- •
Risk factors for child abuse vary depending on age, developmental factors, social context, and type of abuse.
- •
Support for parents is critical for prevention efforts.
- •
Selecting appropriate resources, based on risks and type of abuse, requires understanding of local programs.
- •
Recognition of physical findings, particularly sentinel injuries, is necessary to prevent further abuse.
- •
Sexual abuse prevention requires recognition of subtle signs, including signs of trafficking and peer victimization.
Making the Most of Clinical Encounters: Prevention of Child Abuse and Maltreatment
Section snippets
Key points
Public health prevention framework
The public health prevention framework aids in categorizing programs.
- •
Primary prevention programs are population-based and engage the community. These may include home visits from a nurse and/or provision of parenting information and education. Strategies focus on addressing risk factors. Primary prevention offers the best opportunity to reduce long-term sequelae of child maltreatment by preventing trauma to the developing brain during the first 3 years of life.5
- •
Secondary prevention programs
Identifying risk factors for abuse and maltreatment
Parent or caregiver characteristics and psychological functioning, characteristics of the child, and the social context within which the family unit lives influence parenting methods.7 Within these components are several risk factors for the abuse and maltreatment of children. Parental stress is a common denominator.
Abusive head trauma
Abusive head trauma (AHT), formerly referred to as shaken baby syndrome, describes the signs and symptoms resulting from nonaccidental shaking of the head and neck, impacting of the head and neck area, or a combination of acceleration/deceleration injury and impact.
Infant crying is a common trigger for AHT. This association is based on age-specific curves for AHT that have similar onset and patterns as age-specific curves for crying. Crying usually increases during the first month of life,
Prevention strategies
Successful interventions not only reduce risk factors but also promote protective factors. Families with good social supports have lower rates of physical abuse and are more likely to use nonphysical disciplinary strategies.9,17 A parent’s sense of self-efficacy and competence enables better coping strategies and reduces the adverse effects of risk factors. For example, parents who can secure resources and services for their family’s particular needs, such as services for a developmentally
Summary
Opportunities to prevent child maltreatment and abuse can be integrated into the pediatric health care visit. Providers should take a broad view of the social, emotional, structural, and family context to identify risks for abuse. Key areas include the public health framework, including support systems that are available to parents. It is important to recognize risk factors for abuse and potential examination findings of physical abuse (especially sentinel injuries) to intervene and prevent
Disclosure
The authors have nothing to disclose.
References (61)
The continuing role of maternal factors in child maltreatment and placement
Child Abuse Negl
(2015)Prevention of child maltreatment
Pediatr Clin North Am
(2014)- et al.
Age-related incidence curve of hospitalized shaken baby syndrome cases: convergent evidence for crying as a trigger to shaking
Child Abuse Negl
(2006) - et al.
Development and evaluation of a shaken baby syndrome prevention program
J Obstet Gynecol Neonatal Nurs
(2009) "Don't shake the baby": the effectiveness of a prevention program
Child Abuse Negl
(1992)- et al.
Informal support in maltreating families: its effect on parenting practices
Child Youth Serv Rev
(2005) - et al.
Risk factors for child sexual abuse
Aggress Violent Behav
(2001) Understanding the nature and dimensions of child sexual abuse to inform its prevention
- et al.
Pediatric primary care to help prevent child maltreatment: the safe environment for every kid (SEEK) model
Pediatrics
(2009) - et al.
The pediatrician's role in child maltreatment prevention
Pediatrics
(2010)
Interventions to Prevent Child Maltreatment: Recommendation Statement
Am Fam Physician
(2019)
Administration for Children & Families, Children's Bureau, Child Welfare Information Gateway. Framework for Prevention of Child Maltreatment
Maltreatment in infancy: a developmental perspective on prevention and intervention
Trauma Violence Abuse
(2016)
Ongoing pediatric health care for the child who has been maltreated
Pediatrics
(2019)
Effects of parenting programs on child maltreatment prevention: a meta-analysis
Trauma Violence Abuse
(2016)
U.S. Department of Health and Human Services, Administration on Children, Youth and Families. Child maltreatment 2017
Do educational materials change knowledge and behaviour about crying and shaken baby syndrome? A randomized controlled trial
CMAJ
(2009)
Parent education by maternity nurses and prevention of abusive head trauma
Pediatrics
(2011)
Association of a postnatal parent education program for abusive head trauma with subsequent pediatric abusive head trauma hospitalization rates
JAMA Pediatr
(2017)
Self-efficacy and parenting quality: findings and future applications
Developmental Rev
(1998)
Children who prosper in unfavorable environments: the relationship to social capital
Pediatrics
(1998)
The safe environment for every kid model: promotion of children's health, development, and safety, and prevention of child neglect
Pediatr Ann
(2014)
The safe environment for every kid model: impact on pediatric primary care professionals
Pediatrics
(2011)
California Department of Social Services, Office of Child Abuse Prevention. The California evidence-based clearinghouse for child welfare
Preventing child maltreatment and crime with prenatal and infancy support of parents: the nurse-family partnership
J Scand Stud Criminol Crime Prev
(2008)
Parenting programs for the prevention of child physical abuse recurrence: a systematic review and meta-analysis
Clin Child Fam Psychol Rev
(2017)
Nurse-Family Partnership. Nurse-Family Partnership Web site
American Academy of Pediatrics. Connected Kids: Safe, Strong, Secure
American Academy of Pediatrics. Practicing Safety Program
Cited by (9)
Impulsivity as a mediator between childhood maltreatment and suicidal behavior: A systematic review and meta-analysis
2022, Journal of Psychiatric ResearchCitation Excerpt :It includes integrated treatment of mental health disorders in these populations. Finally, tertiary prevention focuses on preventing the recurrence of maltreatment and its consequences (Ashraf et al., 2020; Harden et al., 2016). To our knowledge, this is the first systematic review on the role of impulsivity in mediating the relationship between childhood maltreatment and lifelong suicidal behavior.
Child Maltreatment Prevention: Essentials for the Pediatric Nurse Practitioner
2022, Journal of Pediatric Health CareCitation Excerpt :Practice interventions for the prevention of child maltreatment can best be understood using the public health prevention framework (U.S. Department of Health & Human Services, 2017). The public health framework includes primary prevention programs which target all pediatric patients and their families regardless of known risk for child maltreatment, secondary prevention programs targeting families with specific child maltreatment risk factors, and tertiary prevention programs to prevent adverse outcomes from child maltreatment victimization and recurrence of abuse or neglect (Ashraf, Pekarsky, Race, & Botash, 2020). See Box 1 for practice interventions.
Overcoming barriers to recognizing and reporting child abuse
2024, Journal of the American Academy of Physician AssistantsThe Association Between Child Abuse and Aggressive Behavior: A Three-Level Meta-Analysis
2023, Trauma, Violence, and Abuse
© 2020 Elsevier Inc. All rights reserved.