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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 2021, an estimated 4 million referrals were made to child protective service agencies, involving the alleged maltreatment of approximately 7.2 million children.

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 600,000 in 2021, yielding an abuse victimization rate of 8.1 per 1000 American children. Neglect is the most common form of maltreatment and was substantiated in 76% of cases, while 16% of cases involved physical abuse and 10.1% involved sexual abuse.

There were 1820 victims of fatal child abuse in 2021 from 50 states, resulting in a rate of 2.46 child abuse deaths per 100,000 children. The rate of African-American child fatalities was about 2.9 times greater than that of White and Hispanic children, a notable public health disparity.

Substance use disorders, 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. This chapter focuses on the knowledge necessary for the recognition, intervention, and follow-up of the more common forms of child maltreatment and highlights the role of pediatric professionals in prevention. As childhood adversity, including maltreatment, has been shown to have serious implications for life-long health and well-being, the delivery of trauma informed behavioral health treatment is now a standard of care.

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U.S. Department of Health And Human Services: Administration for Children, Youth, And Families. Child Maltreatment 2019. Https://Www.Acf.Hhs.Gov/Cb/Report/Child-Maltreatment-2021. Accessed March 9, 2023.
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