In practice, there are borderline areas where what constitutes child abuse is not clear. For example, the U.S. Supreme Court has ruled (1944) that parents do not have an absolute right to deny life-saving medical treatment to their children, but devout members of the Church of Christ, Scientist, and other churches believe in the healing power of prayer and do not always seek medical help. Most U.S. states, however, permit parents to use religious beliefs as a defense against prosecution for the withholding of medical treatment from their sick children, even in cases where the lack of treatment results in a child's death.
There are many interacting causes of child abuse and neglect. Characteristics or circumstances of the abuser, the child, and the family may all contribute. In many cases the abuser was abused as a child. Substance abuse (see drug addiction and drug abuse) has been identified as a key factor in a growing number of cases. In some cases abusers do not have the education and skills needed to raise a child, thus increasing the likelihood of abuse, and providing inadequate parental role models for future generations. Children who are ill, disabled, or otherwise perceived as different are more likely to be the targets of abuse. In the family, marital discord, domestic violence, unemployment and poverty, and social isolation are all factors that can precipitate abuse.
Patterns of abusive behavior may result in the physical or mental impairment of the child or even death. Small children are especially vulnerable to physical injury such as whiplash or shaken infant syndrome resulting from battery. Abused children are more likely to experience generalized anxiety, depression, truancy, shame and guilt, or suicidal and homicidal thoughts or to engage in criminal activity, promiscuity, and substance abuse.
In the United States, New York became the first state to institute child protection laws (1875) that made abuse against children a crime, and other states soon followed with similar laws. In 1974 the U.S. Congress passed the Child Abuse Prevention and Treatment Act, which encouraged remaining states to pass child protection laws and created the National Center on Child Abuse and Neglect. In addition, all states have their own reporting laws, juvenile and family court laws, and criminal laws.
Cases of child abuse are handled by an multidisciplinary team including medical personnel, law enforcement officers, the schools, social workers, and the courts. School personnel may be the first to notice and report signs of abuse. Child-abuse cases are often coordinated by a community's child protective services unit, which sends case workers to the home for evaluation and offers services to the child and family. Medical professionals may report cases, provide treatment for injured children, provide testimony in court, or help to educate parents. Law enforcement personnel may be involved when cases are reported or when there is a question of a criminal action. The courts provide emergency protective orders or decide whether the child should be removed from the home. Child abuse may be punished by incarceration of the perpetrator or by the denial of custody rights to abusive parents or guardians.
Despite efforts to reduce child abuse in America, more than a million children are physically abused each year; about 2,000 die. Although the magnitude of sexual abuse of children in the United States is unknown, it is considered to be an escalating problem, and one that can result in serious psychological damage among victims. There are no reliable statistics available for emotional abuse and neglect, but these types of child abuse are as potentially damaging to their victims as are various forms of physical abuse. Child abuse extends across racial, ethnic, and socioeconomic lines, but there are consistently more reports concerning children born into poverty. The reporting of child abuse is complicated by the private nature of the crime, the fearfulness of the child, and strong motivation for denial in the abuser.
See J. Goldstein, A. Freud, A. J. Solnit, and S. Goldstein, In the Best Interests of the Child (1986); J. Garbarino, E. Guttmann, and J. W. Seeley, The Psychologically Battered Child (1987); D. E. H. Russell, The Secret Trauma: Incest in the Lives of Girls and Women (1986); R. E. Helfer and R. S. Kempe, The Battered Child (4th ed. 1987); D. J. Besharov, Recognizing Child Abuse: A Guide for the Concerned (1990); publications of the National Clearinghouse on Child Abuse and Neglect.
The convictions of the McCuans and Kniffens were overturned in 1996 and the two couples were released. In 2001, a TV movie about the Kniffens was released under the name Just Ask My Children.
Six similar cases occurred throughout Kern County. For instance, the testimony of five young boys was the prosecution's key evidence in a trial in which four defendants were convicted, with John Stoll, a 41-year-old carpenter, receiving the longest sentence of the group: 40 years for 17 counts of lewd and lascivious conduct. "It never happened," Ed Sampley, one of the accusers, told a New York Times reporter in 2004. He lied about Stoll. Sampley and three other former accusers returned in 2004 to the courthouse where they had testified against Stoll, this time to say that Stoll never molested them. In their late 20's, each of them said he always knew the truth -- that Stoll had never touched them. However, Stoll's son has "continued to say that he had been molested." In the case, the only defendant with a previous conviction of molestation was Grant Self, who rented Stoll's pool house briefly. Self had a long record of sex crimes against children. John Stoll had to wait until 2004 for the reversal of his convictions, but was released on the new testimony. Self remains in a mental hospital for sexual offenders because he had prior convictions for child molestation, had violated his parole by associating with children, and had violated hospital rules by possessing photos of young children.