children's Development Potential: The Case of Moral Development Z. Eisikovits and A. Sagi . . . . . . . . . . . . . . . . . . . . .. 21 II. Child Abuse and the Law Child Abuse and Neglect: A Survey of the Law (United Stated of America) A. Schwartz and H. L. Hirsh . . . . . . . . . . . . . . . . . . .. 31 The Medically Neglected Child (West Germany) E. Deutsch ...................... 60 The Medical Needs of the Child and Religious Doctrines (North America) F.A.Rozovsky ........................ 66 Child Abuse and Criminal Process: Dilemmas in Punishment and Protection B. M. Dickens . . . . . . . . . . . . . . . . . . . . . . . . . . .. 77 Professional Intervention in the Family M.A. Somerville ...... . . . . . . . . . . . . . . . . . . .. 93 III. Child Abuse and Psychiatry Child Abuse: A Psychiatrist's View R.Mayer .............................. 113 VIII Contents Divorce and the Emotionally Abused Child R. L. Sadoff. . . . . . . . . . . . . . . . . . . . . . . . . . . .. 121 IV. The Sexually Abused Child The Daughter as a Sexual Victim in the Family O.Ayalon . . . . . . . . . . . . . . . . . . . . . . . 133 Legal Protection of Children in Sexual Assault Cases D. Reifen . . . . . . . . . . . . . . . . . . . . . . . . . .141 v. Child Abuse and Pathology The Battered Child Syndrome (1) C. H. Wecht and G. M. Larkin . . . . 157 The Battered Child Syndrome (2) I. H. Krasna, A. Oren, and E. R. Krasna . . 183 The Role of the Forensic Pathologist in the Investigation of Child Abuse Deaths J. E. Holloway and T. T. Noguchi . ................. 193 Subject Index ............................ 215 List of Contributors O.Ayalon 7 Zevulun, Kiriat Tivon 33217, Israel Prof. Dr. E. Deutsch Holty Strasse 8, 3400 G6ttingen, FRG Prof. Dr. B. M. Dickens Faculty of Law, University of Toronto, 84 Queen's Park Crescent, Toronto, M5S 1A1, Canada Dr. R. A. Eisikovits Social Work School, University of Haifa, Mount Carmel, Haifa 31999, Israel Dr. Z. Eisikovits Social Work School, University of Haifa, Mount Carmel, Haifa 31999, Israel Dr. H. L. Hirsh 2801 New Mexico Avenue, Washington, DC 20067, USA Dr. J. E. Holloway County of Los Angeles, 1104 No Mission Road, Los Angeles, CA 90033, USA Prof. Dr. E. R. Krasna The Department of Pediatric Surgery and the Shaare Zedek Hospital, POB 293, Jerusalem 92-585, Israel Prof. Dr. I. H. Krasna The Department of Pediatric Surgery and the Shaare Zedek Hospital, POB 293, Jerusalem 92-585, Israel Dr. G. M. Larkin Coroner, County of Allegney, 542 4th Avenue, Pittsburgh, PA 15219, USA X List of Contributors Dr. R.Mayer 8 Rakafot Street, Rehovot 76608, Israel Dr. T. Noguchi County of Los Angeles, 1104 NO Mission Road, Los Angeles, CA 90033, USA Dr. A Oren Dr. D. Reifen (t) 7 Vitkin Street, Tel Aviv 63474, Israel F.ARozovsky, POB 2382 Halifax, Nova Scotia, B3J 3H4, Canada Dr. R. L. Sadoff Suite 326, The Benjamin Fox Pavilion, Jenkintown, PA 19046, USA Dr. ASagi Social Work School, University of Haifa, Mount Carmel, Haifa 31999, Israel Prof. M. A Somerville McGill University, 3644 Peel Street, Montreal, H3A IW9, Canada Dr. A. Schwartz 2801 New Mexico Avenue, Washington, DC 20067, USA Dr. C. H. Wecht Coroner, County of Allegeney, 542 4th Avenue, Pittsburgh, PA 15219, USA I. The Phenomenon Battering Behavior: One Phenomenon, Many Explanations H.Zimrin 1 Introduction Over the past few years, we have witnessed increasing awareness of the phenome non of child abuse by parents. It is by no means a new phenomenon; there is evi dence of its existence even in ancient times (Radbill1968). Nowadays, in the light of changes in cultural norms and developments in our ability to diagnose cases of child-battering, awareness of the problem has increased and child abuse is recog nized as a phenomenon demanding comprehension and treatment. In families where children are abused, they become objects of neglect or victims of physical and mental cruelty, rather than subjects of parental love and care. Such abuse is far from circumstantial when children suffer the consequences of their parents' apathy or impulses. Thousands of children - most of them infants - are treated annually in hospital emergency rooms and pediatric wards, suffering from deliberately inflicted bums, fractures, cerebral hemorhages, or malnutrition (McNeese and Hebeler 1977; Nagi 1977). Most of these children are released and sent home, only to return again with fresh injuries. The number of battered children who are not taken to the hospital and who receive no medical treatment whatsoever is undoubtedly several times greater. Battering certainly causes the child great suffering while taking place. However, in light of the knowledge of necessary conditions for proper child development, as well as through a follow-up study of battered children, one cannot overlook the harmful effect of battering upon the child's development and his realizing this fu ture individual and social potential (Baher 1976). Battering has a destructive effect not only upon a child's present situation, but also upon his functioning as an adult in the future. Hence it is vital to comprehend the phenomenon of child abuse com pletely and even more important to attempt to prevent its occurence. 2 Battering Defined as a Uniform Phenomenon "Battering behavior" is the accepted term defined in the literature. Although this behavior is divided into "abuse" (injuries inflicted through a conscious act on the part of the parent) and "neglect" (injuries sustained through the parent's failure to act) most authors attempt nonetheless to find a common denominator. Gil (1968) defined abuse as a physical attack - including refusal of treatment - which is deliberate rather than circumstantial and ranges from miminal to fatal.