The epidemiology of child maltreatment

Child maltreatment is a significant worldwide problem, with consequences that can include impaired physical and mental health throughout life, and adverse social and occupational effects that carry a heavy economic and social burden. One estimate of cost to the US economy in 2007, for example, was over US$100bn. In middle- and low-income countries, there have been fewer studies of incidence and prevalence, and the economic and social costs are harder to estimate. It is very difficult to obtain full case ascertainment even in the most severe forms of child maltreatment, and even for fatal cases. In general, self-reporting and surveys identify higher rates of child maltreatment than data from sources relating to official notification. This paper reviews the epidemiology of child maltreatment from a practical perspective, with a focus on factors in the social environment, and the clinical history and examination, that predict an increased risk of child maltreatment.     

The relation between child death and child maltreatment

The death of a child is a sentinel event in a community, and a defining marker of a society's policies of safety and health. Child death as a result of abuse and neglect is a tragic outcome that occurs in all nations of the world. The true incidence of fatal child abuse and neglect is unknown. The most accurate incidence data of such deaths have been obtained from countries where multi-agency death review teams analyse the causes of child fatalities, as is done in the United States and Australia.     

The relation between child death and child maltreatment.

The death of a child is a sentinel event in a community, and a defining marker of a society's policies of safety and health. Child death as a result of abuse and neglect is a tragic outcome that occurs in all nations of the world. The true incidence of fatal child abuse and neglect is unknown. The most accurate incidence data of such deaths have been obtained from countries where multi-agency death review teams analyse the causes of child fatalities, as is done in the United States and Australia.     

The affective and cognitive sequelae of child maltreatment

This article discusses the affective and cognitive sequelae of child maltreatment. It provides a brief historical overview and various definitional issues in the field. The tasks of childhood are identified, and developmental processes are discussed. A review of the literature of the sequelae of maltreatment is presented, followed by a discussion of the impact of these sequelae and the implications for the child's development.     

Update on child maltreatment

PURPOSE OF REVIEW: The authors discuss the significance of studies published over the previous year regarding assessment and treatment and prevention of child maltreatment, including physical and sexual abuse, inflicted traumatic brain injury, and child neglect. RECENT FINDINGS: The evidence base for many forms of child abuse is growing. As clinicians begin to understand the factors which may increase child vulnerability to abuse, more sophisticated and focused prevention efforts are being implemented. In response to a very public reprimand by the General Medical Council of two child abuse pediatricians, which was felt by many to be unwarranted, the UK government re-emphasized its commitment to the protection of children. In the US, this well-publicized set of events has renewed the medical community's commitment to the recognition of child abuse pediatrics as a formal subspecialty. Several authors detail the short-term and long-term outcome of varying forms of abuse for children as they grow into adults, reinforcing the importance of community efforts to prevent abuse and support families during times of heightened stress such as the current war in Iraq. SUMMARY: The short-term and long-term impact of child maltreatment is significant not only for individuals, but for families and communities where abuse is taking place. General pediatricians have an important role to play with families and in the community as advocates for the protection of children.     

Update on child maltreatment

PURPOSE OF REVIEW: Recent literature regarding assessment, management and prevention of child maltreatment will be considered. Unexplained infant and child death will also be reviewed. RECENT FINDINGS: Controversies in the evaluation of unexpected infant death and inflicted traumatic brain injury are ongoing. Evidence continues to accumulate describing the serious long-term sequelae of child maltreatment. Studies have examined the earliest beginnings of these adverse outcomes commencing in childhood. Despite sustained efforts to develop a variety of training and intervention programs, the deployment of these efforts has been hampered by the lack of evidence that they make any difference in improving recognition of child abuse or in preventing recurrent maltreatment. There is a great need in the child abuse field for more formal, rigorous assessment of all manner of intervention programs. SUMMARY: Efforts to improve the recognition of and management of child abuse need to be sustained. As our understanding of child maltreatment continues to grow, evidence-based interventions will likely improve outcomes for abused children and their families. General pediatricians are often the first to notice signs and symptoms of possible child maltreatment; collaboration with hospital-based Child Protection Teams is critical when considering the possibility of abuse or neglect.     

Radiological features of child maltreatment

Child maltreatment is serious, highly prevalent and topical. Approximately 1% of children are neglected or psychologically maltreated and 4%–16% are physically abused each year.     

Interpreting fractures in child maltreatment

All paediatricians and health professionals working with young children need to be aware of the potential for child abuse to be a cause of physical injuries, such as fractures. Clinical experience, Serious Case Reviews and research show us that maltreatment should be kept in mind, in order for investigations to be carried out where appropriate and to prevent further harm. Whilst accidental fractures are common, fractures may also be the sentinel injury that alerts professionals to the possibility of child abuse, presenting clinically or detected as an occult injury on imaging for other reasons or when investigating a case of suspected maltreatment. The health professional evaluating a child with any fracture should be aware of features that raise the suspicion of abuse as a cause and be familiar with current recommendations for further investigations. This article outlines the current research concerning abusive fractures in children. It offers guidance on how to optimize radiological investigations and avoid common pitfalls in clinical practice.     

Cultural issues in child maltreatment

Aims: Waves of immigration from the latter half of the 20th century have changed the cultural and ethnic mix of major regions of the world. Dynamic multicultural societies now are a reality across the Western world. The relationship and influence of these diverse cultures to the understanding and identification of child abuse and neglect is challenging and complex. Health professionals working with children from culturally and linguistically diverse groups often find themselves with the challenge of exploring and resolving the tension between definitions of harm in child protection practice and various cultural and child‐rearing practices. In this paper, we set out ways of thinking about the influence of culture when approaching and dealing with the suspicion of child maltreatment. Methods: We will explore how culture shapes the experiences of childhood, child‐rearing practices, and identify common barriers in working with children and families from culturally diverse backgrounds when presenting with child maltreatment. We will use case examples from Europe and Australia to illustrate the real life challenges of working in the area of child maltreatment across cultures. We will review the scientific literature exploring the nexus between culture and child maltreatment, identifying the gaps in the literature and highlight areas for future research. Results: We suggest a model for dealing with cultural issues in child maltreatment that is culturally competent and respectful. Conclusions: The model for cultural competency in child health and child protective services incorporates four domains for advocacy and action – individual, professional, organisational and systemic.     

Teaching pediatric residents about child maltreatment

Child maltreatment is a growing problem faced by pediatricians; however, there are many deficiencies in pediatricians' relevant knowledge and skills. Residency programs typically have included limited teaching in the area of child maltreatment. Fifty pediatric residents participated in an evaluation of a model educational course in child maltreatment developed by an interdisciplinary faculty. The course resulted in significant short-term improvements in knowledge and skills as well as a greater sense of competence in managing cases of child maltreatment. The importance of teaching pediatric residents about the "new morbidity" is discussed.     

Pediatrician's role in preventing child maltreatment

Pediatricians have the opportunity to play an important role in preventing child maltreatment. Major issues that influence pediatric practice in this area are discussed in this article. General ideas and specific strategies are presented to help guide the pediatrician's prevention efforts.     

A conceptual approach to child maltreatment

Philosophical questions are critical to a broader conceptualization of parenting and childhood maltreatment, whether it is neglect or abuse, because they allow a reconsideration of established institutional models and the constitution of alternative approaches. Examining five areas where philosophical discussion may change the conceptual approach of practitioners--epistemology, certainty, causality, ethics and aesthetics--this paper attempts to provide an agenda for future research and experimentation.     

Decomposing Black-White differences in child maltreatment

This article examines conflicting visions of the racial composition of the maltreated populations. The National Child Abuse and Neglect Data System (NCANDS) data shows Blacks are overrepresented among reported and substantiated abuse and neglect cases, while the National Incidence Study of Child Abuse and Neglect (NIS) shows no apparent overrepresentation of children of color. To understand the conflicting evidence, the authors produce from NIS approximate measures of maltreatment rates in NCANDS. Maltreatment rates is broken down into allegation, report and substantiation components. Without disaggregating the data by welfare status, all or most of the racial gap in official maltreatment is found to arise from racial differences in allegations. Disaggregation changes the results. Among welfare cases, on average, half of the Black-White gap in maltreatment is due to racial differences in substantiation. Among nonwelfare cases, about half of the racial gap in official maltreatment is due to racial differences in allegations.