What is the role of environmental stress in the etiology of physical child abuse?

Updated: Apr 24, 2017
  • Author: Angelo P Giardino, MD, MPH, PhD; Chief Editor: Caroly Pataki, MD  more...
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Helfer builds on this ecological viewpoint and states that physical maltreatment arises when a caregiver and child interact around an event, in a given environment, with the end result being injury to the child. [8] Viewing maltreatment in this way allows consideration of the factors that the caregiver, child, and environment contribute to placing the child at risk for injury. The caregiver is viewed as having a personal developmental history, personality style, psychological functioning, and coping strategies. The caregiver often possesses expectations of the child, and a level of ability to nurture the child's development that meets the child's developmental and caregiving needs.

The child may have certain characteristics that make providing care more complex; however, caution must be used in considering the child's contribution to the abusive interactions. A "difficult" child does not justify abusive treatment by a caregiver. Specific factors that may place the child at higher risk for physical maltreatment include prematurity, poor bonding with caregiver, medical fragility, various special needs (attention deficit hyperactivity disorder), and the child being perceived as different (owing to physical, developmental, and/or behavioral/emotional abnormalities) or difficult, based on temperament style.

Finally, the environment may contain stressors that may make the caregiving less than ideal and may overextend the coping abilities of the caregiver. While exploring the role of environmental stress and caregiver frustration in the occurrence of child abuse, Straus and Kantor found a complex interaction between the amount of stress present in the family setting and the response of the caregivers. [9] Not all stressed caregivers responded by inflicting harm on the children in the environment.

Straus and Kantor concluded that human beings have a capacity for acting violently both in and outside the family setting. Physical abuse can result if a specific home situation arises that has a relatively high degree of stress and a baseline amount of violence within it (eg, spanking the children, pushing or slapping a spouse). Thus, risk of child abuse is related to the response of caregivers whose caregiving environment has a certain amount of overall risk for violent behavior. The caregivers' level of social connectedness to nonrelatives seems to have a role to play in the children's risk for maltreatment. Caregivers under high degrees of stress who did not participate in clubs, unions, and other organizations (ie, socially isolated) had higher rates of abusing children than those who were not as socially isolated. However, children whose caregivers had many family members living nearby did not achieve the same protective effect, as did the nonfamilial social connectedness group.

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