Emotionally abused infants and young children are harmed by the deprivation of nuturing affection and touch or exposed to toxic stress and fabricated or induced illness (Munchausen syndrome by proxy).
Lack of touch
In the 19th century it was noticed infants in institutions such as orphanages died from wasting away, then called marasmus, even when they were fed and changed (Chapin, 1915).(Now marasmus is a term used for wasting from lack of adequate nutrition and not from lack of touch.)
In 1945, Spitz investigated children in orphanages and recorded his research on film. The film Psychogenic Disease in Infancy (1952) shows the negative effects of emotional and maternal deprivation on attachment.Spitz’s research contributed to major changes in the care of institutionalized infants and children. Children without ample physical and emotional attention are more apt to have emotional and social problems (Harmon, 2010).
Field has recently conducted numerous studies using massage therapy on preterm newborns. Generally, her research shows greater and faster weight gain of infants who receive moderate pressure massage (Field, Hernandez-Reif & Freedman, 2004)
In addition, these weight gain findings have been replicated in other independent groups (Cifra & Sancho, 2004; De-Roiste & Bushnell, 1996). Field states warm and caring touch lowers stress hormones (e.g., cortisol), and stimulates the release of oxytocin, which enhances security, trust, and secure attachment (Field, 2004).
An outgrowth of these research studies has been the development of kangaroo or skin to skin care for preterm infants. Sharma,Murki andPratap (2016) studied the efficacy of kangaroo care on preterm infants in the Kangaroo ward compared with preterm infants receiving typical care in an intermediate intensive care. One hundred and forty-one infants were randomized to KWC (n = 71) or IIC (n = 70) once the infant reached a weight of 1150 g. There was significant reduction in IIC stay post randomization and increase in weight gain before discharge in the KWC group. There was a significant increase in incidence of apnea in the IIC group.
Toxic stress and toxic parents
Toxic stress comes about in children from adverse childhood experiences (ACEs) include dysfunctional parenting sometimes referred to as having toxic parents (Bucci et al, 2016). The dysfunction leads to prolonged stress responses which can become maladaptive and toxic to the growth and development of a child.
The toxic parent, mother and/or father, is typically not emotionally mature and can blame the child for his or her problems, while trying to live vicariously through the child. The actual type of toxicity varies but the following are common elements:
Inadequate parenting
- Demand the child take care of her or him, particularly doing work the parent should be doing
- Covers up inadequacies by misrepresenting the truth with the child often being presented as being at fault when in fact it is the parent’s doing
- Competes with the child for attention from the other parent
- Does not advocate for what would help the child’s growth and development
- Overshares personal information
Controller
- Controls time and affection between the other parent and child and other relatives
- Punishes the child by withholding affection or threatening to take away something significant
- Does not allow the child to express negative feelings
- Makes plan for the older child’s life even when contrary to the child’s wishes
- Gives away the child’s belongings without asking permission
Verbal abuser
- Sends constant negative messages about the child being unworthy of attention, love and validation.
- Screams threats
- Complains about what the parent had to give up because of the child, blaming the child (Forward & Buck, 2002) https://agileleanlife.com/toxic-parents/.
Nurses will see this type of parenting behavior in a variety of settings. A child can show physical signs of stress such as anxiety, worrying, not able to relax, aggressive behavior, no desire to participate in normal childhood activities. A referral can be made for counseling and/or child abuse agencies when severe. Adults can learn to detach emotionally from what the parent says or does if there is a desire to keep in contact with the parent. https://www.psychologytoday.com/us/blog/toxic-relationships/201808/12-signs-toxic-parent.
Fabricated or induced illness (Munchausen Syndrome by proxy)
Fabricate or induced illnesses, formerly known as Munchausen syndrome by proxy,are a form a mental illness in the caregiver that leads to child abuse. The child is given fake symptoms by the caretaker which can lead to physical discomfort and issues from unnecessary tests and issues. The child is subjected to hospitalizations, medical tests, surgeries and the belief he or she is very ill. The caretaker often works in health care and have information about medical care (Stirling, . 2007).
The fabricated symptoms can include the following:
- Add blood to the child's urine or stool
- Withhold food so the child looks like they can't gain weight
- Heat up thermometers so it looks like the child has a fever
- Falsifying lab results
- Give the child drugs to make the child throw up or have diarrhea
- Infect an intravenous (IV) line to make the child sick
https://medlineplus.gov/ency/article/001555.htm.
Diagnosis
The diagnosis of a fabricated illness can be difficult to make. The mother seems to be attentive to the child. The clues that can lead to a diagnosis are the following:
• The child sees a lot of health care providers and has been in the hospital a lot.
• The child often has had many tests, surgeries, or other procedures.
• The child has strange symptoms that don't fit with any disease. The symptoms do not match the test results.
• The child's symptoms are reported by the caretaker. They are never seen by health care professionals. The symptoms are gone in the hospital but start again when the child goes home.
• Blood samples do not match the child's blood type (Bass & Glaser, 2014).Treatment
Treatment includes first of all protecting the child. He or she many need to be removed from the caretaker faking the symptoms. Bass and Glaser (2014) state helping the perpetrator depends largely on the parents’ capacity to understand their pathology and be amenable to treatment. Medical care needs to be provided to treat injuries or infections. Counseling should be provided the child. If advisable, family therapy can be offered. This is a reportable child abuse offense and should be reported to the National Child Abuse Hotline 1-800-4-A-CHILD (1-800-422-4453) or the areas local reporting agency.https://medlineplus.gov/ency/article/001555.htm.
Instant Feedback:
A referral can be made for counseling and/or child abuse agencies when severe.
References
Bass, C. &Glaser, D.(2014). Early recognition and management of fabricated or
induced illness in children.Lancet. 383 (9926), 1412-21.
Bucci, M., Marques, S. S., Oh, D. & Harris, B. H. (2016). Toxic Stress in Children
and adolescents, Advances in Pediatrics. 62(1), 403-428.
Chapin, H.D. (1915).Are institutions for infants really necessary? Journal of the
American Medical Association, LXIV, 1–3.
Cifra, H.L. & Sancho, M.N. (2004). Massage therapy with preterm infants and
children withchronic illnesses. In: Field T, editor. Touch and Massage Therapy in
Early Development. Johnson & Johnson Pediatric Institute.
De-Roiste, A. & Bushnell, I.W.R. (1996). Tactile stimulation: short and long-term
benefits for preterm infants. British Journal of Developmental Psychology. 41,41–
53.
Field, T., Diego, M.& Hernandez-Reil, M. (2010). Preterm Infant Massage Therapy
Research: A Review. Infant Behav Dev. 33 (2), 115–124.
Forward, S. & Buck, C. (2002). Toxic Parents: Overcoming Their Hurtful Legacy and Reclaiming Your Life. Bantam books.
Glaser, D. (2002). Emotional abuse and neglect (psychological maltreatment): A conceptual framework. Child Abuse & Neglect, 26, 697-714.
Harmon, K. (2010). How Important Is Physical Contact with Your Infant? Scientific American. https://www.scientificamerican.com/article/infant-touch/.
Kent, A. & Waller, G. (1998). The impact of childhood emotional abuse: an
extension of the Child Abuse and Trauma Scale. Child Abuse and Neglect.
22(5), 393-399.
Korfmacher, J. (1998). Emotional Neglect: Being Hurt by What Is Not There.
Chicago: National Committee to Prevent Child Abuse.
Mathews, A. (2018). Surviving the toxic parent. Psychology Today.
https://www.psychologytoday.com/us/blog/traversing-the-inner-terrain/201805/surviving-the toxic-parent.
Royce, D. (2015). Emotional Abuse of Children. United Kingdom: Routledge publishing.
Shapiro, M. & Nguyen, M. (2011). Psychological sequelae of Munchausen's syndrome by proxy. Child Abuse Negl. 35: 87-88.
Sharma, D., Murki, S. &Pratap,O.T.(2016). The effect of kangaroo ward care in comparison with "intermediate intensive care" on the growth velocity in preterm infant with birth weight <1100 g: randomized control trial. Eur J Pediatr. 175(10),1317-24.
Spitz, R.A. (1965). The first year of life : a psychoanalytic study of normal and
deviant development of object relations. New York: International Universities Press.
Stirling, J. (2007). Beyond Munchausen Syndrome by Proxy: Identification and Treatment of Child Abuse in a Medical Setting, Pediatrics. 119, 1026-1030.
©RnCeus.com