Description

• Types of abuse: neglect (most common and highest mortality), physical abuse, emotional/psychological abuse, sexual abuse, and sexual exploitation
• 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, pulmonary, cardiac, immune, and psychiatric
• Synonym(s): nonaccidental trauma; child maltreatment; inflicted injury

Epidemiology

Prevalence
Children’s Bureau report for federal fiscal year (FFY) 2019 (1):

• Child Protective Services agencies received an estimated 4.4 million referrals alleging maltreatment, with a national screened-in referral rate of 32.2 referrals per 1,000 children).
• Approximately 3.5 million children received either an investigation or alternative response. Of those investigated, just >650,000 children (8.9 per 1,000) were found to be victims of abuse or neglect.
• Neglect is the most common type of reported maltreatment at 74.9%, followed by physical abuse at 17.5%, and sexual abuse at 9.3%.
• The overall rate of child fatalities was 2.5 deaths per 100,000 children in the national population. The rate of child fatalities is slightly higher in boys compared to girls.
• The majority of perpetrators are the parents of their victims (77.5%).

Risk Factors

• American Indian or Alaska Native children had the highest rates of victimization, followed by African-American children.
• Children in the age group of birth to 1 year had the highest rate of victimization at 25.3 per 1,000 infants and the highest rate of mortality from maltreatment.
• Girls have a slightly higher rate of victimization when compared to boys.
• Military families are a risk of abuse, especially around times of deployment.
• Child risk factors include chronic illness, physical/congenital disability, developmental delay, preterm, unintended pregnancy
• Caregiver risk factors include poverty, substance misuse, lower educational status, parental history of abuse, parental mental health issues, young and/or unmarried mother, poor support network, and domestic violence (2).

General Prevention

• Know your patients and ask about their family situations; screen for risk factors at prenatal, postnatal, and pediatric visits.
• Physicians can educate parents on a range of normal behaviors to expect in infants and children:
  • E.g., anticipatory guidance on ways to handle crying infants; methods of discipline for toddlers
• Train first responders, teachers, and childcare workers to look for signs of abuse and know methods for reporting.
• 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 delays
• Poor school performance
• Poor social skills
• Low self-esteem
• Anxiety or depression