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) 2020 (1):

• Child Protective Services agencies received an estimated 3.9 million referrals alleging maltreatment, with a national screened-in referral rate of 28.9 referrals per 1,000 children.
• Approximately 3.1 million children received either an investigation or alternative response. Of those investigated, just >618,000 children (8.4 per 1,000 children) were found to be victims of abuse or neglect.
• Neglect is the most common type of reported maltreatment at 76.1%, followed by physical abuse at 16.5%, and sexual abuse at 9.4%.
• The overall rate of child fatalities was 2.38 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 (77.2%).

Risk Factors

• American Indian or Alaska Native children had the highest rates of victimization.
• Children from birth to 1 year had the highest rate of victimization 25.3 per 1,000 infants and highest rate of mortality.
• Females have a slightly higher rate of victimization versus males.
• Military families are at risk, especially with deployment.
• Child risk factors: chronic illness, physical/congenital disability, developmental delay, preterm, unintended pregnancy
• Caregiver risk factors: 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

General Prevention

• 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: for example, anticipatory guidance on ways to handle crying infants; methods of discipline for toddlers

Commonly Associated Conditions

Failure to thrive, prematurity, developmental delays, poor school performance, poor social skills, low self-esteem, anxiety or depression