Child Physical Abuse and Neglect

Key points

Epidemiology

Each year in the United States, Child Protective Service (CPS) agencies receive more than 3 million reports of suspected child maltreatment and investigate more than 2 million of these reports; more than 650,000 children are substantiated by child welfare as maltreatment victims.³ Most maltreated children are victims of neglect (78.5%), 17.6% are victims of physical abuse, and 9.1% are victims of sexual abuse. More than 1500 child deaths are attributed annually to child abuse or neglect.³

Risk factors

Child abuse and neglect result from a complex interaction of child, caregiver, and environmental factors. Although child physical abuse and neglect affect children of all ages, ethnicities, and sociodemographic backgrounds, particular factors increase maltreatment vulnerability, and specific situations more commonly trigger maltreatment. Most often multiple factors coexist and are interrelated, increasing the risk for maltreatment of the child.⁸

Child characteristics that predispose a child to

Definitions

Federal and state laws define child abuse and neglect. Each state determines the process for investigating abuse, protecting children, and holding perpetrators accountable for their actions or inactions. The Federal Child Abuse Prevention and Treatment Act provides minimum standards to states for defining maltreatment; however, states have the responsibility for specifically defining child abuse for their constituents.¹ State laws vary widely, and defining terms used by states such as “risk of

Clinical outcomes

Adverse childhood experiences, including physical abuse and neglect, alter the architecture and function of the developing brain, and influence the neuroendocrine stress response and immune system function.²⁸ These physiologic disruptions can persist far into adulthood, and lead to lifelong poor physical and mental health.²⁸ Indeed, more than 80 scientific articles have been published elucidating the multitude of poor health outcomes experienced by adults who were maltreated as children.⁴

Therapeutic strategies

Prevention and treatment of child maltreatment are complex and challenging. Many of the approaches developed by child welfare agencies, health care providers, therapists, and others have not been rigorously tested, and many families suffer from chronic dysfunction and a multitude of challenges that require broad approaches to management. In addition to addressing the consequences of poverty, substance abuse, mental health, and other common problems encountered by families involved with child

Health care provider mandates for reporting

In every state, health care providers are mandated by law to identify and report all cases of suspected child abuse and neglect. It is the responsibility of CPS to investigate reports of suspected abuse to ensure the ongoing safety of the child. Law enforcement investigates crimes such as serious physical abuse or neglect for possible criminal charges against a perpetrator. Much of the abuse that is recognized by health care providers does not get reported to CPS for investigation.⁴⁴ In part

Important tools for practice

Ultimately, health care providers need to remain vigilant to the possibility of child maltreatment, be aware of their professional mandates, and be willing to advocate on behalf of these vulnerable patients. The extensive differential diagnosis of physical abuse depends on the type of injury, and requires careful, objective assessments of all children with suspected maltreatment. However, for children who present with pathognomonic injuries to multiple organ systems, an exhaustive search for

Future directions

Future approaches to the prevention of child maltreatment and the protection of children require meaningful collaboration between child welfare, judicial, education, health, and mental health professionals and systems. There have been recent calls for more rigorous legislative requirements for the reporting of child abuse.⁵⁴ Both federal and state legislation can improve laws to protect children and mandate improved interdisciplinary work. For example, identifying HIPAA exceptions that allow

Summary

Few problems have as profound an impact on the health and well-being of children as child abuse and neglect. Experiencing child maltreatment increases the risk of developing behaviors in adolescence and adulthood that predict adult morbidity and early mortality. The child welfare, foster, and health care systems have struggled to collaborate to address the health needs of children who have been maltreated. Although recognizing maltreatment and advocating for the safety of a child is a great