Child Abuse

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  • Types of abuse: neglect (most common and highest mortality), physical abuse, emotional/psychological abuse, sexual abuse
  • Neglect includes physical (e.g., failure to provide necessary food or shelter or lack of appropriate supervision), medical (e.g., failure to provide necessary medical or mental health treatment), educational (e.g., failure to educate a child or attend to special education needs), and emotional (e.g., inattention to a child’s emotional needs, failure to provide psychological care, or permitting the child to use alcohol or other drugs).
  • System(s) affected: gastrointestinal (GI), endocrine/metabolic, musculoskeletal, nervous, renal, reproductive, skin/exocrine, psychiatric
  • Synonym(s): suspected nonaccidental trauma; child maltreatment; child neglect


  • The National Incidence Study (NIS) estimates the incidence of neglect in the United States using estimates from child protective services (CPS) statistics and other sources. Most recent NIS-4 (published 2010) looked at data from 2004 to 2009.
  • Using the stringent “harm standard” definition, >1.25 million children experience maltreatment (1 in 58).
  • Using the “endangerment standard,” 3 million children experienced maltreatment (1 child in 25).


Children’s Bureau report for federal fiscal year (FFY) 2015 (1):

  • CPS agencies received an estimated 4.0 million referrals (national referral rate of 53.2 referrals per 1,000 children).
  • Approximately 3.4 million children received either an investigation or alternative response. Of those investigated, 9.2 per 1,000 children were found to be victims of abuse or neglect.
  • The overall rate of child fatalities was 2.25 deaths per 100,000 children in the national population.
  • The majority of perpetrators were parents—one or both parents maltreated 91.6% of victims.
  • Types of maltreatment:
    • 75.3% neglect
    • 17.2% physical abuse
    • 8.4% sexual abuse

Risk Factors

  • African American children had the highest rates of victimization at 14.5 per 1,000 children (1).
  • Children in the age group of birth to 1 year had the highest rate of victimization (1).
  • Slightly more than one half of the child victims were girls and 48.6% were boys.
    • Risk of physical abuse increases with age.
    • Risk of fatal abuse is more common in those <3 years (74.8% of children who died were <3 years old).
  • Poverty, drug abuse, lower educational status, parental history of abuse, mentally ill parent/maternal depression, poor support network, and domestic violence:
    • Child abuse is 4.9 times more likely in family with spouse abuse.
    • Children in households with unrelated adults, 50 times more likely to die of inflicted injuries
    • Adults who were abused as children are at higher risk of becoming abusers than those not abused.

General Prevention

  • Know your patients and document their family situations; have increased suspicion to screen for risk factors at prenatal, postnatal, and pediatric visits.
  • Physicians can educate parents on range of normal behaviors to expect in infants and children:
    • Anticipatory guidance on ways to handle crying infants; methods of discipline for toddlers
  • Train first responders—teachers, childcare workers—to look for signs of abuse.
  • Some studies suggest developing screening tools to identify high-risk families early and offer interventions such as early childhood home visitation programs.

Commonly Associated Conditions

  • Failure to thrive
  • Prematurity
  • Developmental deficits
  • Poor school performance
  • Poor social skills
  • Low self-esteem, depression

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