Child Abuse and Neglect

Table of Contents

1. Child Abuse and Neglect
2. What is Child Abuse and Neglect?
3. Physical Abuse
4. Sexual Abuse
5. Child Neglect
6. When you suspect abuse or neglect
7. Domestic Violence and Children
8. Preventing Child Abuse
9. References

Child Abuse and Neglect

James L. Lukefahr, MD

Each year in the United States, Child Protective Services agencies receive almost 3 million reports of the abuse or neglect of children. About a third of these are validated, or legally determined to be true.

About 2,000 children die each year as a result of abuse or neglect. 85% are under age 5, and almost half are under age 1. Over 405 die due to neglect, 22% die from physical abuse, and 31% die from multiple causes. At least 1/3 die as a result of inflicted head trauma. Inflicted head trauma is the most common manner of death from abuse under age 1, and is also the most common type of fatal head trauma in this age group.

Child abuse is synonymous with violence against children, and most perpetrators of this violence are family members. Not surprisingly, child abuse occurs hand-in-hand with other family violence, i.e., spousal abuse. Pediatricians and other child health professionals generally deal with children and their mothers, and may be the only professionals in a position to recognize either form of domestic violence.

Identifying domestic violence (either spousal abuse or child abuse) within the context of limited primary-care visits, and offering help to victims remain major challenges for child health professionals.

Types of Child Abuse

Child abuse and neglect can take many forms, as evidenced by the following list:

1. Physical Abuse
2. Sexual Abuse
3. Nutritional Neglect
4. Medical Neglect
5. Educational Neglect
6. Emotional or Psychological Abuse
7. Neglectful Supervision
8. Factitious Disorder by Proxy (Munchhausen Syndrome by Proxy)

This chapter will focus on the first three types of child abuse, which are the most common presentations of abuse or neglect in pediatric practice settings.

Learning Objectives

1. List characteristics of the history that should trigger concern for possible abuse.
2. List the physical and behavioral signs of physical abuse, sexual abuse, and child neglect.
3. Know the laws of your state for mandatory reporting of suspected child abuse and neglect.
4. Understand the importance of a full, detailed, carefully documented history and physical examination in the evaluation of child abuse.
5. Recognize the role of the physician in reducing child maltreatment.