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The legal definitions regarding child maltreatment vary from state to state. In general, neglect is the failure to provide adequate care and protection for children. It may involve failure to feed the child adequately, provide medical care, provide appropriate education, or protect the child from danger. Physical abuse is the infliction of nonaccidental injury by a caretaker. It may take the form of beating, punching, kicking, biting, or other methods. The abuse can result in injuries such as broken bones, internal hemorrhages, bruises, burns, and poisoning. Cultural factors should be considered in assessing whether the discipline of a child is abusive or normative. Sexual abuse of children refers to sexual behavior between a child and an adult or between two children when one of them is significantly older or more dominant. The sexual behaviors include the following: touching breasts, buttocks, and genitals, whether the victim is dressed or undressed; exhibitionism; fellatio; cunnilingus; penetration of the vagina or anus with sexual organs or with objects; and pornographic photography. Emotional abuse occurs when a caretaker causes serious psychological injury by repeatedly terrorizing or berating a child. When serious, it is often accompanied by neglect, physical abuse, sexual abuse, and exposure to domestic violence.

The psychiatric classification of abuse and neglect in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) appears in the chapter “Other Conditions That May Be a Focus of Clinical Attention” and in the section “Problems Related to Abuse or Neglect.” The categories of abuse and neglect take a number of factors into consideration including: whether the maltreatment consisted of physical abuse, sexual abuse, or neglect; whether the victim was a child or an adult; whether the focus of clinical attention is on the victim or the perpetrator; and whether, in the case of adults, the perpetrator was the victim's partner or a person other than the victim's partner. The DSM-IV-TR categories related to child maltreatment are in given in the Box above. These conditions are coded on Axis I.

DSM-IV-TR classification of child maltreatment

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Physical abuse of child if the focus of clinical attention is on the victim.


Sexual abuse of child if the focus of clinical attention is on the victim.


Neglect of child if the focus of clinical attention is on the victim.

Giardino AP,Alexander R:Child Maltreatment: A Clinical Guide and Reference & A Comprehensive Photographic Reference Identifying Potential Child Abuse, 3rd edn. St. Louis: GW Medical Publishing, 2005.
Hamarman S,Bernet W: Evaluating and reporting emotional abuse in children: Parent-based, action-based focus aids in clinical decision making. J Am Acad Child Adolesc Psychiatry 2000;39:928.  [PubMed: 10892236]
Helfer ME,Kempe RS,Krugman RD, (eds):The Battered Child, 5th edn. revised. Chicago: University of Chicago Press, 1999.

Practitioners in private practice, as well as ...

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