What would cause a child to choose the mean streets of a city or a town rather than living at home?

What would cause a child to choose the mean streets of a city or a town rather than living at home? And what happens to those children who cannot leave, who are too young to make such a harrowing decision and so must remain, all the while suffering chronic and unremitting abuse?

But first, how is child abuse defined?

According to the Center for Disease Control there are four categories of child abuse: neglect, physical abuse, sexual abuse and psychological abuse.

In Jackson County, according to Children First for Oregon, in 2007, 440 children suffered abuse and neglect and 320 children suffered from threat of harm. Of those 760 children, Doug Mares, District 8 manager of the Department of Human Services, reports that 404 were younger than six years of age; 268 were six to 12; and 88 were 13 and older.

Neglect

"Neglect," writes Marlene Mish of the Children's Advocacy Center, "is the most serious form of abuse. A neglected child does not make good attachments and that child will struggle forever when forming relationships. Kids whose needs are not met in the first year of life — a baby cries and sometimes is fed, sometimes he's hit, sometimes he just has to cry himself back to sleep — will develop a view of the world that says, 'This is not a safe place. I can't be sure of anything.'"

Mish points out that neglected children often have no parents at home; many only have one parent in their lives; family meals are not eaten together; children miss school because they have to take care of their parents; children are not valued, noticed or protected from abuse from within or without the family; they have no rules, no consistency, no real family identity or unit; kids are left to their own devices and the choices they make are not always good ones; they are rarely taken to doctors, and suffer from an abiding abuse by omission.

Those children who live with parents who are involved in chronic substance abuse, such as meth or alcohol, can go for days unclothed, living in the detritus of feces and garbage, syringes in cribs, lacking adequate food and care while strangers come and go.

While it is the most prevalent form of child abuse, is also the most difficult to establish by educators and agency workers because of the varied cultural views and standards of care which come into play as does the variable known as poverty.

Physical Abuse

Physical abuse is defined as non-accidental physical injury due to aggression such as punching, beating, kicking, biting, shaking, throwing and choking by a caretaker. Agencies find that neglected children are often physically abused.

"Physical abuse or neglect of children ages 0-4," writes Jennifer Mylenek, executive director of Court Appointed Special Advocates, "comprises 48 percent cases founded. Remember that these are the years when their brains are developing the most. Some of these children were born with the affects of drugs or alcohol and have behavioral challenges that exasperate a parent with already poor parenting skills. Many times abuse is at the hands of a boyfriend, too. Sadly, we see some women who choose their boyfriends over their children and the children remain in foster care."

Marlene Mish of Children's Advocacy Center writes, "What happens if you have no tools in your parenting toolbox and you were hit, slapped, and kicked as a child? One tends to revert back to that place in times of stress. If you look at shaken-baby syndrome, those babies often have broken bones in various stages of healing. Remember that the littlest are the most vulnerable and the easiest targets and they cannot report the crime."

Physical abuse can be a disconcerting gray area, for in the state of Oregon it is permissible to use corporal punishment to discipline a child leaving a mark. Not every mark is abuse. Yet for many children, the marks left are not just physical, but emotional as well.

Emotional abuse

Of all forms of child abuse, emotional abuse may be the most insidious. It leaves no physical mark, yet can leave its imprint on the psyche of a person for years, if not forever. This form of abuse involves belittling, coldness, cruelty, shaming, withholding of affection, support, guidance, harassment, inconsistency, as well as attacking the child's sense of self-worth through sustained criticism. Caregivers can also terrorize (a threat of harm), eliciting in the child a stress response. A child living in terror has no opportunities to develop anything other than unhealthy and anti-social survival skills.

"Emotional abuse is the core of all forms of abuse," according to Findcounseling.com, "and the long term effects of child abuse and neglect stem mainly from the emotional aspects of abuse. Actually, it is the psychological aspect of most abusive behaviors that defines them as abusive."

If a child breaks his or her arm, it will heal; however, if a caregiver twists the child's arm in a rage, breaking it, or throws the child down the stairs, the child will heal physically but may never heal psychologically.

Usually, emotional abuse is often accompanied by physical abuse and neglect. What makes it insidious is that it leaves no physical mark that can be evaluated, hence is the most difficult form of abuse to substantiate. Actual physical injury is needed for an agency to step forward and help the child.

Sexual abuse

While not the one of the most common forms of child abuse, sexual abuse is the most egregious and predatory and one of our society's most fiercely held taboos. It is defined as sexual acts between an adult and a child involving fondling, penetration or exposure to adult sexuality. While not the most common form of child abuse it can be the most egregious and predatory. According to some studies, 1 in 4 girls and 1 in 6 boys will be sexually abused before the age of 18.

There are an estimated 39 million survivors of sexual abuse in America. More than 90 percent of all children sexually abused know their abuser.

"Any sexual act," writes Marlene Mish, of Children's Advocacy Center, "between an adult and a minor or between minors when one exerts power over the other, is sexual abuse. If one forces or persuades a child to engage in any type of sexual act, it is sexual abuse. Besides sexual conduct, exhibitionism, exposure to pornography, voyeurism and soliciting a child over the Internet is considered abuse. All of these are crimes."

Most cases of sexually abused children are never reported. Children are threatened or coached into silence, others feel shame or believe they are responsible; therefore, these incidents of abuse do not come to the attention of government agencies. It is estimated by some caseworkers that the data regarding abuse represent only 5 percent of the total.