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BACKGROUND

Child abuse and neglect (CAN) is a serious public health problem that affects millions of children around the world.1,2 While some populations are more vulnerable to CAN, exposure affects everyone—all races, genders, socioeconomic statuses, and geographic boundaries. Exposure to CAN has far-reaching impacts beyond a single time-period, person, or generation. CAN is often associated with short-term health consequences, such as broken bones, bruises, and mental health issues [e.g., posttraumatic stress disorder (PTSD), anxiety and depressive symptoms]. However, the science of brain development, childhood adversity, and toxic stress demonstrate strong associations between CAN and longer-term health consequences, including changes in the physiological development of the nervous, endocrine, and immune systems, physical and mental health problems, engagement in risky health behaviors, limited life opportunities, and premature death.3–9 Addressing and treating exposure to CAN is important, but the goal in preventing CAN is clear—to stop this violence from happening in the first place. In this chapter, we define and describe CAN from a public health perspective, including both the magnitude and the health and social burden of CAN, as well as risk and protective factors for exposure. We will also provide evidence-based strategies for the prevention of CAN and prevention implementation considerations.

NATURE AND BURDEN OF THE PROBLEM

Definitions

Consistent definitions for CAN are important for two main reasons. First, monitoring the problem of CAN relies on a stable definition to track trends over time. Second, a clear definition helps us understand the scope of the problem and allows for comparisons of the issue across international, national, state, and local jurisdictions. CAN is defined as any act or series of acts of commission or omission by a parent, caregiver, or another person in a custodial role that result in harm, potential for harm, or threat of harm to a person under 18 years of age.10 CAN, also referred to as child maltreatment, includes four common types: physical abuse, sexual abuse, emotional abuse, and neglect. Brief definitions for each type of CAN developed by the Centers for Disease Control and Prevention (CDC) are presented in Table 176-1.10 These definitions align with the World Health Organization’s (WHO) definitions and support Article 19 of the United Nations Convention on the Rights of a Child, which serve to protect children from violence, exploitation, and abuse while in the care of parents and other caregivers.11–13

TABLE 176-1BRIEF DEFINITIONS OF CHILD ABUSE AND NEGLECT DEVELOPED BY THE CENTERS FOR DISEASE CONTROL AND PREVENTION

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