Description

• Types of abuse: Neglect (most common and highest mortality), physical abuse, emotional/psychological abuse, sexual abuse
• System(s) affected: Gastrointestinal (GI); Endocrine/Metabolic; Musculoskeletal; Nervous; Renal; Reproductive; Skin/Exocrine; Psychiatric
• Synonym(s): Suspected nonaccidental trauma; Child maltreatment; Child neglect

Epidemiology

• The National Incidence Study (NIS) estimates the incidence of child and neglect in the US, using estimates from official child protective service (CPS) statistics and other sources (data not reported to CPS or screened out by CPS without investigation). Most recent NIS-4 (2010) looked at data from 2005 to 2006 (1).
• Using the stringent “Harm Standard” definition, >1.25 million children experienced maltreatment (1 child in 58).
• Using the “Endangerment Standard,” 3 million children experienced maltreatment (1 child in 25).

• In 2010, there were an estimated 3.3 million referrals to CPS agencies involving the alleged maltreatment of ~5.9 million children (2).
• Nearly 2 million reports were screened for a CPS response, putting the victimization rate in 2010 at 9.2 for every 1,000 children; with those aged <1 year had the highest rate (20.6 per 1,000 children) (2).
• The greatest percentage of children were neglected (78.3%) compared to 17.6% suffering physical abuse and 9.2% suffering sexual abuse (2).
• The overall rate of child fatalities was 2.07 deaths per 100,000 children. Nearly 80% were in children <4 years old, and 79% of fatalities were caused by ≥1 parent (2).
• >30% of child fatalities were attributed exclusively to neglect, and >40% were caused by multiple maltreatment types (2).

Risk Factors

• All ages; Male = Female:
  • Risk of physical abuse increases with age
  • Risk of fatal abuse more common <2 years of age
  • Physical abuse 2.1× higher among children with disabilities (3)
• Poverty, drug abuse, lower educational status, parental history of abuse, mentally ill parent/maternal depression, poor support network, and domestic violence:
  • Child abuse 4.9× more likely in family with spouse abuse (3).
  • Children in households with unrelated adults 50× more likely to die of inflicted injuries (3)
  • Adults who were abused as children 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, pediatric visit.
• 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 (4)[A].

Commonly Associated Conditions

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