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INTRODUCTION

ESSENTIALS OF DIAGNOSIS & TYPICAL FEATURES

  • Forms of maltreatment:

    • Physical abuse

    • Sexual abuse

    • Emotional abuse and neglect

    • Physical neglect

    • Medical care neglect

    • Medical child abuse (Munchausen syndrome by proxy)

  • Common historical features in child physical abuse cases:

    • Implausible mechanism provided for an injury

    • Discrepant, evolving, or absent history

    • Delay in seeking care

    • Event or behavior by a child that triggers a loss of control by the caregiver

    • History of abuse in the caregiver’s childhood

    • Inappropriate affect of the caregiver

    • Pattern of increasing severity or number of injuries if no intervention

    • Social or physical isolation of the child or the caregiver

    • Stress or crisis in the family or the caregiver

    • Unrealistic expectations of caregiver for the child

In 2019, an estimated 4.4 million referrals were made to child protective service agencies, involving the alleged maltreatment of approximately 7.9 million children. Policies about how to screen incoming calls regarding abuse concerns and how to investigate suspicious cases varies among states. Some states investigate every case that is referred, while others may screen out referrals based on certain criteria. More and more states are using an “alternative response” system to handle screened-in reports that are deemed low or moderate risk. While traditional investigative methods focus on identifying whether a child has been maltreated, these alternative response models prioritize service needs of the family over determining victimization. Data collection strategies have been altered to capture both forms of assessment.

Children 3 years of age and younger have the highest rates of maltreatment. The total number of children confirmed as maltreated by child protective services was estimated to be 656,000 in 2019, yielding an abuse victimization rate of 8.9 per 1000 American children. This statistic is referred to as the “unique count” where a child is counted only once regardless of the number of times the child is substantiated as a victim. Neglect is the most common form of maltreatment and was substantiated in 74.9% of cases, while 17.5% of cases involved physical abuse, and 9.3% involved sexual abuse.

There were 1840 victims of fatal child abuse in 2019 from 50 states, resulting in a rate of 2.50 child abuse deaths per 100,000 children, approximately 10.8% higher than the 2015 rate. The rate of African-American child fatalities was about 2.5 times greater than that of White and Hispanic children, a notable public health disparity.

Substance abuse, poverty and economic strains, parental capacity and skills, and domestic violence are cited as the most common presenting problems in abusive families. Almost a third of substantiated maltreatment cases include domestic violence as a caregiver risk factor. Abuse and neglect of children are best considered in an ecological perspective, which recognizes the individual, family, social, and psychological influences that come together to contribute to the problem. Children whose parents have substance use disorders tend to be reported to child protective services at a younger age than other children ...

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