Journal of Pediatric Nursing (2013) xx, xxx–xxx

Risk Factors for Child Abuse: Quantitative

Correlational Design1,2
Merav Ben-Natan RN, PhD a,b,⁎, Ira Sharon BA, RN a , Polina Barbashov BA, RN a ,
Yulia Minasyan BA, RN a , Isabella Hanukayev BA, RN a ,
David Kajdan BA, RN a , Adi Klein–Kremer MD c
a
Pat Matthews Academic School of Nursing, Hillel Yaffe Medical Center, Hadera, Israel
b
Department of Nursing, School of Health Professions, Tel Aviv University, Tel Aviv, Israel
c
Head of Pediatric Department, Hillel Yaffe Medical Center, Hadera, Israel

Key words:
The aim of this research study is to identify risk factors typical of different types of suspected child
Child abuse;
abuse reported at a hospital. The study was based on 114 cases of children for whom some type of abuse
Israel;
was reported. Physical abuse was the most frequently reported of all types of suspected child abuse.
Neglect;
Most victims of sexual abuse were female and at least half the cases of neglect and physical abuse were
Pediatric nursing
attributed to parents. Most cases were identified in the emergency room, by nurses. Children aged N 10
were more susceptible to physical abuse and neglect.
© 2013 Elsevier Inc. All rights reserved.

CHILD ABUSE IS a serious social problem threatening
the life and welfare of children and teens (Begle, Dumas, &
Hanson, 2010; Crawford, 2010; Shefe et al., 2007) and
overburdening the healthcare system (Fang, Brown, Flor-
ence, & Mercy, 2012). In many countries, including the US
(Dubowitz, 2007), England (Pritchard & Sharples, 2008) and
Israel (Yehuda, Attar-Schwartz, Ziv, Jedwab, & Benbe-
nishty, 2010) child abuse is the leading cause of children's
referral to social services. In 2009, 45,588 reports of
suspected child abuse were recorded in Israel, a sharp rise
of 171% in a matter of 15 years (Ben Arieh, Tzionit, &
1
Conflict of interest No conflict of interests has been declared by the
authors.
2
Author contributions: MBN, IS, PB,YM, IH, DK and AK were
responsible for the study conception and design. PB,YM, IH, and DK
performed the data collection and data analysis. MBN was responsible for
the drafting of the manuscript. MBN made critical revisions to the paper for
important intellectual content. MBN and IS provided statistical expertise. IS,
PB,YM, IH, DK and AK provided administrative, technical, and material
support. MBN supervised the study.
⁎ Corresponding author: Merav Ben-Natan RN, PhD.
E-mail address: meraav@hy.health.gov.il.
Berman, 2009). Most reports of child abuse in Israel focus on
several main types: physical, sexual and neglect.
Background
Child abuse is defined as physical, sexual, intellectual or
mental maltreatment, whether through action, omission or
continuous neglect (Yehuda et al., 2010; Zimmerman, 2006) or
by a child caregiver causing intentional harm or threatening to
cause harm to the child (Goldstein, 2005). Reporting child abuse
in Israel is mandatory, based on the 1989 amendment to the
Penal Law (amendment no. 26) part 6 sections 368a-368h,
which obligates both professionals and the population at large to
report violence towards minors or the helpless. Professionals
have an increased obligation to report, according to section
368d(b), which states: “A doctor, nurse, social worker, social
services worker, policeman, psychologist, criminologist or
paramedical therapist, or a director or staff member at a
residential home for minors or helpless people – who due to their
occupation or work had reasonable grounds to think that an
offense had been committed against a minor or a helpless person

0882-5963/$ – see front matter © 2013 Elsevier Inc. All rights reserved.
http://dx.doi.org/10.1016/j.pedn.2013.10.009
2 M. Ben-Natan et al.
by someone responsible for him – must report this as soon as
possible to a welfare officer or to the police; anyone violating
this instruction – is liable for a six-month prison sentence.”
Hospitals and clinics are the first point of arrival for many
children suspected of having been subjected to abuse. They
provide children with initial protection, access to professional
resources, proper references and care (Davidson-Arad &
Benbenishty, 2010). Therefore, abused children are currently
diagnosed based on the evaluations and diagnosis ability of
staff who treat the children, mainly nurses, doctors and social
workers. Nurses carry the most responsibility for detecting
cases of violence, as they are often the first to see abused
children when presenting at the hospital (Taylor, Baldwin, &
Spencer, 2008). Types of abuse most often reported are
physical violence, sexual violence and neglect, and they will
be the focus of this study (Glasser & Chen, 2006).
Physical abuse is defined as an action that causes
temporary or permanent damage to children's physical
functioning, for example: hitting, causing intentional burns,
hair pulling and choking (Crawford, 2010). Child sexual
abuse is defined as engaging children in sexual activities they
cannot understand or consent to, including genital or anal
contact; exposing the child to exhibitionism, voyeurism or
sexually explicit material; using the child in pornography;
and pandering the child for sex by others (Committee on
Child Abuse and Neglect, 2011).
Child neglect refers to inadequate care of the child's basic
needs, either physical or emotional. Child neglect may vary in
type, severity and length (Currie, Stabile, Maniyong, & Roos,
2010). In the US, neglect is the most prevalent type of abuse,
with over 794,000 cases in 2007. A study that examined the
occurrence of neglect among a sample of 303 child victims of
domestic violence found that 72.5% suffered from neglect
(Mennen, Kim, Sang, & Trickett, 2010). Physical abuse is the
second most frequent type of abuse; it is more common than
sexual abuse and has a greater likelihood of being inflicted on
both sexes, versus sexual abuse which is more typical of girls
than boys (Springer, Sheridan, Kuo, & Carnes, 2007). Similar
to the US findings, in Israel as well the most common type of
abuse is neglect, followed by physical and then sexual abuse
(Weisblay, 2010).
A literature review of child abuse shows that features of
the child and of the family system were found to have a
significant effect on the risk of child abuse. Conspicuous
features are: mother's origin, mother's limited schooling,
mother's young age at pregnancy, number of siblings (more
than 2), baby's sex, baby's low birth weight, poverty in the
family, and premature birth (Wu et al., 2004). The literature
shows that recurring violence against the child together with
a history of violence experienced by parents increase the risk
of violence towards children (Sidebotham & Heron, 2006;
Whitaker et al., 2008). Whitaker et al. show a high potential
for abuse also among parents who felt less control over their
child's aggressive behavior and developed a negative
approach towards their own educational methods and their
children's behavior (Begle et al., 2010).
The social–cultural setting has an effect on child abuse.
Shawna, Guterman, and Yookyong (2008) examined 1257
fathers from 20 cities in the US and found that men of
African American origin who live with a spouse and are
married have a greater risk of abusing their children than men
who live with a spouse and are not married. This correlation
was not found for men of Caucasian or Hispanic ethnicity.
They also found that men of Hispanic origin are less inclined
to inflict psychological abuse or physical abuse than men of
African American or Caucasian origins. These correlations
were found to be significant even after standardization for
sociodemographic variables such as level of income and
schooling. In addition, there is a correlation between
mother's ethnicity and the involvement of child protection
services. For example, Afro-American mothers were more
inclined to report child abuse than mothers from European
and South American origins (Begle et al., 2010). In addition,
single-parent families were found to have almost double the
risk of child abuse (Sidebotham & Heron, 2006).
In Israel, studies examining the effect of culture on child
abuse found cultural differences in how violence was
manifested in the family in regard to the assailant's and
victim's sex. For instance, differences were found between
Muslim, Druze and Bedouin Arabs and Christian Arabs. For
example, Muslim and Druze mothers were more inclined to
hit their children than Arab Christian mothers. In addition,
differences were also found in the reporting of violence
between Christian Arab society and Druze and Muslim Arab
society (Weisblay, 2010).
There are also differences between the Arab sector and the
Jewish sector, where members of the Arab sector are less
inclined to reporting violence against children to welfare
officers than members among the Jewish sector. This is a
result both of cultural characteristics and of a shortage of
professional human resources for detecting and treating such
cases, and does not indicate a lower rate of child abuse in the
Arab than in the Jewish sectors (Weisblay, 2010). Thus, in
2009 welfare officers at departments of social services
received 33,751 new reports of child abuse, including 5253
new reports of child abuse in the Arab sector—1116 reports
of domestic violence, 199 reports of sexual violence in the
family, and 2368 reports of neglect. That year, 2433 files on
domestic violence against minors were opened, including
242 in the Arab sector, and from January to October 2010
another 2066 files were opened, including 166 in the Arab
sector (Weisblay, 2010).
In the Jewish sector, a similar disparity was found
between the secular and Orthodox society (Haj-Yahia &
Ben-Arieh, 2000). Thus, in 2009, the 33,751 reports included
only 2194 cases of ultra-Orthodox children who had been
subjected to violence and risk situations in the family. The
reason for this disparity is that the obligation to report meets
with only partial compliance in ultra-Orthodox society and
the rate of applications to welfare officers regarding child
abuse in ultra-Orthodox towns is low in proportion to that of
the general population. Members of this sector are wary of
Risk Factor for Child Abuse
the criminal process and of the publicity involved and also do
not trust the police (Weisblay, 2010). This disparity was also
evident between urban and rural families, with urban families
reporting abuse more than rural families (Haj-Yahia & Ben-
Arieh, 2000; Roer-Strier, 2001).
The relationship between poverty, level of schooling, and
child abuse, is a recurring variable in many studies (Coohey,
2006). In poor towns and residential areas there is a higher
rate of child abuse, such that the lower the income level the
higher the risk of child abuse. This is also true of parents'
schooling, such that the lower the schooling the higher the
risk of abuse (Guterman, Shawana, Yookyong, Waldfogel, &
Rathouz, 2009). In addition, it seems that having a social
network and social support are a significant factor in family
decisions concerning stressful life events. In cases of a
limited social network there is an increased risk of child
abuse (Sidebotham & Heron, 2006). Moreover, studies have
shown that one's quality of and satisfaction with social
support, predict the potential for abuse, such that the lower
one's satisfaction with social support the higher the risk of
child abuse (Begle et al., 2010). Child's age is another risk
factor, as it seems that the highest rate of abuse is evident
from birth to 1 year. Children 3 and younger had the highest
risk of becoming victims of abuse or neglect (Wu et al.,
2004). Regarding child's sex, opinions are mixed (Side-
botham & Heron, 2006).
The fact that the risk factors for each of these types of
common abuse have not been studied in Israel, side by side
with the lack of uniformity among the global literature on
potential risk factors for frequent types of child abuse,
indicate the need to explore and understand this important
topic, with the aim of facilitating its optimal treatment.
Aim
The purpose of this study was to identify the risk factors
characteristic of those types of abuse reported on the
Ministry of Health's form for reporting violence (physical
abuse, sexual abuse and neglect) against minors and the
helpless. In other words, does the familial, social, and
cultural system in which the child was raised, as well as
personal features, affect the risk of abuse for each of the
types of abuse mentioned, and which of these factors is the
most significant risk factor for each of the types of abuse.
Method
Design and Sample
This correlational design study was conducted in Israel
between November 2011 and April 2012. The sample
included all files of children aged 0–18 for whom there was a
report of one of the types of abuse in the medical records of
3
the medical center from the previous three years (2008–
2010). A total of 114 cases were examined. This medical
center is located in a geographical region with a high
proportion of Arab residents. As a result, over 50% of
patients at the medical center are Arab, a disproportionate
number in comparison to the total proportion of Arabs in
Israel, which is 20.6% (Central Bureau of Statistics, 2013).
Data Collection
After receiving the approval of the institutional ethics
committee, the researchers collected data from the medical
records of children suspected of having been subjected to one
of the following types of abuse: physical, sexual or neglect,
using a data extraction form created by the researchers on the
basis of the literature review. The structured form comprised
13 items. Five items dealt with sociodemographic informa-
tion on the child and family (for example, age, sex), five with
the identifying person and setting (for example, who was the
caregiver who identified the abuse), and three with the abuse
itself (for example, type of abuse).
Ethical Considerations
This study was conducted with the approval of the
Helsinki Ethics Committee at the hospital in Israel where the
research was conducted.
Data Analysis
The data were analyzed using the Statistical Package for the
Social Sciences version 19 for Windows (SPSS Inc., Chicago,
IL, USA). Descriptive statistics, i.e. frequencies, percentages,
means, ranges, SD and correlation, were used. The analysis
was conducted in two stages: in the first, the three groups of
cases of abuse were compared for each of the study variables.
In the second stage, multiple logistic regressions were carried
out to determine which variables can significantly and
independently predict the three types of abuse.
Findings
The research findings show that children who were
subjected to abuse were in the age range of 10 months to
18 years, with a mean age of 7 (SD = 6.2). Most of the
children were Israeli born (97.4%; n = 111) and the
distribution of sexes was almost equal (boys, n = 56; girls,
n = 58). Most were of Arab origin (67.5%; n = 77) and the
remainder were Jewish (32.5%; n = 37). About one half of
the Jewish children were of Ashkenazi descent (51.4%; n =
19) and half of Sephardic descent (48.6%; n = 18). Most of
the children's parents were married (71.9%; n = 82) and for
20.2% of the children the marital status of their parents was
unknown (n = 23), while the parents of 7% of the children
(n = 8) were divorced and of 0.9% (n = 1) widowed
4 M. Ben-Natan et al.

(Table 1). In about half of the cases the abuser was a parent Table 2 Findings With Distribution of Types of Abuse
(49.1%; n = 56), in 20.2% (n = 23) the abuser was another (N = 114)
family member, while in the remainder of the cases, the Sexual Abuse Physical Neglect
abuser was not a family member. In regard to type of abuse, Variables n (%) Abuse n (%) n (%)
most children were found to have been subjected to physical
Age
abuse (61.4%; n = 70), 25.4% of the children (n = 29) had
Over 10 9 (47%) 36 (53%) 26 (96%)
been neglected, and 13.2% (n = 15) had been subjected to Under 10 10 (53%) 32(47%) 1 (4%)
sexual abuse. p b 0.012 p b 0.01
The correlation between the abuser and the type of abuse χ2(1) = 6.31: χ2(1) =
shows a significant difference between the identity of the 14.84:
abuser for the various types of abuse, where half the cases of Sex
physical abuse were attributed to a parent (50%; n = 34) as Male 5 (26%) 37 (54%) 14 (52%)
were 590% of the cases of neglect (n = 17), versus sexual Female 14 (74%) 31 (46%) 13 (48%)
abuse, where 26% (n = 5) of the cases were perpetrated by p b 0.01
someone who was not a family member (χ2 = 9.62, df = 4, χ2(1) = 6.58:
Nationality
p b 0.05) (Table 2). In about half of the cases (44.7%) were
Jewish 14 (74%) 19 (28%) 4 (15%)
identified by a nurse (n = 51), in 29.8% (n = 34) by a doctor,
Arab 5 (26%) 49 (72%) 23 (85%)
in 14% of cases (n = 16) by a social worker, and in other p b 0.01
cases the identifying person was unknown. Most of the χ2(1) =
children (73%; n = 83) were identified in the emergency 18.46:
room, 24% of children (n = 27) on a hospital ward, and 4% Ethnicity
(n = 4) in the community. Sephardic 5 (26%) 10 (15%) 3 (11%)
Ashkenazi 9 (48%) 9 (13%) 1 (4%)
Physical and Neglect Abuse Arab 5 (26%) 49 (72%) 2 (85%)
p b 0.01 χ2
(2) = 21.008:
The research findings show that being at an age more than Reason for application
10 was characteristic of children who have been subjected to Bruises/burns 5 (26%) 58 (85%) 16 (59%)
physical abuse (χ2 = 6.32, df = 1, p b 0.05) and neglect Gynecological 14 (74%) 10 (15%) 11 (41%)
(χ2 = 14.84, df = 1, p b 0.01), with the following percent- p b 0.01 p b 0.01
ages (physical: 47%; n = 32, and neglect: 96.0%; n = 24). χ2(1) = χ2(1) = 28.5:
The findings also show that in physical abuse the most 16.92:
common reason for seeking treatment was bruises and burns, Assailant
where 85% (n = 58) of children presented at the hospital Parent 5 (26%) 34 (50%) 17 (59%)
with such complaints (χ2 = 28.50, df = 1, p b 0.01). In Other family 7 (37%) 16 (24%) 2 (7%)
member
No 7 (37%) 18 (26%) 10 (34%)
information
Table 1 Sociodemographic Data (N = 114) p b 0.029
χ2(2) = 7.07:
Variable n % Identifying setting
Sex Emergency 12 (63%) 53 (78%) 17 (63%)
Male 56 49.1 room
Female 58 50.8 Hospital ward 0 (0%) 15 (22%) 9 (33%)
Age (years) Community 7 (37%) 0 (0%) 1 (4%)
M (SD) 7 (6.2) p b 0.01 p b 0.003
Sector χ2(2) = χ2(2) =
Jewish 37 32.5 20.88: 11.945:
Arab 77 67.5 Domestic violence
Ethnicity Yes 17 (100%) 55 (81%) 22 (76%)
Sephardic (Jewish) 18 48.6 No 0 (0%) 13 (19.2%) 7 (24%)
Ashkenazi (Jewish) 19 51.4
Arab 77 67.5
Parent marital status
addition, most cases of physical abuse were found to have
Married 82 71.9
Divorced 8 7 been identified at the emergency room (78%; n = 53) and
Widow 1 0.9 the rest on hospital wards (22%; n = 15). No cases of
Unknown 23 20.2 physical abuse were identified in the community (χ2 =
11.94, df = 2, p b 0.05).
Risk Factor for Child Abuse
Table 3 Regression Physical and Neglect
Variables in the Equation
B S.E. Wald df Sig. Exp(B)
Age 1.297 .523 6.164 1 .013 3.660
Type of − 2.131 .524 16.561 1 .000 .119
abuse
Constant − 18.866 13,770.476 .000 1 .999 .000
R2 = 40.3%.
Another finding indicates a correlation between a
history of previous domestic abuse and the risk of physical
abuse of children, such that 81% (n = 55) of all children
who had been subjected to physical violence had a history
of previous domestic violence (χ 2 = 12.77, df = 4,
p b 0.01(. In contrast, for neglect there was a significant
effect of ethnicity, where the large majority of children
(85.0%; n = 23) were of Arab descent (χ2 = 3.71, df = 1,
p b 0.05). In order to examine which factors can
significantly and independently predict physical abuse
and neglect, a logistical regression was performed
(Table 3). This test showed that the child's age (older
than 10) can predict physical abuse or neglect, where the
model's predictive ability is R2 = 40.3%.
Sexual Abuse
The research findings indicate that girls have a higher risk
than boys of being subjected to sexual abuse, and 74% (n =
14) of the victims were girls (χ2 = 18.46, df = 1, p b 0.01).
About half the female victims (48%; n = 9) were Jews of
Ashkenazi descent (χ2 = 21.00, df = 2, p b 0.01) and the
rest Jews of Sephardic descent (26%; n = 5) and Arabs
(26%; n = 5). In addition, parents were found to be the
assailants in one fifth of the cases (26%; n = 5) while in 37%
of cases the assailant was another family member (n = 7). In
the remainder of cases the identity of the assailant was
unknown (χ2 = 7.07, df = 2, p b 0.05). Moreover, a signif-
icant difference was found between the settings in which the
abuse was identified, such that most of the cases of sexual
abuse were identified in the emergency room (63%; n = 12)
and the rest in the community (37%; n = 7). No cases
of sexual abuse was identified in a hospital ward (χ2\ =
20.88, df = 2, p b 0.01). In addition, all abused children
whose parents were divorced were found to be victims of
sexual abuse.
Limitations of the Study
The main limitation of the study were that participants
were recruited from only one Israeli hospital. The current
research population is small and limited from a geographical,
cultural and ethnic perspective. It is advisable to conduct a
5
study on this topic with a larger and more varied research
population in order to receive more extended and precise
information on causes of abuse that are true of the different
types of abuse. In addition, in the future it would be useful to
examine which factors cause nurses to identify or report
child abuse. The subjects in the study were reported to
have been the victims of child abuse yet the actual number
of children who were confirmed as victims of child abuse
is unknown.
Discussion
Child abuse is a serious social problem with implica-
tions for all fields of life, both for children and for society
(Feng & Levine, 2005; Feng & Wu, 2005; Shefe et al.,
2007). In Israel in 2010, about 2400 children presented at
emergency rooms as a result of abuse in the family. Of
these, about 37% presented due to violence, about 35%
due to neglect, and about 10% due to sexual abuse
(Weisblay, 2010).
The incidence rates of types of abuse in this study are
similar to those found in Israel and elsewhere (Allin, Wathen,
& MacMillan, 2005; Maguire, Mann, Sibert, & Kemp, 2005;
May-Chahal & Cawson, 2005; Perez-Albeniz & De Paul,
2005) and physical violence and neglect are the most
common forms of violence against children found in this
study. A possible reason that cases of sexual abuse against
children constitute the least frequent type of abuse is that in
cases of sexual abuse children are ashamed to tell others what
happened to them and fear that their story will not be
believed (Saisan, Smith, & Segal, 2012).
According to the research findings, most cases of child
abuse were identified in the hospital, and the literature shows
that hospitals are the first point of entrance for many children
suspected as having been subjected to abuse. They provide
the child with initial protection, access to professional
resources, appropriate references and treatment. Identifica-
tion of child abuse always requires the expertise of the
medical staff (Davidson-Arad & Benbenishty, 2010). In
addition, the research findings show that most children who
experienced abuse were of Arab descent. This finding is
compatible with the literature (Al-Mahroos, 2007; Al-
Mahroos, Abdulla, Kamal, & Al-Ansari, 2005) and it has
several possible explanations. One is that in this study the
files examined were those for whom abuse was reported, and
there may be an excessive assumption of cases of abuse
among the Arab population which are later disconfirmed. In
addition, the hospital where this study was conducted is
located geographically in a place that caters to a wide Arab
population. Al-Mahroos (2007), who researched child abuse
in the seven countries of the Arab Peninsula, found that
children in the Arab Peninsula are subjected to all forms of
child abuse and neglect. Child abuse is ignored or may even
be tolerated and accepted as a form of discipline, while
6 M. Ben-Natan et al.
abused children continue to suffer and most abusers go free,
unpunished and untreated.
Physical Abuse and Neglect
The research findings show that both physical abuse and
neglect is found more often in children older than 10. This
finding contradicts the existing literature that shows that it is
more common in younger children (Sedlak et al., 2010).
A possible explanation of this finding is that children
older than 10 are perceived as sufficiently mature to take
responsibility for their actions, and this is why more serious
physical punishments are inflicted on them as part of parents'
customary and legitimate educational methods (Al-Mahroos,
2007; Krug, Dahlberg, Mercy, Zwi, & Lozano, 2002). This
finding might even illuminate other findings whereby the
main perpetrator of physical abuse is the parent, and the most
common causes of coming to the hospital are bruises and
burns, where 87.1% of children present with such a
complaint. This finding is compatible with that of Pabis,
Wronska, Slusarska, and Cuber (2011) who found that
various types of bruises and burns constitute about 80% of
offenses against abused children.
In addition, neglect was found to be more typical of the
Arab population (84%) than of the Jewish population (16%).
These findings are incompatible with those of Ben-Arieh,
Boyer, and Gajst, (2004) who found that rates of reported
neglect are lower among the Arab than among the Jewish
population. A possible reason for this contradiction might
have to do with the fact that the Arab population usually
constitutes a population with a lower socioeconomic status
and one with which social services are more familiar
(NSPCC, 2007).
Sexual Abuse
The research findings indicate that girls (80%) are
subjected to sexual abuse more than boys. A similar finding
was found by Saewyc, Pettingell, and Magee, (2003) who
found that sexual abuse was reported among girls five times
more than among boys. The reason may have to do with the
fact that girls have a lower status in society and less power
and therefore have a higher risk of being victimized. An
alternative explanation for these results is the lower chance
of boys' reporting sexual harassment, as fear of a
homosexual stigma and of loss of self-esteem may cause
boys to report abuse less than girls (Valente, 2005).
Another finding shows that sexual abuse is more typical
of the Jewish population (80%) than of the Arab population
(20%). A possible explanation of the lower reports among
the Arab population is rooted in its religious tradition. In
this population the status of a girl's virginity is very sig-
nificant and a potential accusation of loss of virginity can
prevent girls from telling their parents about incidents of
abuse and make it harder for parents to apply for pro-
fessional help, in the concern that this might be harmful to
the girl's “value” and even to the honor of the entire family.
Observation of the values of “haya” (modesty) and “haram”
(shame) does not arouse awareness or encourage reporting
of such problems.
In contrast to the Arab population, in the Jewish
tradition cases of sexual abuse and incest legitimize
removal of parents who sexually molest their children
and also justify actions against the abusers (Fonter &
Plamer, 2010). In addition, differences were found between
Jews of Ashkenazi descent (who came from Western
countries), who report sexual abuse more than Jews of
Sephardic descent (53.3 versus 26.7%). This may be
because the culture of Jews of Sephardic descent (who
came from Arab countries) has been affected by the Arab
culture due to their lengthy historical contact with the Arab
populations among whom they lived, whose culture is
based on a patriarchal ideology that espouses values of
preserving family honor and respect for parents, more than
individual human dignity (Lev, 2003).
The research findings show that family members
constitute the main assailants in cases of sexual abuse
(60%). These findings contradict those of Weisblay (2010)
who found that acquaintances or friends constitute the
main assailants, rather than family members. A possible
explanation of this finding may derive from the fact that in a
large proportion of cases, the assailant is unknown. In
other words, the “unknown” person may actually be an
acquaintance or family member of the child. Nonetheless, a
possible explanation of why family members constitute
the assailants is that normally, children crave attention
and affection; however, this could be transformed into
exploitation and sexual abuse. In addition, sometimes the
significant relationship between children and their family
makes it hard for children to interpret the action as sexual
abuse (Dedel, 2010).
Conclusions and Implications
Child abuse is a serious and worrisome problem all
over the world and in Israel in particular. A promising array
of prevention and response programs have a great potential
of reducing child maltreatment. Since it is often nurses
who are the first to come into contact with reports of the
abuse, nurses must be aware of the prevalent types of abuse
(physical, neglect and sexual) with an emphasis on the
various risk factors. For this purpose, nurses should
participate in designated programs training them to identify
children at risk of abuse in order to facilitate professional
care by nurses and other caregivers, while remaining
sensitive to and understanding of cultural differences within
the population.
The education of nurses who work with children can be
developed by incorporating more applied knowledge
Risk Factor for Child Abuse
concerning interventions with child abuse into nursing
curricula and simulated practice on working with high-risk
children. Nurses might also need additional support and
supervision to handle complex situations. Discussions with
colleagues would offer them a chance to provide and receive
support. This topic should be further studied through an
ethnographic or anthropological lens.
Acknowledgments
This research received no specific grant from any funding
agency in the public, commercial, or non-profit sectors.
References
Allin, H., Wathen, C. N., & MacMillan, H. (2005). Treatment of child
neglect: A systematic review. Canadian Journal of Psychiatry, 50,
497–504.
Al-Mahroos, F. (2007). Child abuse and neglect in the Arab Peninsula.
Saudi Medical Journal, 28, 241–248.
Al-Mahroos, F., Abdulla, F., Kamal, S., & Al-Ansari, A. (2005). Child
abuse: Bahrain's experience. Child Abuse and Neglect, 29, 87–93.
Begle, A. M., Dumas, J. E., & Hanson, R. F. (2010). Predicting child
abuse potential: An empirical investigation of two theoretical
frameworks. Journal of Clinical Child & Adolescent Psychology,
39, 208–219.
Ben Arieh, A., Tzionit, Y., & Berman, T. (2009). Children in Israel 2009.
Jerusalem: The National Commission for the Wellbeing of Children
[Hebrew].
Ben-Arieh, A., Boyer, Y., & Gajst, I. (2004). Children's welfare in Israel:
Growing up in a multi-cultural society. Children's Welfare in Ageing
Europe, 2, 771–811.
Central Bureau of Statistics (2013). Report of the demographic situation in
Israel. Available at: http://www.cbs.gov.il/population/demo_skira.pdf
(accessed 27/05/12).
Committee on Child Abuse and Neglect (2011). Protecting children from
sexual abuse by health care providers. Pediatrics, 128, 407–426.
Coohey, C. (2006). Physically abusive fathers and risk assessment. Child
Abuse and Neglect, 30, 467–480.
Crawford, M. (2010). Physical abuse: Pitfalls and challenges. Pediatrics
and Child Health, 20, 566–570.
Currie, J., Stabile, M., Maniyong, P., & Roos, L. (2010). Child health
and young adult outcomes. Journal of Human Resources, 45,
517–548.
Davidson-Arad, B., & Benbenishty, R. (2010). Distinguishing neglect from
abuse and accident: Analysis of the case files of a hospital child
protection team in Israel. Health and Social Care in the Community, 18,
614–623.
Dedel, K. (2010). Child abuse and neglect in the home. Problem-Oriented
Guides for Police Problem-Specific Guides Series. Guide No. 55
(pp. 1–74).
Dubowitz, H. (2007). Understanding and addressing the “neglect of
neglect”: Digging into the molehill. Child Abuse & Neglect, 31,
603–606.
Fang, X., Brown, D. S., Florence, C. S., & Mercy, J. A. (2012). The
economic burden of child maltreatment in the United States and
implications for prevention. Child Abuse & Neglect, 36, 156–165.
Feng, J. Y., & Levine, M. (2005). Factors associated with nurses' intention
to report child abuse: A national survey of Taiwanese nurses. Child
Abuse & Neglect, 29, 783–795.
7
Feng, J., & Wu, Y. B. (2005). Nurses' intention to report child abuse in
Taiwan: A test of the theory of planned behavior. Research in Nursing
& Health, 28, 337–347.
Fonter, L. A., & Plamer, C. (2010). Cultural issues in disclosures of child
sexual abuse. Journal of Child Sexual Abuse, 19, 491–518.
Glasser, S., & Chen, W. (2006). Survey of a pediatric hospital staff
regarding cases of suspected child abuse and neglect. Israel Medical
Association Journal, 8, 179–183.
Goldstein, S. (2005). Talking silence. Jerusalem (pp. 21–211) [Hebrew].
Guterman, N. B., Shawana, J. L., Yookyong, L., Waldfogel, J., & Rathouz,
P. J. (2009). Fathers and maternal risk for physical child abuse. Child
Maltreatment, 14, 277–290.
Haj-Yahia, M. M., & Ben-Arieh, A. (2000). The incidence of
Arab adolescents' exposure to violence in their families of origin and
its sociodemographic correlates. Child Abuse & Neglect, 24,
1299–1315.
Krug, E. G., Dahlberg, L. L., Mercy, J. A., Zwi, A. B., & Lozano, R. (2002).
World Report on Violence and Health. Geneva: World Health
Organization.
Lev, R. (2003). Shine the light: Sexual abuse and healing in the
Jewish community (pp. 46–60). Boston: Northeastern University
Press.
Maguire, S., Mann, M. K., Sibert, J., & Kemp, A. (2005). Are there patterns
of bruising in childhood which are diagnostic or suggestive of abuse? A
systematic review. Archives of Disease in Childhood, 90, 182–186.
May-Chahal, C., & Cawson, P. (2005). Measuring child maltreatment in
United Kingdom: A study of the prevalence of child abuse and neglect.
Child Abuse & Neglect, 29, 969–984.
Mennen, F. E., Kim, K., Sang, J., & Trickett, P. K. (2010). Child neglect:
Definition and identification of adolescents' experiences. Child Abuse &
Neglect, 34, 647–658.
NSPCC (2007). Child protection research briefing child neglect. Available
at: www.nspcc.org.uk/inform (accessed 27/05/12).
Pabis, M., Wronska, I., Slusarska, B., & Cuber, T. (2011). Paediatric nurses'
identification of violence against children. Journal of Advanced
Nursing, 67, 384–393.
Perez-Albeniz, A., & De Paul, J. (2005). Empathy in individuals at risk for
child physical abuse: The effects of victim's pain cues on aggression.
Aggressive Behaviour, 31, 336–349.
Pritchard, C., & Sharples, A. (2008). Violent deaths of children in
England and Wales compared to the major developed countries 1974–
2002: Possible evidence for improving child protection? Child Abuse
Review, 17, 297–312.
Roer-Strier, D. (2001). Reducing risk for children in changing cultural
contexts: Recommendations for training and intervention. Child Abuse
and Neglect, 25, 231–248.
Saewyc, M. E., Pettingell, S., & Magee, L. L. (2003). The prevalence of
sexual abuse among adolescents in school. The Journal of School
Nursing, 19, 266–271.
Saisan, J., Smith, M., & Segal, J. (2012). Child abuse and neglect. Available at:
http://www.helpguide.org/mental/childabusephysicalemotionalsexual
neglect.htm (accessed 27/05/2012).
Sedlak, A. J., Mettenburg, J., Basena, M., Petta, I., McPherson, K., Green,
A., et al. (2010). Child abuse and neglect. Fourth National Incidence
Study of Child Abuse and Neglect (NIS-4).
Shawna, J. L., Guterman, N. B., & Yookyong, L. (2008). Risk factors
for paternal physical child abuse. Child Abuse & Neglect, 32,
846–858.
Shefe, T. D., Dascal-Weichhendle, H., Rubin, O., Pessach, N., Itzik, D.,
Benita, S., et al. (2007). Domestic violence: A national simulation-based
educational program to improve physicians' knowledge, skills and
detection rates. Medical Teacher, 29, 133–138.
Sidebotham, P., & Heron, J. (2006). Child maltreatment in the “children of
the nineties”: A cohort study of risk factors. Child Abuse & Neglect, 30,
497–522.
Springer, K. W., Sheridan, J., Kuo, D., & Carnes, M. (2007). Long-term
physical and mental health consequences of childhood physical abuse:
8 M. Ben-Natan et al.
Results from a large population-based sample of men and women. Child
Abuse & Neglect, 31, 517–530.
Taylor, J., Baldwin, N., & Spencer, N. (2008). Predicting child abuse and
neglect: Ethical, theoretical and methodological challenges. Journal of
Clinical Nursing, 17, 1193–1200.
Valente, S. M. (2005). Sexual abuse of boys. Journal of child and
adolescent psychiatric nursing, 18, 10–16.
Weisblay, A. (2010). The authorities' treatment of reports of sexual offenses
against children and teenagers. Jerusalem: The Knesset, Research and
Information Centre [Hebrew].
Whitaker, D. J., Le, B., Hanson, R. K., Baker, C. K., McMahon, P. M.,
Ryan, G., et al. (2008). Risk factors for the perpetration of child sexual
abuse: A review and meta-analysis. Child Abuse & Neglect, 32,
529–548.
Wu, S. S., Ma, C. X., Carter, R. L., Ariet, M., Feaver, E. A., Resnick, M. B.,
et al. (2004). Risk factors for infant maltreatment: A population-based
study. Child Abuse & Neglect, 28, 1253–1264.
Yehuda, Y. B., Attar-Schwartz, S., Ziv, A., Jedwab, M., & Benbenishty, R.
(2010). Child abuse and neglect: Reporting by health professionals and
their need for training. Israel Medical Association Journal, 12, 598–602.
Zimmerman, S. (2006). The phenomenon of abuse and sexual assault.
Ministerial Commission for Prevention of Violence. Available at: http://
www.alimut.gov.il/template/default.asp?PageId=107&catId=
7&maincat=1 (Accessed 3/2/2011) [Hebrew].