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Please read the materials provided and write a reflection paper by answering the following questions and according to the rubric.

(1) What were 3 of the most important points made in the chapters/presentations/videos in the past week?
(2) What controversial issues or information (include 2) challenged your assumptions or surprised you?

• Do not use much of the page to indicate your name and other personal details
• Do not submit the answers to these questions in a bulleted format. Use the questions listed above as a guide to write a complete full page answer.
• Paper must read well and be well-organized. Make sure that points 1 and 2 are clearly addressed in your write up

I am attaching requirements, materials and examples from previous weeks. You don't need to write a full citation, simply mention from what article/work the idea came from (see examples).

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CM E Child Physical Abuse: The Need for an Objective Assessment Emalee G. Flaherty, MD; and Amanda K. Fingarson, DO CM E EDUCATIONAL OBJECTIVES 1. Identify factors that inhibit physicians from reporting child abuse when identified in the office setting. 2. Determine indicators that provide objective support to a diagnosis of suspected physical abuse. Emalee G. Flaherty, MD, is an Associate Professor in Pediatrics–Academic General Pediatrics and Primary Care, Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago and Northwestern University Feinberg School of Medicine. Amanda K. Fingarson, DO, is an Instructor in Pediatrics–Academic General Pediatrics and Primary Care, Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago and Northwestern University Feinberg School of Medicine. Address correspondence to: Emalee G. Flaherty, MD, Ann & Robert H. Lurie Children’s Hospital of Chicago, 225 E. Chicago Avenue, Box 16, Chicago, IL 60611; fax: 312-227-9418; email: eflaherty@luriechildrens.org. Disclosure: The authors have no relevant financial relationships to disclose. doi: 10.3928/00904481-20121126-12 PEDIATRIC ANNALS 41:12 | DECEMBER 2012 © Shutterstock 3. Develop increased confidence in reliably identifying and reporting suspected child physical abuse. P hysicians may fail to recognize child abuse for a number of reasons,1 including a lack of training and experience. Many physicians received little training during medical school or residency;2 such training increases pediatric residents’ self-rating of competency in evaluating child maltreatment.3 Pediatricians and pediatric residents who received child abuse education expressed more confidence in their ability to identify and manage child maltreatment4,5 and were more likely to diagnose child maltreatment.6 Because the diagnosis of child maltreatment requires a thorough clinical and historical assessment, the diagnosis can be missed if the physician does not ask detailed questions about how an injury occurred, whether witnesses were present, and whether the child suffered previous injuries.7,8 A careful Healio.com/Pediatrics | 1 CM E physical examination may reveal bruises, the most common injury caused by child abuse.9 Finally, appropriate laboratory and imaging studies may reveal old or occult fractures, intracranial bleeding, or the presence of other medical conditions, which explain the observed injuries. FAILURE TO DIAGNOSE CHILD ABUSE Not Enough Data Gathered If child abuse is not considered a possibility or included in differential diagnoses, the diagnosis may be missed.10 Complete evaluations are often not accomplished; a small study of children younger than 2 years of age with subdural hematomas demonstrated that only 22 of 33 children had received all basic laboratory and imaging tests.11 When physicians do order appropriate imaging studies, the diagnosis of child abuse may be missed if imaging studies are of poor quality, incomplete, or incorrectly interpreted.12 The physician must identify any child, family, and social factors that may place a child at risk of abuse, recognizing that the absence of obvious risk factors does not rule out child abuse. Children with physical, cognitive, or emotional disabilities are more vulnerable to abuse.13,14 Parental stress, poverty, unwanted pregnancies, maternal depression, substance abuse, and interpersonal violence are associated with child abuse.15,16 A caregiver’s poor understanding of appropriate child development and behavior also increases the risk of abuse.17 Physician Bias Physicians may fail to identify child maltreatment if they are not objective in their assessment because they have preconceived ideas about who abuses children. A study by Jenny et al18 examining cases of abusive head trauma left undiagnosed by physicians, found 2 | Healio.com/Pediatrics that missed cases were more likely to involve white, two-parent families. This confirms other studies with similar findings about race and class.19 Even after adjusting for socioeconomic differences, minority children older than 1 year with an accidental injury were three times more likely than a white child with an accidental injury to receive an unnecessary skeletal survey.20 Physicians may fail to identify child maltreatment if they are not objective in their assessment. In other studies, race did not influence physician willingness to consider the possibility of child abuse, but socioeconomic status did.21,22 Biases can influence clinical reasoning and lead to misdiagnosis. The dual process model of reasoning divides decision making into two types of reasoning: intuitive reasoning and analytical reasoning.23 Biases particularly affect intuitive reasoning because physicians rely on their previous training and experience. Although intuitive reasoning is fast and reflexive, errors are common. Analytical reasoning is more deliberate and more rule-based. Physicians may follow guidelines or decision trees. This type of reasoning is slower, but much less prone to error. Generally, physicians use both systems and move back and forth between the two. When a physician recognizes a certain pattern early, then the quicker intuitive thinking takes over. If a pattern is not recognized, the physician engages in more analytical thinking. When abuse is possible, the physician should take a more analytical approach and perform a more systematic evaluation to avoid errors in decision making. FAILURE TO REPORT SUSPECTED CHILD ABUSE Physician Uncertainty Physicians have admitted that they do not report all cases of suspected maltreatment.24-26 When physician reporting behavior was examined prospectively, physicians failed to report 27% of children with injuries they suspected were likely or very likely caused by child abuse.27 Physicians said the main reason they did not report suspected abuse was they were not certain that it was child abuse,24,25 although states mandate physicians to report if they have “reasonable cause” to suspect child abuse rather than “certainty” that a child was abused. Unfamiliarity with Child Protective Services Physicians also cited their previous experience with Child Protective Services (CPS) and factors related to CPS, including their own prior reporting experiences such as CPS failing to protect a child, as reasons for not reporting.25,26,28 The physicians also said they did not report because they were concerned that they would lose families from their practice and that they would have to appear in court.25,26 As with the diagnosis of abuse, child and family features influence the likelihood that a physician will make a CPS report. In one study, physicians were PEDIATRIC ANNALS 41:12 | DECEMBER 2012 CM E more likely to report suspected abuse when they were unfamiliar with the family, and when the child was black with private insurance.27,28 Among children without private insurance, reporting rates were the same for black and white patients. Black patients may not have been over-reported, but instead white patients may have been underreported.18 Other studies showed that physicians were more likely to report younger children and children from poor families.29 Physician biases appear to influence their reporting decisions just as biases may influence their diagnosis or recognition of child abuse. MANDATE TO REPORT Although all 50 states mandate that physicians report suspected child abuse to CPS, physicians appear confused about the meaning of these state laws.30 In the Child Abuse Reporting Experience Study, clinicians showed great variability in reporting injuries at various levels of suspicion. They reported 0.5% of the patients with injuries they judged “unlikely” to be caused by child abuse, 24% of the injuries they deemed “possible,” and 86% of those they judged “likely caused by abuse.” Only 64% of the injuries judged “very likely” caused by child abuse were reported, suggesting that additional factors influenced the physicians’ decisions to report.27 Reasonable Suspicion Levi and Brown31 have conducted several studies examining how physicians interpret the concept of reasonable suspicion. He found great variability in how they interpreted “reasonable suspicion,” when he asked Pennsylvania pediatricians to designate how high child abuse would need to be on the differential diagnoses list to be considered reasonable suspicion of child abuse. While 12% of the pediatricians PEDIATRIC ANNALS 41:12 | DECEMBER 2012 said it should be ranked first or second on the differential diagnosis, 41% said third or fourth, and 47% indicated it could rank anywhere from fifth to tenth on the list and be considered reasonable suspicion. Levi and Brown also asked the pediatricians to estimate the probability that an injury was caused by abuse to be considered reasonable suspicion: their threshold for reporting ranged from 10% chance that it was abuse to more than 75% probability.31 When the two scales were paired, their responses were inconsistent. The pediatricians commonly indicated that reasonable suspicion required a 50% to 60% probability, but could be ranked as low as fourth or fifth on the differential diagnosis list. Even child abuse experts show variability in how they assess the likelihood that an injury was caused by child abuse.32 When these experts were asked to rate the percentage likelihood of the injury being caused by abuse, the physicians rarely rated a case as “definite abuse” when the likelihood was estimated at less than or equal to 95%, and they were unlikely to report to CPS if the injury was rated as less than or equal to 15% likelihood of abuse. They are more likely to agree about cases that had the highest concern for abuse. They also showed some agreement about which cases needed to be reported. Recommended Actions Physicians who treat children are in a key position to identify child physical abuse and prevent further abuse. In order to do this effectively, the possibility of abuse should be considered when evaluating an injury. Physicians must take a thorough history, determining who was present at the time of the injury event, when the injury occurred, and what exactly happened. They need to ask about previous injuries and screen for factors that may SIDEBAR 1. When Suspicions Should Be Raised for Child Physical Abuse • No history to explain an injury in a nonverbal child. • History of injury implausible or inconsistent with mechanism of injury. • Conflicting histories or changing histories. • Bruises or fractures in a nonambulatory child. • Multiple injuries and/or injuries occurring at different times. • Delay in seeking care for an injury. Source: Flaherty and Fingarson place a child at risk of maltreatment. Physicians also need to examine the child, including a complete skin exam for bruises. Appropriate laboratory tests and imaging studies (see Sidebar 1) are also needed. Objective assessment and clear analytical reasoning will reduce the likelihood of bias, conscious or unconscious, in their decision making. Flow sheets, checklists, and operationalized criteria may help physicians recognize and report child maltreatment.33-35 Three questions appear to increase the identification of physical abuse: 1) Do findings from the examination conform with the history provided?; 2) Was there a delay in seeking care?; and 3) Is the history inconsistent with the injury?35,36 The use of screening guidelines has been shown to decrease the racial disparity between which infants were screened with skeletal surveys.37 Many of the decisions about whether a child has been maltreated are complex. Although all physicians should evaluate for maltreatment and report their suspicions of maltreatment to CPS, they should recognize their own limitations and advocate for a child to have a more definitive evaluation by a Healio.com/Pediatrics | 3 CM E child abuse expert when the findings are not definitive. Also, when pediatricians are uncertain whether to suspect and report maltreatment, they can discuss their questions with a child abuse pediatrician or child abuse team. Most children’s hospitals and pediatric training hospitals have multidisciplinary child abuse teams and many are staffed by board-certified child abuse pediatricians. These physicians and teams are available for consultation. IMPROVED TRAINING All physicians need some education in child maltreatment, but particularly physicians who care for children in any capacity. They need to learn how to take a complete history, the importance of a thorough physical examination including a skin examination, and the appropriate imaging and laboratory studies that may facilitate diagnosis. Training should include education about counter transference reactions that may occur as result of reporting.38 Physicians who only occasionally encounter child maltreatment particularly need this training. Physicians need a better understanding of the mandate to report if they have “reasonable suspicion” of child maltreatment. Perhaps providing a clear threshold for reporting as part of the definition of “reasonable suspicion,” such as whether a physician is a particular percentage certain that maltreatment is present, would improve their reporting performance.39 Physicians often cite systems issues as a barrier to evaluating and reporting suspected child maltreatment. For example, they mention the lack of follow-up by CPS and the perception that children who were reported to CPS did not benefit from the intervention.25,40 Their fear of causing harm to a family may supersede their belief that the child could suffer further harm without their intervention, despite the fact that CPS permanently removes very few chil4 | Healio.com/Pediatrics dren. Education about what happens after a report could help to allay these fears. This education could include information about the child protection investigation, law enforcement investigation, legal proceedings, as well as the outcome for children with or without intervention.41 Physicians should learn about the likelihood of continuing and escalating Physicians need a better understanding of the mandate to report if they have “reasonable suspicion” of child maltreatment. abuse in households without CPS intervention. Professionals often assume that caregivers will perceive CPS intervention as punitive, but, in fact, the majority of clients report satisfaction with the intervention provided.42,43 When physicians were asked what would help them evaluate children for maltreatment, they cited informative articles to read and regional trainings.40 In addition, physicians said they would find hands-on training with patients in the physician’s office and hands-on training in academic centers useful. Self-instructional programs also have been shown to increase physicians’ knowledge about child maltreatment.44 Some states require physicians and other professionals to receive training in child maltreatment as a prerequisite for licensure.45 Most of the professionals who participated in such a training in New York said that they learned something new in the course.46 The majority of the physicians said that the course should be repeated at some point. CONCLUSION Child maltreatment often goes un- recognized and unreported to CPS. Physicians must remain alert to the possibility of maltreatment, systematically evaluate any child who has findings or complaints that may have been caused by maltreatment, consult others when needed, and report any “reasonable suspicions” of maltreatment to CPS. REFERENCES 1. Loiselle JM, Westle RE. Inpatient reports of suspected child abuse or neglect (SCAN): a question of missed opportunities in the acute care setting. Pediatr Emerg Care. 1999;15(2):90-94. 2. Woolf A, Taylor L, Melnicoe L, et al. What residents know about child abuse. Implications of a survey of knowledge and attitudes. Am J Dis Child. 1988;142(6):668-672. 3. Ward MG, Bennett S, Plint AC, King WJ, Jabbour M, Gaboury I. Child protection: a neglected area of pediatric residency training. Child Abuse Negl. 2004;28(10):1113-1122. 4. Flaherty EG, Sege R, Price LL, Christoffel KK, Norton DP, O’Connor KG. Pediatrician Characteristics Associated With Child Abuse Identification and Reporting: Results From a National Survey of Pediatricians. Child Maltreat. 2006;11(4):361-369. 5. Starling SP, Heisler KW, Paulson JF, Youmans E. Child Abuse Training and Knowledge: A National Survey of Emergency Medicine, Family Medicine, and Pediatric Residents and Program Directors. Pediatrics. 2009;123(4):e595-e602. 6. Flaherty EG, Sege R, Mattson CL, Binns HJ. Assessment of suspicion of abuse in the primary care setting. Ambul Pediatr. 2002;2(2):120-126. 7. Sege R, Stigol LC, Perry C, Goldstein R, Spivak H. Intentional injury surveillance in a primary care pediatric setting. Arch Pediatr. Adolesc Med. 1996;150(3):277-283. 8. Boyce MC, Melhorn KJ, Vargo G. Pediatric trauma documentation. Adequacy for assessment of child abuse. Arch Pediatr Adolesc Med. 1996;150(7):730-732. 9. McMahon P, Grossman W, Gaffney M, Stanitski C. Soft-tissue injury as an indication of child abuse. J Bone Joint Surg (American Vol). 1995;77(8):1179-1183. 10. Oral R, Yagmur F, Nashelsky M, Turkmen M, Kirby P. Fatal abusive head trauma cases: consequence of medical staff missing milder forms of physical abuse. Pediatr Emerg Care. 2008;24(12):816-821. 11. Jayawant S, Rawlinson A, Gibbon F, et al. Subdural haemorrhages in infants: population based study. Br Med J. 1998;317(7172):1558. 12. Ravichandiran N, Schuh S, Bejuk M, et al. Delayed identification of pediatric abuse-related PEDIATRIC ANNALS 41:12 | DECEMBER 2012 CM E fractures. Pediatrics. 2010;125(1):60-66. 13. Spencer N, Devereux E, Wallace A, et al. Disabling conditions and registration for child abuse and neglect: a population-based study. Pediatrics. 2005;116(3):609-613. 14. Sullivan PM, Knutson JF. Maltreatment and disabilities: a population-based epidemiological study. Child Abuse Negl. 2000;24(10):1257-1273. 15. Altemeier WA, O’Connor S, Vietze PM, Sandler HM, Sherrod KB. Antecedents of child abuse. J Pediatr. 1982;100(5):823-829. 16. Berger LM. Income, family characteristics, and physical violence toward children. Child Abuse Negl. 2005;29(2):107-133. 17. Dadds MR, Mullins MJ, McAllister RA, Atkinson E. Attributions, affect, and behavior in abuse-risk mothers: a laboratory study.[see comment]. Child Abuse Negl. 2003;27(1):21-45. 18. Jenny C, Hymel KP, Ritzen A, Reinert SE, Hay TC. Analysis of missed cases of abusive head trauma.[see comment] JAMA. 1999;281(7):621-626. [erratum appears in JAMA 1999;282(1):29]. 19. Wood JN, Hall M, Schilling S, Keren R, Mitra N, Rubin DM. Disparities in the Evaluation and Diagnosis of Abuse Among Infants With Traumatic Brain Injury. Pediatrics. 2010;126(3):408-414. 20. Lane WG, Rubin DM, Monteith R, Christian CW. Racial differences in the evaluation of pediatric fractures for physical abuse. JAMA. 2002;288(13):1603-1609. 21. Laskey AL, Stump TE, Perkins SM, Zimet GD, Sherman SJ, Downs SM. Influence of race and socioeconomic status on the diagnosis of child abuse: a randomized study. J Pediatr. 2012;160(6):1003-1008.e1001. 22. Lane WG, Dubowitz H. What factors affect the identification and reporting of child abuse-related fractures? Clin Orthop Relat Res. 2007;461:219-225. 23. Croskerry P, Norman G. Overconfidence in clinical decision making. Am J Med. PEDIATRIC ANNALS 41:12 | DECEMBER 2012 2008;121(5 Suppl):S24-29. 24. Saulsbury FT, Campbell RE. Evaluation of child abuse reporting by physicians. Am J Dis Child. 1985;139(4):393-395. 25. Flaherty EG, Sege R, Binns HJ, Mattson CL, Christoffel KK. Health care providers’ experience reporting child abuse in the primary care setting. Pediatric Practice Research Group. Arch. Pediatr Adolesc Med. 2000;154(5):489493. 26. Gunn VL, Hickson GB, Cooper WO. Factors affecting pediatricians’ reporting of suspected child maltreatment. Ambul Pediatr. 2005;5(2):96-101. 27. Flaherty EG, Sege RD, Griffith J, et al. From suspicion of physical child abuse to reporting: primary care clinician decision-making. Pediatrics. 2008:122(3):611. 28 Jones R, Flaherty EG, Binns HJ, et al. Clinicians’ description of factors influencing their reporting of suspected child abuse: report of the Child Abuse Reporting Experience Study Research Group. Pediatrics. 2008;122(2):259-266. 29. Zellman GL. The impact of case characteristics on child abuse reporting decisions. Child Abuse Negl. 1992;16(1):57-74. 30. Foreman T, Bernet W. A misunderstanding regarding the duty to report suspected abuse. Child Maltreat. 2000;5(2):190-196. 31. Levi BH, Brown G. Reasonable suspicion: a study of Pennsylvania pediatricians regarding child abuse. Pediatrics. 2005;116(1):e5-12. 32. Lindberg DM, Lindsell CJ, Shapiro RA. Variability in expert assessments of child physical abuse likelihood. Pediatrics. 2008;121(4):e945-e953. 33. Benger JR, Pearce V. Simple intervention to improve detection of child abuse in emergency departments. BMJ. 2002;324(7340):780. 34. Louwers EC, Korfage IJ, Affourtit MJ, et al. Detection of child abuse in emergency departments: a multi-centre study. Arch Dis Child. 2011;96(5):422-425. 35. Louwers EC, Korfage IJ, Affourtit MJ, et al. 36. 37. 38. 39. 40. 41. 42. 43. 44. 45. 46. Effects of systematic screening and detection of child abuse in emergency departments. Pediatrics. 2012;130(3):457-464. Louwers EC, Affourtit MJ, Moll HA, Koning HJ, Korfage IJ. Screening for child abuse at emergency departments: a systematic review. Arch Dis Child. 2010;95(3):214-218. Rangel EL, Cook BS, Bennett BL, Shebesta K, Ying J, Falcone RA. Eliminating disparity in evaluation for abuse in infants with head injury: use of a screening guideline. J Pediatr Surg. 2009;44(6):1229-1235. Pollak J, Levy S. Countertransference and failure to report child abuse and neglect. Child Abuse Negl. 1989;13(4):515-522. Levi BH, Loeben G. Index of suspicion: feeling not believing. Theor Med Bioeth. 2004;25(4):277-310. Socolar RR, Reives P. Factors that facilitate or impede physicians who perform evaluations for child maltreatment. Child Maltreat. 2002;7(4):377-381. Sege R, Flaherty E. Forty years later — inconsistencies in reporting of child abuse. Arch Dis Child. 2008;93(10):822-824. Chapman MV, Gibbons CB, Barth RP, McCrae JS. Parental views of in-home services: what predicts satisfaction with child welfare workers? Child Welfare. 2003;82(5):571-596. Huebner RA, Jones BL, Miller VP, Custer M, Crithchfield B. Comprehensive family services and customer satisfaction outcomes. Child Welfare. 2006;85(4):691-714. Showers J, Laird M. Improving knowledge of emergency physicians about child physical and sexual abuse. Pediatr Emerg Care. 1991;7(5):275-277. Reiniger A, Robison E, McHugh M. Mandated training of professionals: a means for improving reporting of suspected child abuse. Child Abuse Negl. 1995;19(1):63-69. Khan AN, Rubin DH, Winnik G. Evaluation of the mandatory child abuse course for physicians: do we need to repeat it? Public Health. 2005;119(7):626-631. Healio.com/Pediatrics | 5 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. BEATING THE DEVIL OUT OF THEM Corporal Punishment in American Families and its Effects on Children Murray A. Straus with Denise A. Donnelly With a new introduction by the author Transaction Publishers New Brunswick (U.S.A.) and London (U.K.) Preface ood science tends to be a labor of love. Unfortunately, my love is mostly unrequited. As of this writing, almost no social scientists have embraced my belief, even as a hypothesis, that spanking, that is, hitting children, is a major psychological and social problem. A somewhat larger number considers corporal punishment undesirable for both parents and children, but not truly a major problem. Even among those who disapprove of spanking, it would be hard to find anyone who puts hitting children in the same class as hitting wives. I am a feminist, but my theory that corporal punishment is one of the causes of wife beating has been denounced by some of my feminist colleagues as a diversionary tactic that takes away attention from the "real" cause-male dominance (Breines and Gordon, 1983; Pagelow, 1984). I am a scientist, but my theory that corporal punishment in and of itself causes serious psychological harm typically is regarded as not even worthy of discussion (see McCord, 1988 for an exception) because it does not deal with the "real" cause-incompetent parenting in general. For these reasons, I want to add a few words about the view that inadequate parenting is the "real" cause of the harmful side effects of corporal punishment. Chapter 1 picks up that theme and attempts to explain why social scientists have ignored corporal punishment of children, except as an incidental part of harsh parenting. G Hitting Children and Hitting Wives are Equivalent For more than 20 years I argued that slapping a wife is a unique type of family violence. Writing this book caused me to reconsider xviii • Preface that and come to what will seem like an outrageous conclusion to most people-that slapping a child deserves equal billing with hitting wives because the problems are equivalent. Consider some of the ways that hitting children and hitting wives are believed to be different, but really are similar. Hitting children is legal and socially approved, but hitting a spouse is a crime. This is the case now, but hitting a wife was legal until the 1870s, when courts in the United States stopped recognizing the common-law principle that a husband had the right to "physically chastise an errant wife" (Calvert, 1974). It is time to also change the law on hitting children. Children themselves believe they sometimes need "strong discipline." This is not very different from the fact that many wives think they "deserved it," as did many slaves who were "disciplined" by their masters. The battered-women's movement has worked for years to tell women that no one deserves to be hit and no one should tolerate it. Now it is time to do the same for children. All children misbehave, but no child deserv~s to be physically assaulted. Hitting children is thought to be different from hitting wives because it rarely results in physical injury. The low injury rate is correct, but this also applies to hitting wives. There have been only two studies of assaults on wives in the general population. One shows that 97 percent of women who were physically assaulted by their spouses did not suffer an injury that required medical attention (Stets and Straus, 1990). The other study showed that 99 percent were not physically injured (Brush, 1990). Staff members of battered-women's shelters do not see this because injury is one of the reasons women go to a shelter. When done in moderation, corporal punishment is believed to be different from hitting wives because it does not cause the psychological injuries that assaulted wives experience. On the contrary, all the chapters in Part II of this book show that children who have been hit by their parents suffer serious psychological harm, just as wives suffer serious psychological injury as a result of being hit by their husbands. Minor assaults on wives, such as slapping, are thought to be different from minor assaults on children (corporal punishment) because the minor assaults on wives can escalate into severe assaults, namely, wife beating. Unfortunately, corporal punishment can esca- late into physical abuse as well Martin, 1981). While slapping< late, research shows that "mine typically escalate into severe as Usually, minor violence stops tl 1989; Suitor, Pillemer, and Stra parent because women whose 1 do not seek help from a shelter. typically stops at the minor le1 lence is acceptable. Minor viole the violence by parents that goe punishment must also stop. Sw all spanking and other forms < Chapter 11). Spanking or slapping a child . a wife is an act of violence. In l as one man told me, "I didn't h same thing about slapping their The campaign to end violen of shelters for battered wome women's movement. Ending should be added to the femini First, since hitting children is c: lence is part of the feminist ide the evidence in Chapter 7 indic: the root causes of wife beating. important step toward protectir The main differences betwee1 es are that hitting children is sti ize the harmful side effects of ' effects do not show up until la child, there is no obvious clue chance that the child will grow her children, or suffer from me chological ills. When I say that hitting child tally the same, I am referring t< corporal punishment, and to tl least once in perhaps two-thir Preface • xix late into physical abuse as well (see Chapter 5, and Kadushin and Martin, 1981). While slapping a child and slapping a wife can escalate, research shows that "minor" violence against wives does not typically escalate into severe assaults in the form of wife beating. Usually, minor violence stops there (Fagan, 1988; Feld and Straus, 1989; Suitor, Pillemer, and Straus, 1990). Of course, this is not apparent because women whose partners have stopped hitting them do not seek help from a shelter. Just because violence against wives typically stops at the minor level does not mean that minor violence is acceptable. Minor violence against women must stop, and the violence by parents that goes under the euphemism of physical punishment must also stop. Sweden has taken the lead by making all spanking and other forms of corporal punishment illegal (see Chapter 11). Spanking or slapping a child is an act of violence, just as slapping a wife is an act of violence. In both
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