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INTRODUCTION

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ESSENTIALS OF DIAGNOSIS

  • Forms of maltreatment:

    • Physical abuse

    • Sexual abuse

    • Emotional abuse and neglect

    • Physical neglect

    • Medical care neglect

    • Medical child abuse (Munchausen syndrome by proxy)

  • Common historical features in child abuse cases:

    • Implausible mechanism provided for an injury

    • Discrepant, evolving, or absent history

    • Delay in seeking care

    • Event or behavior by a child that triggers a loss of control by the caregiver

    • History of abuse in the caregiver's childhood

    • Inappropriate affect of the caregiver

    • Pattern of increasing severity or number of injuries if no intervention

    • Social or physical isolation of the child or the caregiver

    • Stress or crisis in the family or the caregiver

    • Unrealistic expectations of caregiver for the child

    • Behavior changes of child

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In 2011, an estimated 3.4 million referrals were made to child protective service agencies, involving the alleged maltreatment of approximately 6.2 million children. Children 3 years of age and younger have the highest rates of maltreatment. The total number of children confirmed as maltreated by child protective services was 676,569 in 2011, yielding an abuse victimization rate of 9.1 per 1000 American children. (This statistic is referred to as the "unique count" where a child is counted only once regardless of the number of times the child is substantiated as a victim.) This is the lowest victimization rate over the previous 5-year period. This reflects a drop in rates for physical and sexual abuse, as neglect rates have remained fairly steady. Neglect was substantiated in 78.5% of cases, while 17.6% of cases involved physical abuse, and 9.1% involved sexual abuse. These declines correlate with overall decreases in crime. Additional factors such as improvements in education, reporting, and system responses have also likely played a role in the reduction.

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There were 1545 victims of fatal child abuse in 2011 from 51 states, resulting in a rate of 2.1 child abuse deaths per 100,000 children, the same rate as the year prior. Unlike physical and sexual abuse rates, fatality rates have varied over the last 5 years. Based on this information, it is estimated that nationally 1570 children died from abuse and neglect.

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Substance abuse, poverty and economic strains, parental capacity and skills, and domestic violence are cited as the most common presenting problems in abusive families. Abuse and neglect of children are best considered in an ecological perspective, which recognizes the individual, family, social, and psychological influences that come together to contribute to the problem. Kempe and Helfer termed this the abusive pattern, in which the child, the crisis, and the caregiver's potential to abuse are components in the event of maltreatment. This chapter focuses on the knowledge necessary for the recognition, intervention, and follow-up of the more common forms of child maltreatment and highlights the role of pediatric professionals in prevention.

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U.S. Department of Health and Human Services: Administration for Children, Youth, and Families. Child Maltreatment 2011. http://www.acf.hhs.gov/programs/cb/resource/child-maltreatment-2011. Accessed March 28, 2013.
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