essay on physical child abuse

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Physical Abuse

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Physical abuse is one of the most common forms of child maltreatment. Legal definitions vary from state to state, but broadly, physical abuse occurs when a parent or caregiver commits an act that results in physical injury to a child or adolescent, such as red marks, cuts, welts, bruises, muscle sprains, or broken bones, even if the injury was unintentional.

The impact of physical abuse on a child’s life can be far-reaching. It is especially devastating when a parent, the person a child depends on for protection and safety, becomes a danger.

Interventions

The interventions below are among those that are being used by NCTSN members to help children who have been, or are at risk of becoming, victims of physical abuse.

NCTSN Resources

The following resources on Physical Abuse were developed by the NCTSN.

The Devastating Clinical Consequences of Child Abuse and Neglect: Increased Disease Vulnerability and Poor Treatment Response in Mood Disorders

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“It is not the bruises on the body that hurt. It is the wounds of the heart and the scars on the mind.” —Aisha Mirza “We can deny our experience but our body remembers.” —Jeanne McElvaney, Spirit Unbroken: Abby’s Story

Prevalence and Consequences of Childhood Maltreatment

Childhood Maltreatment Increases Risk for Illness Severity and Poor Treatment Response in Mood Disorders

Timing of childhood maltreatment: are there periods of heightened sensitivity, experiencing single subtypes of abuse and neglect versus experiencing multiple types, underlying mechanisms by which childhood maltreatment increases risk for mood disorders and contributes to disease course.

Biological Abnormalities Associated With Childhood Maltreatment

Pathways to mood disorder outcomes, childhood maltreatment and associated alterations in neural structure and function, limitations and future directions, acknowledgments, information, published in.

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• Posttraumatic Stress

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Child Abuse: Effects and Preventive Measures

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Child Abuse and Neglect Essay

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Introduction

Events to strengthen the family.

Children are vulnerable individuals whose welfare is dependent on their parents or guardians. This exposes the children to the risk of suffering abuse and neglect from their caretakers. Hunt (2014) declares that the maltreatment of children occurs across all socio-economic, cultural and ethnic groups with negative consequences on the development of the child. Child abuse and neglect have deleterious effects on the future life of the child.

It is therefore necessary to take steps to tackle these issues and ensure the healthy emotional and physical development of the child. This paper will describe four events that can be implemented to strengthen the family and therefore reduce or eliminate incidents of child abuse and neglect.

Playgroup events can play a major role in strengthening the family on issues of child abuse and neglect is playgroups. Parents who come from the same neighborhood or those whose children attend the same school or daycare facility can form playgroups. The events provide a chance for families with similar interests and children of the same ages to connect with each other and share their experiences. Selph and Bougatsos (2013) reveal that the events are hugely beneficial to both the parents and their children.

The children are able to develop through play and interaction with their peers. The social skills and learning of the children is enhanced as they engage in play activities. Research indicates that play groups contribute to shaping family life and equipping parents with the tools necessary to engage in the challenging task of raising children (Hunt, 2014). Playgroup events provide an informal forum for parents to discuss their parenting issues and concern.

Nilsen (2010) confirms that parents are not only able to obtain important advice from their peers, but they also get to realize that other people are going through the same hurdles as they are. This is empowering especially to new parents who might feel overwhelmed by the difficulties of parenting.

These events also promote a feeling of community and each parent begins to take an interest in the wellbeing of the children of his/her friend. This makes it possible to identify incidents of abuse among children in the playgroup and take appropriate action in response.

A church/synagogue/mosque retreat activity for parents and they children can be beneficial in strengthening parents to deal with the issues of child abuse and neglect. Religion plays an important role in the lives of many individuals and they rely on their faith to inform their actions in many situations. The religious institute can therefore play a major role in promoting child safety in the community (Nilsen, 2010).

A retreat event can be planned for the parents in the congregation on a weekend. This retreat will be sponsored by the religious body, which will make it affordable to all the parents. An important advantage of faith-based events is that they possess significant resources since the congregation is made up of a variety of professionals including teachers, nurses, pediatricians, and social works. These professionals will be able to provide free advice on how to safeguard children during the retreat (Hunt, 2014).

Another benefit of the faith-based event is that it relies on the shared religious beliefs of the participants. The religious beliefs of the parents can therefore be used to exhort them to engage in good parenting practices. The religious-based family retreat will provide numerous opportunities for the families to socialize with each other.

There will be coffee breaks during which the parents and children will interact with each other and exchange contacts. Veteran parents will share their experiences and provide advice to the younger parents. The faith-based event will therefore serve as a good opportunity for the parents to establish social support systems.

Technological events can play a part in mitigating child abuse and neglect in the society. Specifically, parents can make use of online forums to learn about appropriate parenting practices and acquire skills for protecting their children against abuse. The online forum should be designed to attract parents who wish to improve the safety and wellbeing of their children. This technological tool can include a facilitator who will initiate discussion topics and moderate the discussions taking place on the website.

Online forums enable parents to express their concerns and issues in a safe environment. Through online forums, parents can be linked to numerous resources for strengthening families. Nilsen (2010) documents that there is a correlation between exposure to educational resources and a decrease in incidents of child abuse and neglect. Parents are also able to gain tangible benefits from the online events. Through the event, parents are made aware of the community resources available to them as they raise their child.

Nilsen (2010) asserts that information on available community resources is of great importance especially to parents who are at-risk of neglecting their children due to limited economic resources. A benefit of online events is that they are accessible to many parents at their convenience.

Parents do not need to adjust their schedules in order to participate in these events. This is an important factor since most parents might be overwhelmed by obligations that make it impossible for them to engage in events that require them to be physically present at venues outside their home or work setting.

Parents can enroll on home visitation programs to assist in the prevention of child abuse and neglect. The home visitation event should be voluntary and semi-formal in nature. An important feature of these events is that Nurses or Educators, who possess expert knowledge on childhood development, carry them out. These experts are able to convey to the parents professional information on subjects such as positive parenting practices.

Selph and Bougatsos (2013) reveal that such events can be of great service to pregnant women as well as families with young children. Through the home visitation, the parents are provided with information about their child’s development. The professionals can also help parents to gain a better understanding about age-appropriate behavior for their children. The home visitation events should be developed with cultural factors in mind.

Different cultures have varying values and customs that influence how the parents deal with their children. Nilsen (2010) asserts that the professionals engaging in the visitation must demonstrate sensitivity to cultures whose values and customs are different from their own. The strengths of the specific culture should be exploited to increase the safety of the child. In cultures were extended family bounds are strong, the visitation events can be scheduled to include some of the members of the extended family.

These members can be equipped to provide assistance to at-risk children and parents within their family. Parents who enroll in home visitation events are well equipped to engage in positive parenting and as a result, they engage in fewer acts of physical aggression towards their children (Promising Practices Network, 2010).

Child abuse and neglect have a lasting negative impact on the lives of children. This paper set out to discuss events that can be used to strengthen families and therefore mitigate or prevent these damaging issues from happening.

The paper has described playgroup events, faith-based activities, technological events, and home visitation programs that can be used to strengthen families. By implementing these events, the family will be equipped to prevent child abuse and neglect therefore ensuring the healthy psychological and physical wellbeing of the child.

Hunt, K. (2014). Safeguarding children – the need for vigilance. Practice Nurse, 44 (6), 18-22.

Nilsen, B. A. (2010). Week by Week: Plans for Documenting Children’s Development. NY: Cengage Learning.

Promising Practices Network. (2010). Promising Practices for Preventing Child Abuse and Neglect . NY: RAND Corporation.

Selph, S. & Bougatsos, C. (2013). Behavioral Interventions and Counseling to Prevent Child Abuse and Neglect: A Systematic Review to Update the U.S. Preventive Services Task Force Recommendation. Annals of Internal Medicine, 158 (3), 179-190.

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Child Abuse: Signs, Types, Impact

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Indicators of Child Abuse

Types of child abuse, impact of child abuse, how to manage the effects of child abuse.

Child abuse is the wrongful treatment of a child. It may be in the form of physical, emotional , or sexual abuse . This form of abuse may also be recognized as the exploitation of a child, as well as the failure to properly care for a child, otherwise known as neglect .

Children that are subjected to abuse usually experience harm to their health, welfare, and self-respect.

This article covers the many forms of child abuse, how each form impacts a child's mental and physical well-being, and discusses how childhood trauma can be treated.

If you are a victim of child abuse or know someone who might be, call or text the Childhelp National Child Abuse Hotline at 1-800-422-4453 to speak with a professional crisis counselor.

For more mental health resources, see our National Helpline Database .

When a child is experiencing ill-treatment from a caregiver or other person, there are signs that may indicate abuse. These include:

Signs of Physical Abuse

• Unexplained facial injuries
• Injuries on forearms
• Burn marks on the skin
• Bruises on the ears
• Oral and dental injuries
• Dislocations around the body
• Internal damage 
• Vomiting or breathing difficulties due to head trauma

Signs of Sexual Abuse

• Bruising around the genitals
• Painful urination or defecation
• Discharge around the genital or rectal areas
• Difficulty walking or sitting

Signs of Neglect

• Poor hygiene
• Improper clothing during the seasons
• Lack of access to medical care
• Worsening medical conditions
• Poorly-tended wounds
• Malnutrition

Behavioral Cues of Child Abuse

• Excessive crying in infants
• Poor concentration
• Development of phobias
• Eating issues
• Displays fear around parents/caregivers
• Speech difficulties
• Poor performance at school
• Substance abuse
• Discomfort while undressing
• Docile during physical exams
• Withdrawing when touched

Child abuse is committed in epidemic proportions in the United States. Every year, approximately one million children are deprived of a normal, harm-free childhood. Instead, they are subjected to the horrors of maltreatment in their formative stages.

The abuse of children may take different forms, listed below.

Physical Abuse

This form of abuse refers to the deliberate physical harm of a child by parents or caregivers. Physical abuse affects around 18% of maltreated children, and is a leading cause of child deaths—homicide falling in second for the loss of infant lives younger than one.

Physical abuse may involve hitting a child with hands or an object. Burning, biting, or physically restraining a child with the intent to do harm is also considered physical abuse.

Children of all races, ethnicities and economic groups may be subject to physical abuse. It is, however, more commonly observed in boys and infant children.

A child is also at a higher risk of physical abuse where they live with a disability or are under the care of an unmarried mother.

There is also an increased chance of violence where a child is raised in poverty, or in a home where domestic violence is rampant. The same goes in situations where a child grows up with an unrelated adult, or with more than two siblings at home.

Emotional Abuse

This form of abuse may not always have the immediately apparent signs of physical harm but is no less painful.

Emotional abuse occurs where a child is degraded, terrorized, isolated, or exploited by a parent/caregiver. This is seen where a child is constantly criticized, threatened, rejected, or given no support or love while growing up.

In 2010, The Federal Report of Child Maltreatment Statistics stated that 8% of all reported cases of child maltreatment involve emotional abuse. There is a chance that cases of emotional abuse may be even higher than those reported.

Sexual Abuse

Sexual abuse refers to the forceful participation of children in sexual acts. It may also involve forcing a child to engage in sexual acts that they do not fully understand.  This abuse may also force children to engage in sexual acts that they do not fully understand.

Sexual abuse includes sexual assault, rape, incest, fondling, oral sexual contact, the commercial sexual exploitation of children, or genital/anal penetration. Sexual abuse is a worryingly common form of child abuse. By adulthood, it is estimated that 26% of girls and 5% of boys will experience this maltreatment.

While sexual contact typically makes up sexual abuse, non-contact improper treatment may also come under the abuse classification. This includes the exposure of a child to sexual activity or taking inappropriate photographs of children.

This is the failure of a caregiver/parent to meet the most basic needs of a child. It is the most common form of child abuse where approximately two-thirds of reports to child protective services are made over concerns of child neglect.

Neglect takes many forms and can be observed where a child is not taken for regular doctor appointments, or is denied access to healthcare by a caregiver.

This form of abuse is also apparent where a child is not given the right nutritional care, or when children are exposed to harmful substances like drugs.

Abuse has far-reaching effects on every aspect of a child’s well-being.

Impact of Physical Abuse

Physically, children may suffer the pains of fractures, burns, facial or bodily disfigurement, and even seizures brought on by bodily maltreatment. The mental effects of this treatment may leave children with PTSD or even cognitive retardation.

Impact of Emotional Abuse

Emotional abuse may cause a disconnect in a child’s sense of self. This abuse could be responsible for negative disruptions in the brain, anxiety, depression, low self-esteem , hostile behaviors , and noticeable delinquent habits such as alcohol use in early adulthood.  

Impact of Sexual Abuse

The sexual abuse of children has both immediate and long-term effects on their well-being. Survivors of child sexual abuse may feel anger, guilt, and shame over the treatment they have endured.

Children who have experienced sexual abuse are also at a higher risk of developing anxiety, depression, and inappropriate sexual behaviors in life. In later years, these survivors may experience problems like alcoholism , drug dependency, marriage/family difficulties, and a  worrying preoccupation with suicide .

Impact of Neglect

A child left without the useful tools and care for proper development may perform poorly in school. This child is also likely to display emotional and behavioral problems as a result of their abandonment. 

Later difficulties in life like liver and heart disease may also be traceable to poor treatment received in childhood.

In suspected cases of child abuse at the hands of a parent or caregiver, this treatment should be reported to child protection services or other relevant law enforcement agencies. 

Children that have been physically abused should then be stabilized, with examinations carried out to determine the extent of the ill-treatment endured. 

Physical, emotional, and sexual abuse victims, as well as children that have lived through neglect, need appropriate care. These children may be protected using treatments like psychotherapy , medication, or a combination of both.

Therapy is useful for addressing the issues linked with abuse and neglect. It is also necessary to teach a child appropriate behaviors for adult-child relationships. Therapy can also provide a support system for poorly treated children.

Medication may be recommended for the PTSD, anxiety, depression, and other pains associated with abusive treatment.

Maltreatment is a painful thing to experience during development. The different forms of child abuse have far-reaching effects on welfare, but may be managed using the right methods.

A Word From Verywell

Child abuse is an alarmingly common form of abuse. With many different forms, children are exposed to multiple ripple effects from the maltreatment they've been subjected to. While recovery from a life punctuated by physical assault, sexual violence, or neglect can be difficult, healing is possible. Putting a child affected by abuse in therapy, or placing them on medication to manage adverse outcomes are effective ways to manage child abuse. To protect a child against abuse, it's important to report suspected cases of ill-treatment to the correct authorities.

Gonzalez D, Bethencourt Mirabal A, McCall JD. Child Abuse and Neglect .In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan. 

Stanford Medicine. Child abuse .

Mahoney J. Types of abuse . Nurs Clin North Am . 2011;46(4):385-v. doi:10.1016/j.cnur.2011.08.005

Brown CL, Yilanli M, Rabbitt AL. Child Physical Abuse And Neglect . In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan. 

Shin SH, Lee S, Jeon SM, Wills TA. Childhood emotional abuse, negative emotion-driven impulsivity, and alcohol use in young adulthood . Child Abuse Negl . 2015;50:94-103. doi:10.1016/j.chiabu.2015.02.010

Murray LK, Nguyen A, Cohen JA. Child sexual abuse . Child Adolesc Psychiatr Clin N Am . 2014;23(2):321-337. doi:10.1016/j.chc.2014.01.003

Melmer MN, Gutovitz S. Child Sexual Abuse And Neglect . In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan. 

Dubowitz H. Neglect in children . Pediatr Ann . 2013;42(4):73-77. doi:10.3928/00904481-20130326-11

Childwelfare.gov. Anthony U., Cynthia W. Treatment for Abused and Neglected Children: Infancy to Age 18 .

Center for Substance Abuse Treatment. Substance Abuse Treatment for Persons with Child Abuse and Neglect Issues . Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2000. (Treatment Improvement Protocol (TIP) Series, No. 36.) Chapter 3—Comprehensive Treatment for Adult Survivors of Child Abuse and Neglect. 

By Elizabeth Plumptre Elizabeth is a freelance health and wellness writer. She helps brands craft factual, yet relatable content that resonates with diverse audiences.

Understanding Child Abuse and Neglect (1993)

Chapter: 1 introduction, 1 introduction.

Child maltreatment is a devastating social problem in American society. In 1990, over 2 million cases of child abuse and neglect were reported to social service agencies. In the period 1979 through 1988, about 2,000 child deaths (ages 0-17) were recorded annually as a result of abuse and neglect (McClain et al., 1993), and an additional 160,000 cases resulted in serious injuries in 1990 alone (Daro and McCurdy, 1991). However tragic and sensational, the counts of deaths and serious injuries provide limited insight into the pervasive long-term social, behavioral, and cognitive consequences of child abuse and neglect. Reports of child maltreatment alone also reveal little about the interactions among individuals, families, communities, and society that lead to such incidents.

American society has not yet recognized the complex origins or the profound consequences of child victimization. The services required for children who have been abused or neglected, including medical care, family counseling, foster care, and specialized education, are expensive and are often subsidized by governmental funds. The General Accounting Office (1991) has estimated that these services cost more than $500 million annually. Equally disturbing, research suggests that child maltreatment cases are highly related to social problems such as juvenile delinquency, substance abuse, and violence, which require additional services and severely affect the quality of life for many American families.

The Importance Of Child Maltreatment Research

The challenges of conducting research in the field of child maltreatment are enormous. Although we understand comparatively little about the causes, definitions, treatment, and prevention of child abuse and neglect, we do know enough to recognize that the origins and consequences of child victimization are not confined to the months or years in which reported incidents actually occurred. For those who survive, the long-term consequences of child maltreatment appear to be more damaging to victims and their families, and more costly for society, than the immediate or acute injuries themselves. Yet little is invested in understanding the factors that predispose, mitigate, or prevent the behavioral and social consequences of child maltreatment.

The panel has identified five key reasons why child maltreatment research should be viewed as a central nexus of more comprehensive research activity.

Research On Child Maltreatment Is Currently Undervalued And Undeveloped

Research in the field of child maltreatment studies is relatively undeveloped when compared with related fields such as child development, so-

cial welfare, and criminal violence. Although no specific theory about the causes of child abuse and neglect has been substantially replicated across studies, significant progress has been gained in the past few decades in identifying the dimensions of complex phenomena that contribute to the origins of child maltreatment.

Efforts to improve the quality of research on any group of children are dependent on the value that society assigns to the potential inherent in young lives. Although more adults are available in American society today as service providers to care for children than was the case in 1960, a disturbing number of recent reports have concluded that American children are in trouble (Fuchs and Reklis, 1992; National Commission on Children, 1991; Children's Defense Fund, 1991).

Efforts to encourage greater investments in research on children will be futile unless broader structural and social issues can be addressed within our society. Research on general problems of violence, substance addiction, social inequality, unemployment, poor education, and the treatment of children in the social services system is incomplete without attention to child maltreatment issues. Research on child maltreatment can play a key role in informing major social policy decisions concerning the services that should be made available to children, especially children in families or neighborhoods that experience significant stress and violence.

As a nation, we already have developed laws and regulatory approaches to reduce and prevent childhood injuries and deaths through actions such as restricting hot water temperatures and requiring mandatory child restraints in automobiles. These important precedents suggest how research on risk factors can provide informed guidance for social efforts to protect all of America's children in both familial and other settings.

Not only has our society invested relatively little in research on children, but we also have invested even less in research on children whose families are characterized by multiple problems, such as poverty, substance abuse, violence, welfare dependency, and child maltreatment. In part, this slower development is influenced by the complexities of research on major social problems. But the state of research on this topic could be advanced more rapidly with increased investment of funds. In the competition for scarce research funds, the underinvestment in child maltreatment research needs to be understood in the context of bias, prejudice, and the lack of a clear political constituency for children in general and disadvantaged children in particular (Children's Defense Fund, 1991; National Commission on Children, 1991). Factors such as racism, ethnic discrimination, sexism, class bias, institutional and professional jealousies, and social inequities influence the development of our national research agenda (Bell, 1992, Huston, 1991).

The evolving research agenda has also struggled with limitations im-

posed by attempting to transfer the results of sample-specific studies to diverse groups of individuals. The roles of culture, ethnic values, and economic factors pervade the development of parenting practices and family dynamics. In setting a research agenda for this field, ethnic diversity and multiple cultural perspectives are essential to improve the quality of the research program and to overcome systematic biases that have restricted its development.

Researchers must address ethical and legal issues that present unique obligations and dilemmas regarding selection of subjects, provision of services, and disclosure of data. For example, researchers who discover an undetected incident of child abuse in the course of an interview are required by state laws to disclose the identities of the victim and offender(s), if known, to appropriate child welfare officials. These mandatory reporting requirements, adopted in the interests of protecting children, may actually cause long-term damage to children by restricting the scope of research studies and discouraging scientists from developing the knowledge base necessary to guide social interventions.

Substantial efforts are now required to reach beyond the limitations of current knowledge and to gain new insights that can improve the quality of social service efforts and public policy decisions affecting the health and welfare of abused and neglected children and their families. Most important, collaborative long-term research ventures are necessary to diminish social, professional, and institutional prejudices that have restricted the development of a comprehensive knowledge base that can improve understanding of, and response to, child maltreatment.

Dimensions Of Child Abuse And Neglect

The human dimensions of child maltreatment are enormous and tragic. The U.S. Advisory Board on Child Abuse and Neglect has called the problem of child maltreatment ''an epidemic" in American society, one that requires a critical national emergency response.

The scale and severity of child abuse and neglect has caused various public and private organizations to mobilize efforts to raise public awareness of individual cases and societal trends, to improve the reporting and tracking of child maltreatment cases, to strengthen the responses of social service systems, and to develop an effective and fair system for protecting and offering services to victims while also punishing adults who deliberately harm children or place them in danger. Over the past several decades, a growing number of state and federal funding programs, governmental reports, specialized journals, and research centers, as well as national and international societies and conferences, have examined various dimensions of the problem of child maltreatment.

The results of these efforts have been inconsistent and uneven. In addressing aspects of each new revelation of abuse or each promising new intervention, research efforts often have become diffuse, fragmented, specific, and narrow. What is lacking is a coordinated approach and a general conceptual framework that can add new depth to our understanding of child maltreatment. A coordinated approach can accommodate diverse perspectives while providing direction and guidance in establishing research priorities and synthesizing research knowledge. Organizational mechanisms are also needed to facilitate the application and integration of research on child maltreatment in related areas such as child development, family violence, substance abuse, and juvenile delinquency.

Child maltreatment is not a new problem, yet concerted service, research, and policy attention toward it is just beginning. Although isolated studies of child maltreatment appeared in the medical and sociological literature in the first half of the twentieth century, the publication of "The Battered Child Syndrome" by C. Henry Kempe and associates (1962) is generally considered the first definitive paper in the field in the United States. The efforts of Kempe and others to publicize disturbing medical experience with child abuse and neglect led to the passage of the first Child Abuse Prevention and Treatment Act in 1974 (P.L. 93-247). The act, which has been amended several times (most recently in 1992), established a governmental program designed to guide and consolidate national and state data collection efforts regarding reports of child abuse and neglect, conduct national surveys of household violence, and sponsor research and demonstration programs to prevent, identify, and treat child abuse and neglect.

However, the federal government's leadership role in building a research base in this area has been complicated by changes and inconsistencies in research plans and priorities, limited funding, politicized peer review, fragmentation of effort among various federal agencies, poorly scheduled proposal review deadlines, and bias introduced by competing institutional objectives. 1 The lack of comprehensive, long-term planning for a research base has resulted in a field characterized by contradictions, conflict, and fragmentation. The role of the National Center for Child Abuse and Neglect as the lead federal agency in supporting research in this field has been sharply criticized (U.S. Advisory Board, 1991). Many observers believe that the federal government lacks leadership, funding, and an effective research program for studies on child maltreatment.

The Complexity Of Child Maltreatment

Child maltreatment was originally seen in the form of "the battered child," often portrayed in terms of physical abuse. Today, four general categories of child maltreatment are generally recognized: (1) physical

abuse, (2) sexual abuse, (3) neglect, and (4) emotional maltreatment. Each category covers a range of behaviors, as discussed in Chapter 2.

These four categories have become the focus of separate studies of incidence and prevalence, etiology, prevention, consequences, and treatment, with uneven development of research within each area and poor integration of knowledge across areas. Each category has developed its own typology and framework of reference terms, revealing certain similarities (such as the importance of developmental perspectives in considering the consequences of maltreatment) but also important differences (such as the predatory behavior associated with some forms of sexual abuse that do not appear in the etiology of other forms of child maltreatment).

In addition to the category of child maltreatment, the duration, source, intensity, timing, and situational context of incidents of child victimization are now recognized as important factors in studying the origin and consequences of child maltreatment. Yet information about these factors is rarely requested or recorded by social agencies or health professionals in the process of identifying or documenting reports of child maltreatment. Furthermore, research is often weakened by variation in research definitions of child maltreatment, bias in the recruitment of research subjects, the absence of information regarding circumstances surrounding maltreatment reports, the absence of measures to assess selected variables under study, and the absence of a developmental perspective in many research studies.

The co-occurrence of different forms of child maltreatment has been examined only to a limited extent. Relatively little is known about areas of similarity and differences in terms of causes, consequences, prevention, and treatment of selected types of child abuse and neglect. Inconsistencies in definitions often preclude comparative analyses of clinical studies. For example, studies of sexual abuse have indicated wide variations in its prevalence, often as a result of differences in the types of behavior that might be included in the definition adopted by each research investigator. Emotional abuse is also a matter of controversy in some quarters, primarily because of broad variations in its definition.

Research on child maltreatment is also complicated by the fragmentation of services and responses by which our society addresses specific reports of child maltreatment. Cases may involve children who are victims or witnesses to single or repeated incidents of child abuse and neglect. Sadly, child maltreatment often involves various family members, relatives, or other individuals who reside in the homes or neighborhoods of the affected children. Adult figures may be perpetrators of offensive incidents or mediators in intervention or prevention efforts.

The importance of the social ecological framework of the child has only recently been recognized in studies of maltreatment. Responses to child abuse and neglect involve a variety of social institutions, including commu-

nities, schools, hospitals, churches, youth associations, the media, and other social structures that provide services for children. Such groups and organizations present special intervention opportunities to reduce the scale and scope of the problem of child maltreatment, but their activities are often poorly documented and uncoordinated. Finally, governmental offices at the local, state, and federal levels have legal and social obligations to develop programs and resources to address child maltreatment, and their role is critical in developing a research agenda for this field.

In the past, the research agenda has been determined predominantly by pragmatic needs in the development and delivery of treatment and prevention services rather than by theoretical paradigms, a process that facilitates short-term studies of specialized research priorities but impedes the development of a well-organized, coherent body of scientific knowledge that can contribute over time to understanding fundamental principles and issues. As a result, the research in this field has been generally viewed by the scientific community as fragmented, diffuse, decentralized, and of poor quality.

Selection of Research Studies

The research literature in the field of child maltreatment is immense—over 2000 items are included in the panel's research bibliography, a portion of which is referenced in this report. Despite this quantity of literature, researchers generally agree that the quality of research on child maltreatment is relatively weak in comparison to health and social science research studies in areas such as family systems and child development. Only a few prospective studies of child maltreatment have been undertaken, and most studies rely on the use of clinical samples (which may exclude important segments of the research population) or adult memories. Both types of samples are problematic and can produce biased results. Clinical samples may not be representative of all cases of child maltreatment. For example, we know from epidemiologic studies of disease of cases that were derived from hospital records that, unless the phenomenon of interest always comes to a service provider for treatment, there exist undetected and untreated cases in the general population that are often quite different from those who have sought treatment. Similarly, when studies rely on adult memories of childhood experiences, recall bias is always an issue. Longitudinal studies are quite rare, and some studies that are described as longitudinal actually consist of hybrid designs followed over time.

To ensure some measure of quality, the panel relied largely on studies that had been published in the peer-reviewed scientific literature. More rigorous scientific criteria (such as the use of appropriate theory and methodology in the conduct of the study) were considered by the panel, but were not adopted because little of the existing work would meet such selection

criteria. Given the early stage of development of this field of research, the panel believes that even weak studies contain some useful information, especially when they suggest clinical insights, a new perspective, or a point of departure from commonly held assumptions. Thus, the report draws out issues based on clinical studies or studies that lack sufficient control samples, but the panel refrains from drawing inferences based on this literature.

The panel believes that future research reviews of the child maltreatment literature would benefit from the identification of explicit criteria that could guide the selection of exemplary research studies, such as the following:

For the most part, only a few studies will score well in each of the above categories. It becomes problematic, therefore, to rate the value of studies which may score high in one category but not in others.

The panel has relied primarily on studies conducted in the past decade, since earlier research work may not meet contemporary standards of methodological rigor. However, citations to earlier studies are included in this report where they are thought to be particularly useful and when research investigators provided careful assessments and analysis of issues such as definition, interrelationships of various types of abuse, and the social context of child maltreatment.

A Comparison With Other Fields of Family and Child Research

A comparison with the field of studies on family functioning may illustrate another point about the status of the studies on child maltreatment. The literature on normal family functioning or socialization effects differs in many respects from the literature on child abuse and neglect. Family sociology research has a coherent body of literature and reasonable consensus about what constitutes high-quality parenting in middle-class, predominantly White populations. Family functioning studies have focused predominantly on large, nonclinical populations, exploring styles of parenting and parenting practices that generate different kinds and levels of competence, mental health, and character in children. Studies of family functioning have tended to follow cohorts of subjects over long periods to identify the effects of variations in childrearing practices and patterns on children's

competence and adjustment that are not a function of social class and circumstances.

By contrast, the vast and burgeoning literature on child abuse and neglect is applied research concerned largely with the adverse effects of personal and social pathology on children. The research is often derived from very small samples selected by clinicians and case workers. Research is generally cross-sectional, and almost without exception the samples use impoverished families characterized by multiple problems, including substance abuse, unemployment, transient housing, and so forth. Until recently, researchers demonstrated little regard for incorporating appropriate ethnic and cultural variables in comparison and control groups. In the past decade, significant improvements have occurred in the development of child maltreatment research, but key problems remain in the area of definitions, study designs, and the use of instrumentation.

As the nature of research on child abuse and neglect has evolved over time, scientists and practitioners have likewise changed. The psychopathologic model of child maltreatment has been expanded to include models that stress the interactions of individual, family, neighborhood, and larger social systems. The role of ethnic and cultural issues are acquiring an emerging importance in formulating parent-child and family-community relationships. Earlier simplistic conceptionalizations of perpetrator-victim relationships are evolving into multiple-focus research projects that examine antecedents in family histories, current situational relationships, ecological and neighborhood issues, and interactional qualities of relationships between parent-child and offender-victim. In addition, emphases in treatment, social service, and legal programs combine aspects of both law enforcement and therapy, reflecting an international trend away from punishment, toward assistance, for families in trouble.

Charge To The Panel

The commissioner of the Administration for Children, Youth, and Families in the U.S. Department of Health and Human Services requested that the National Academy of Sciences convene a study panel to undertake a comprehensive examination of the theoretical and pragmatic research needs in the area of child maltreatment. The Panel on Research on Child Abuse and Neglect was asked specifically to:

The report resulting from this study provides recommendations for allocating existing research funds and also suggests funding mechanisms and topic areas to which new resources could be allocated or enhanced resources could be redirected. By focusing this report on research priorities and the needs of the research community, the panel's efforts were distinguished from related activities, such as the reports of the U.S. Advisory Board on Child Abuse and Neglect, which concentrate on the policy issues in the field of child maltreatment.

The request for recommendations for research priorities recognizes that existing studies on child maltreatment require careful evaluation to improve the evolution of the field and to build appropriate levels of human and financial resources for these complex research problems. Through this review, the panel has examined the strengths and weaknesses of past research and identified areas of knowledge that represent the greatest promise for advancing understanding of, and dealing more effectively with, the problem of child maltreatment.

In conducting this review, the panel has recognized the special status of studies of child maltreatment. The experience of child abuse or neglect from any perspective, including victim, perpetrator, professional, or witness, elicits strong emotions that may distort the design, interpretation, or support of empirical studies. The role of the media in dramatizing selected cases of child maltreatment has increased public awareness, but it has also produced a climate in which scientific objectivity may be sacrificed in the name of urgency or humane service. Many concerned citizens, legislators, child advocates, and others think we already know enough to address the root causes of child maltreatment. Critical evaluations of treatment and prevention services are not supported due to both a lack of funding and a lack of appreciation for the role that scientific analysis can play in improving the quality of existing services and identifying new opportunities for interventions. The existing research base is small in volume and spread over a wide variety of topics. The contrast between the importance of the problem and the difficulty of approaching it has encouraged the panel to proceed carefully, thoroughly distinguishing suppositions from facts when they appear.

Research on child maltreatment is at a crossroads—we are now in a position to merge this research field with others to incorporate multiple perspectives, broaden research samples, and focus on fundamental issues that have the potential to strengthen, reform, or replace existing public policy and social programs. We have arrived at a point where we can

recognize the complex interplay of forces in the origins and consequences of child abuse and neglect. We also recognize the limitations of our knowledge about the effects of different forms of social interventions (e.g., home visitations, foster care, family treatment programs) for changing the developmental pathways of abuse victims and their families.

The Importance Of A Child-Oriented Framework

The field of child maltreatment studies has often divided research into the types of child maltreatment under consideration (such as physical and sexual abuse, child neglect, and emotional maltreatment). Within each category, researchers and practitioners have examined underlying causes or etiology, consequences, forms of treatment or other interventions, and prevention programs. Each category has developed its own typology and framework of reference terms, and researchers within each category often publish in separate journals and attend separate professional meetings.

Over a decade ago, the National Research Council Committee on Child Development Research and Public Policy published a report titled Services for Children: An Agenda for Research (1981). Commenting on the development of various government services for children, the report noted that observations of children's needs were increasingly distorted by the "unmanageably complex, expensive, and confusing" categorical service structure that had produced fragmented and sometimes contradictory programs to address child health and nutrition requirements (p. 15-16). The committee concluded that the actual experiences of children and their families in different segments of society and the conditions of their homes, neighborhoods, and communities needed more systematic study. The report further noted that we need to learn more about who are the important people in children's lives, including parents, siblings, extended family, friends, and caretakers outside the family, and what these people do for children, when, and where.

These same conclusions can be applied to studies of child maltreatment. Our panel considered, but did not endorse, a framework that would emphasize differences in the categories of child abuse or neglect. We also considered a framework that would highlight differences in the current system of detecting, investigating, or responding to child maltreatment. In contrast to conceptualizing this report in terms of categories of maltreatment or responses of the social system to child maltreatment, the panel presents a child-oriented research agenda that emphasizes the importance of knowing more about the backgrounds and experiences of developing children and their families, within a broader social context that includes their friends, neighborhoods, and communities. This framework stresses the importance of knowing more about the qualitative differences between children who suffer episodic experiences of abuse or neglect and those for whom mal-

treatment is a chronic part of their lives. And this approach highlights the need to know more about circumstances that affect the consequences, and therefore the treatment, of child maltreatment, especially circumstances that may be affected by family, cultural, or ethnic factors that often remain hidden in small, isolated studies.

An Ecological Developmental Perspective

The panel has adopted an ecological developmental perspective to examine factors in the child, family, or society that can exacerbate or mitigate the incidence and destructive consequences of child maltreatment. In the panel's view, this perspective reflects the understanding that development is a process involving transactions between the growing child and the social environment or ecology in which development takes place. Positive and negative factors merit attention in shaping a research agenda on child maltreatment. We have adopted a perspective that recognizes that dysfunctional families are often part of a dysfunctional environment.

The relevance of child maltreatment research to child development studies and other research fields is only now being examined. New methodologies and new theories of child maltreatment that incorporate a developmental perspective can provide opportunities for researchers to consider the interaction of multiple factors, rather than focusing on single causes or short-term effects. What is required is the mobilization of new structures of support and resources to concentrate research efforts on significant areas that offer the greatest promise of improving our understanding of, and our responses to, child abuse and neglect.

Our report extends beyond what is, to what could be, in a society that fosters healthy development in children and families. We cannot simply build a research agenda for the existing social system; we need to develop one that independently challenges the system to adapt to new perspectives, new insights, and new discoveries.

The fundamental theme of the report is the recognition that research efforts to address child maltreatment should be enhanced and incorporated into a long-term plan to improve the quality of children's lives and the lives of their families. By placing maltreatment within the framework of healthy development, for example, we can identify unique sources of intervention for infants, preschool children, school-age children, and adolescents.

Each stage of development presents challenges that must be resolved in order for a child to achieve productive forms of thinking, perceiving, and behaving as an adult. The special needs of a newborn infant significantly differ from those of a toddler or preschool child. Children in the early years of elementary school have different skills and distinct experiential levels from those of preadolescent years. Adolescent boys and girls demon-

strate a range of awkward and exploratory behaviors as they acquire basic social skills necessary to move forward into adult life. Most important, developmental research has identified the significant influences of family, schools, peers, neighborhoods, and the broader society in supporting or constricting child development.

Understanding the phenomenon of child abuse and neglect within a developmental perspective poses special challenges. As noted earlier, research literature on child abuse and neglect is generally organized by the category or type of maltreatment; integrated efforts have not yet been achieved. For example, research has not yet compared and contrasted the causes of physical and sexual abuse of a preschool child or the differences between emotional maltreatment of toddlers and adolescents, although all these examples fall within the domain of child maltreatment. A broader conceptual framework for research will elicit data that can facilitate such comparative analyses.

By placing research in the framework of factors that foster healthy development, the ecological developmental perspective can enhance understanding of the research agenda for child abuse and neglect. The developmental perspective can improve the quality of treatment and prevention programs, which often focus on particular groups, such as young mothers who demonstrate risk factors for abuse of newborns, or sexual offenders who molest children. There has been little effort to cut across the categorical lines established within these studies to understand points of convergence or divergence in studies on child abuse and neglect.

The ecological developmental perspective can also improve our understanding of the consequences of child abuse and neglect, which may occur with increased or diminished intensity over a developmental cycle, or in different settings such as the family or the school. Initial effects may be easily identified and addressed if the abuse is detected early in the child's development, and medical and psychological services are available for the victim and the family. Undetected incidents, or childhood experiences discovered later in adult life, require different forms of treatment and intervention. In many cases, incidents of abuse and neglect may go undetected and unreported, yet the child victim may display aggression, delinquency, substance addiction, or other problem behaviors that stimulate responses within the social system.

Finally, an ecological developmental perspective can enhance intervention and prevention programs by identifying different requirements and potential effects for different age groups. Children at separate stages of their developmental cycle have special coping mechanisms that present barriers to—and opportunities for—the treatment and prevention of child abuse and neglect. Intervention programs need to consider the extent to which children may have already experienced some form of maltreatment in order to

evaluate successful outcomes. In addition, the perspective facilitates evaluation of which settings are the most promising locus for interventions.

Previous Reports

A series of national reports associated with the health and welfare of children have been published in the past decade, many of which have identified the issue of child abuse and neglect as one that deserves sustained attention and creative programmatic solutions. In their 1991 report, Beyond Rhetoric , the National Commission on Children noted that the fragmentation of social services has resulted in the nation's children being served on the basis of their most obvious condition or problem rather than being served on the basis of multiple needs. Although the needs of these children are often the same and are often broader than the mission of any single agency emotionally disturbed children are often served by the mental health system, delinquent children by the juvenile justice system, and abused or neglected children by the protective services system (National Commission on Children, 1991). In their report, the commission called for the protection of abused and neglected children through more comprehensive child protective services, with a strong emphasis on efforts to keep children with their families or to provide permanent placement for those removed from their homes.

In setting health goals for the year 2000, the Public Health Service recognized the problem of child maltreatment and recommended improvements in reporting and diagnostic services, and prevention and educational interventions (U.S. Public Health Service, 1990). For example, the report, Health People 2000 , described the four types of child maltreatment and recommended that the rising incidence (identified as 25.2 per 1,000 in 1986) should be reversed to less than 25.2 in the year 2000. These public health targets are stated as reversing increasing trends rather than achieving specific reductions because of difficulties in obtaining valid and reliable measures of child maltreatment. The report also included recommendations to expand the implementation of state level review systems for unexplained child deaths, and to increase the number of states in which at least 50 percent of children who are victims of physical or sexual abuse receive appropriate treatment and follow-up evaluations as a means of breaking the intergenerational cycle of abuse.

The U.S. Advisory Board on Child Abuse and Neglect issued reports in 1990 and 1991 which include national policy and research recommendations. The 1991 report presented a range of research options for action, highlighting the following priorities (U.S. Advisory Board on Child Abuse and Neglect, 1991:110-113):

This report differs from those described above because its primary focus is on establishing a research agenda for the field of studies on child abuse and neglect. In contrast to the mandate of the U.S. Advisory Board on Child Abuse and Neglect, the panel was not asked to prepare policy recommendations for federal and state governments in developing child maltreatment legislation and programs. The panel is clearly aware of the need for services for abused and neglected children and of the difficult policy issues that must be considered by the Congress, the federal government, the states, and municipal governments in responding to the distress of children and families in crisis. The charge to this panel was to design a research agenda that would foster the development of scientific knowledge that would provide fundamental insights into the causes, identification, incidence, consequences, treatment, and prevention of child maltreatment. This knowledge can enable public and private officials to execute their responsibilities more effectively, more equitably, and more compassionately and empower families and communities to resolve their problems and conflicts in a manner that strengthens their internal resources and reduces the need for external interventions.

Report Overview

Early studies on child abuse and neglect evolved from a medical or pathogenic model, and research focused on specific contributing factors or causal sources within the individual offender to be discovered, addressed, and prevented. With the development of research on child maltreatment over the past several decades, however, the complexity of the phenomena encompassed by the terms child abuse and neglect or child maltreatment has become apparent. Clinical studies that began with small sample sizes and weak methodological designs have gradually evolved into larger and longer-term projects with hundreds of research subjects and sound instrumentation.

Although the pathogenic model remains popular among the general public in explaining the sources of child maltreatment, it is limited by its primary focus on risk and protective factors within the individual. Research investigators now recognize that individual behaviors are often influenced by factors in the family, community, and society as a whole. Elements from these systems are now being integrated into more complex theories that analyze the roles of interacting risk and protective factors to explain and understand the phenomena associated with child maltreatment.

In the past, research on child abuse and neglect has developed within a categorical framework that classifies the research by the type of maltreatment typically as reported in administrative records. Although the quality of research within different categories of child abuse and neglect is uneven and problems of definitions, data collection, and study design continue to characterize much research in this field, the panel concluded that enough progress has been achieved to integrate the four categories of maltreatment into a child-oriented framework that could analyze the similarities and differences of research findings. Rather than encouraging the continuation of a categorical approach that would separate research on physical or sexual abuse, for example, the panel sought to develop for research sponsors and the research community a set of priorities that would foster the integration of scientific findings, encourage the development of comparative analyses, and also distinguish key research themes in such areas as identification, incidence, etiology, prevention, consequences, and treatment. This approach recognizes the need for the construction of collaborative, long-term efforts between public and private research sponsors and research investigators to strengthen the knowledge base, to integrate studies that have evolved for different types of child maltreatment, and eventually to reduce the problem of child maltreatment. This approach also highlights the connections that need to be made between research on the causes and the prevention of child maltreatment, for the more we learn about the origins of child abuse and neglect, the more effective we can be in seeking to prevent it. In the same manner, the report emphasises the connections that need to be made between research on the consequences and treatment of child maltreatment, for knowledge about the effects of child abuse and neglect can guide the development of interventions to address these effects.

In constructing this report, the panel has considered eight broad areas: Identification and definitions of child abuse and neglect (Chapter 2) Incidence: The scope of the problem (Chapter 3) Etiology of child maltreatment (Chapter 4) Prevention of child maltreatment (Chapter 5) Consequences of child maltreatment (Chapter 6) Treatment of child maltreatment (Chapter 7)

Human resources, instrumentation, and research infrastructure (Chapter 8) Ethical and legal issue in child maltreatment research (Chapter 9)

Each chapter includes key research recommendations within the topic under review. The final chapter of the report (Chapter 10) establishes a framework of research priorities derived by the panel from these recommendations. The four main categories identified within this framework—research on the nature and scope of child maltreatment; research on the origins and consequences of child maltreatment; research on the strengths and limitations of existing interventions; and the need for a science policy for child maltreatment research—provide the priorities that the panel has selected as the most important to address in the decade ahead.

1. The panel received an anecdotal report, for example, that one federal research agency systematically changed titles of its research awards over a decade ago, replacing phrases such as child abuse with references to maternal and child health care, after political sensitivities developed regarding the appropriateness of its research program in this area.

Bell, D.A. 1992 Faces at the Bottom of the Well: The Permanence of Racism . New York: Basic Books.

Children's Defense Fund 1991 The State of America's Children . Washington, DC: The Children's Defense Fund.

Daro, D. 1988 Confronting Child Abuse: Research for Effective Program Design . New York: The Free Press, Macmillan. Cited in the General Accounting Office, 1992. Child Abuse: Prevention Programs Need Greater Emphasis. GAO/HRD-92-99.

Daro, D., and K. McCurdy 1991 Current Trends in Child Abuse Reporting and Fatalities: The Results of the 1990 Annual Fifty State Survey . Chicago: National Committee for Prevention of Child Abuse.

Fuchs, V.R., and D.M. Reklis 1992 America's children: Economic perspectives and policy options. Science 255:41-46.

General Accounting Office 1991 Child Abuse Prevention: Status of the Challenge Grant Program . May. GAO:HRD91-95. Washington, DC.

Huston, A.C., ed. 1991 Children in Poverty: Child Development and Public Policy . New York: Cambridge University Press.

Kempe, C.H., F.N. Silverman, B. Steele, W. Droegemueller, and H.R. Silver 1962 The battered child syndrome. Journal of the American Medical Association 181(1): 17-24.

McClain, P.W., J.J. Sacks, R.G. Froehlke, and B.G. Ewigman 1993 Estimates of fatal child abuse and neglect, United States, 1979 through 1988. Pediatrics 91(2):338-343.

National Commission on Children 1991 Beyond Rhetoric: A New American Agenda for Children and Families . Washington, DC: U.S. Government Printing Office.

National Research Council 1981 Services for Children: An Agenda for Research . Commission on Behavioral and Social Sciences and Education. Washington, DC: National Academy Press.

U.S. Advisory Board on Child Abuse and Neglect 1990 Child Abuse and Neglect: Critical First Steps in Response to a National Emergency . August. Washington, DC: U.S. Department of Health and Human Services. August. 1991 Creating Caring Communities . September. Washington, DC: U.S. Department of Health and Human Services.

U.S. Public Health Service 1990 Violent and abusive behavior. Pp. 226-247 (Chapter 7) in Healthy People 2000 Report . Washington, DC: U.S. Department of Health and Human Services.

The tragedy of child abuse and neglect is in the forefront of public attention. Yet, without a conceptual framework, research in this area has been highly fragmented. Understanding the broad dimensions of this crisis has suffered as a result.

This new volume provides a comprehensive, integrated, child-oriented research agenda for the nation. The committee presents an overview of three major areas:

• Definitions and scope —exploring standardized classifications, analysis of incidence and prevalence trends, and more.
• Etiology, consequences, treatment, and prevention —analyzing relationships between cause and effect, reviewing prevention research with a unique systems approach, looking at short- and long-term consequences of abuse, and evaluating interventions.
• Infrastructure and ethics —including a review of current research efforts, ways to strengthen human resources and research tools, and guidance on sensitive ethical and legal issues.

This volume will be useful to organizations involved in research, social service agencies, child advocacy groups, and researchers.

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Understanding and Preventing Child Abuse and Neglect

• Physical Abuse and Violence
• Sexual Assault and Harassment

The Child Abuse and Prevention Treatment Act defines child abuse and neglect or child maltreatment as:

Any recent act or failure to act on the part of a parent or caretaker, which results in death, serious physical or emotional harm, sexual abuse or exploitation, or an act or failure to act which presents an imminent risk of serious harm.

Neglect is a failure to meet the child’s basic needs, e.g., not providing enough food, shelter or basic supervision, necessary medical or mental health treatment, adequate education or emotional comfort.

Physical abuse refers to the injury of a child on purpose, e.g., striking, kicking, beating, biting or any action that leads to physical injury.

Sexual abuse is the use, persuasion or forcing of a child to engage in sexual acts or imitation of such acts.

Abuse and neglect of children occurs in families from all walks of life, of all incomes, religions and ethnicities. There is no single cause of child maltreatment; rather, it occurs as a result of many forces working together to impact the family.

Parent or caregiver risk factors

Low self-esteem, poor impulse control, depression, anxiety or antisocial behavior.

Experiencing or witnessing violence as a child, which teaches violent behavior or justifies it as proper behavior.

Substance abuse, which interferes with mental functioning, judgment, self-control, ability to be protective of one’s child and making the child’s needs a priority.

Lack of knowledge about normal child development and unrealistic expectations, frustration and/or inappropriate methods of discipline.

Family risk factors

Children living with single parents are more likely to live in poverty with fewer social supports, which may contribute to stress and increase risks of maltreatment.

Children in violent homes may witness intimate partner violence, may be victims of physical abuse themselves and may be neglected by parents or caregivers who are focused on their partners or unresponsive to their children due to their own fears.

Stressful life events, parenting stress and emotional distress (e.g., losing a job, physical illness, marital problems or the death of a family member) may worsen hostility, anxiety or depression among family members and increase the level of family conflict and maltreatment.

Maltreating parents or caregivers are less supportive, affectionate, playful and responsive with their children and are more likely to use harsh discipline and verbal aggression than positive parenting strategies (e.g., using time outs, reasoning, and recognizing and encouraging the child's successes).

Child risk factors

Infants and young children, because they are small and need constant care, are more likely to experience certain forms of maltreatment such as being shaken by parents or caregivers frustrated or overwhelmed by persistent crying. Teenagers, on the other hand, are at greater risk for sexual abuse.

Children with physical, cognitive and emotional disabilities or chronic illnesses may be at greater risk of maltreatment. Parents or caregivers of children with disabilities are more likely to experience high levels of stress, depression and anger. Children with disabilities may not understand that abusive behaviors are inappropriate and are unable to defend themselves.

Aggression, attention deficits, difficult temperaments and behavior problems in children have been associated with increased risk for maltreatment, especially when parents have poor coping skills, are unable to empathize with the child or have difficulty controlling emotions. Maltreatment often exacerbates the problem. A physically abused child may develop aggressive behaviors that lead to recurring maltreatment.

Environmental risk factors

The vast majority of parents or caregivers who live in these types of environments are not abusive. However, these stresses can increase the risk of abuse for some:

Poverty and unemployment can increase the likelihood of maltreatment, especially in combination with family stress, depression, substance abuse and social isolation.

Parents with less material and emotional support and who do not have positive parenting role models feel less pressure to conform to conventional standards of parenting behaviors.

Children living in dangerous neighborhoods are at higher risk than children from safer neighborhoods for severe neglect, physical abuse and sexual abuse. It is possible that violence may seem an acceptable response or behavior to individuals who witness it more frequently.

Child abuse and neglect can result in physical and psychological developmental delays. A neglectful mother may not feed her baby properly, which can slow brain development, or an emotionally abusive father may damage his child’s ability to form trusting relationships. Abused or neglected children can see the world as an unstable, frightening and dangerous place, which can undermine their sense of self-worth and their ability to cope with and adapt to their environments as they grow up. If unaddressed, maltreatment may contribute to later problems, such alcoholism/substance abuse, depression, domestic violence, multiple sexual partners and exposure to sexually transmitted diseases, suicidal thoughts and attempts.

The impact of abuse can vary depending on:

Age and developmental status of the child when the abuse or neglect occurred,

Type of abuse (physical abuse, neglect, sexual abuse, etc.),

Frequency, duration and severity of abuse,

Relationship between the victim and his or her abuser.

Children’s optimism, high self-esteem, intelligence, creativity, humor and independence, which enhance their coping skills in the face of adversity. 

The acceptance of peers and positive influences such as teachers, mentors and role models

The family’s access to social supports, neighborhood stability and access to safe schools and adequate health care 

The child's experience of love, acceptance, positive guidance and protection from a caring adult, which encourages trust that their parents or caregivers will provide what they need to thrive

Parent's or caregiver’s respectful communication and listening, consistent rules and expectations, and safe opportunities that promote independence

Parents or caregivers who can cope with the stresses of everyday life and have the inner strength to bounce back when things are not going well.

Parents or caregivers with a social network of emotionally supportive friends, family and neighbors

Families who can meet their own basic needs for food, clothing, housing and transportation and know how to access essential services such as childcare, health care and mental health services

Psychologists are heavily involved in the development and implementation of prevention programs for child abuse and neglect. Primary prevention programs raise awareness among the public, service providers and policymakers about the scope of issues involved in child maltreatment. Secondary prevention programs target populations with one or more risk factors for child maltreatment.

Tertiary prevention programs target families where maltreatment has already taken place and aim to reduce the impact and prevent it from reoccurring.

If you suspect someone is abusing or neglecting a child, take action:

Child Welfare Information Gateway Children's Bureau/ACYF 1250 Maryland Avenue, SW Eighth Floor Washington, DC 20024 (800) 394 3366

Child Help USA 15757 North 78th Street Scottsdale, AZ 85260 (800) 4-A-CHILD

American Professional Society on the Abuse of Children 350 Poplar Avenue Elmhurst , IL 60126 (877) 402 7722

Tennyson Center for Children 2950 Tennyson Street Denver, CO 80212 (877) 224 8223

Rape, Abuse, and Incest National Network 2000 L St., NW Suite 406 Washington, DC 20036 (800) 656-HOPE

APA—Resolution on Psychological Issues Related to Child Abuse and Neglect

APA—What is child abuse and neglect? Understanding warning signs and getting help

Child Welfare Information Gateway—Child Abuse and Neglect

Medline Plus—Child Abuse

Information

APA: Act Against Violence Program

APA Topics: Sexual assault and harassment

APA Violence Prevention Office

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Love Doesn’t Have to Hurt Teens (PDF, 640KB)

What is child abuse and neglect? Understanding warning signs and getting help

Report of the Working Group on Child Maltreatment Prevention in Community Health Centers  

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Bullying Among Children and Youth  (PDF, 38KB)

Psychological Issues Related to Child Abuse and Neglect

Resolution Opposing Child Sexual Abuse

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StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

StatPearls [Internet].

Child abuse and neglect.

Dulce Gonzalez ; Arian Bethencourt Mirabal ; Janelle D. McCall .

Affiliations

Last Update: July 4, 2023 .

• Continuing Education Activity

The World Health Organization (WHO) defines child maltreatment as “all forms of physical and emotional ill-treatment, sexual abuse, neglect, and exploitation that results in actual or potential harm to the child’s health, development or dignity.” There are four main types of abuse: neglect, physical abuse, psychological abuse, and sexual abuse. Abuse is defined as an act of commission and neglect is defined as an act of omission in the care leading to potential or actual harm. This activity reviews the epidemiology, presentation, and diagnosis of child abuse and highlights the role of the interprofessional team in its management and prevention.

• Identify the etiology of child abuse and neglect.
• Review the presentation of a child with abuse and neglect.
• Outline the treatment and management options child abuse and neglect.
• Describe interprofessional team strategies for improving care coordination and outcomes in children with abuse and neglect.
• Introduction

The World Health Organization (WHO) defines child maltreatment as “all forms of physical and emotional ill-treatment, sexual abuse, neglect, and exploitation that results in actual or potential harm to the child’s health, development or dignity.” There are four main types of abuse: neglect, physical abuse, psychological abuse, and sexual abuse. Abuse is defined as an act of commission and neglect is defined as an act of omission in the care leading to potential or actual harm.

• Neglect may include inadequate health care, education, supervision, protection from hazards in the environment, and unmet basic needs such as clothing and food. Neglect is the most common form of child abuse.
• Physical abuse may include beating, shaking, burning, and biting. The threshold for defining corporal punishment as abuse is unclear. Rib fractures are found to be the most common finding associated with physical abuse.
• Psychological abuse includes verbal abuse, humiliation, and acts that scare or terrorize a child, which may result in future psychological illness of the child.
• Sexual abuse is defined as “the involvement of dependent, developmentally immature children and adolescents in sexual activities which they do not fully comprehend, to which they are unable to give consent, or that violate the social taboos of family roles.” Some cases of sexual abuse do not need to involve oral, anal, or vaginal penetration and may include exposure to sexually explicit materials, oral-genital contact, genital-to-genital contact, genital-to-anal contact, and genital fondling.

A significant amount of child abuse cases frequently are missed by healthcare providers. For the diagnosis of child abuse to be made, there needs to be a high index of suspicion. [1] [2] [3]

All races, ethnicities, and socioeconomic groups are affected by child abuse with boys and adolescents more commonly affected. Infants tend to have increased morbidity and mortality with physical abuse. Multiple factors increase a child’s risk of abuse. These include risks at an individual level (child’s disability, unmarried mother, maternal smoking or parent’s depression); risks at a familial level (domestic violence at home, more than two siblings at home); risks at a community level (lack of recreational facilities); and societal factors (poverty). Other risk factors include living in an unrelated adult’s home and being a child previously reported to child protective services (CPS). All of these increase the risk of child maltreatment. There are also protective factors that decrease the risk of child maltreatment, which includes family support and parental concern. Preventive factors include parental education regarding child development and parenting, social support, as well as parental resilience. [4] [5] [6]

• Epidemiology

Each year, millions of children are investigated by the Child Protective Services for child abuse and neglect. In 2014, over 3.2 million children were subjects of child maltreatment reports, of those, 20% were found to have evidence of maltreatment. [7]

• History and Physical

To diagnose a patient with child maltreatment is difficult since the victim may be nonverbal or too frightened or severely injured to talk. Also, the perpetrator will rarely admit to the injury, and witnesses are uncommon. Physicians will see children of maltreatment in a range of ways that include:

• An adult or mandated reporter may bring the child in when they are concerned for abuse
• A child or adolescent may come in disclosing the abuse
• The perpetrators may be concerned that the abuse is severe and bring in the patient for medical care
• The child may present for care unrelated to the abuse, and the abuse may be found incidentally.

Physical abuse should be considered in the evaluation of all injuries of children. A thorough history of present illness is important to make a correct diagnosis. Important aspects of the history-taking involve gathering information about the child’s behavior before, during, and after the injury occurred. History-taking should include the interview of each caretaker separately and the verbal child, as well. The parent or caretaker should be able to provide their history without interruptions in order not to be influenced by the physician’s questions or interpretations.

Physical Abuse

Child physical abuse should be considered in each of the following:

• A non-ambulatory infant with any injury
• Injury in a nonverbal child
• Injury inconsistent with child’s physical abilities and a statement of harm from the verbal child
• Mechanism of injury not plausible; multiple injuries, particularly at varying ages
• Bruises on the torso, ear or neck in a child younger than 4 years of age
• Burns to genitalia
• Stocking or glove distributions or patterns
• Caregiver is unconcerned about injury
• An unexplained delay in seeking care or inconsistencies or discrepancies in the histories provided. 

"TEN 4" is a useful mnemonic device used to recall which bruising locations are of concern in cases involving physical abuse: Torso, Ear, Neck and 4 (less than four years of age or any bruising in a child less than four months of age). A few injuries that are highly suggestive of abuse include retinal hemorrhages, posterior rib fractures, and classic metaphyseal lesions.

Bruising is the most common sign of physical abuse but is missed as a sentinel injury in ambulatory children. Bruising in non-ambulatory children is rare and should raise suspicion for abuse. The most common areas of bruising in non-abused children are the knees and shins as well as bony prominences including the forehead. The most common area of bruising for the abused children includes the head and face. Burns are a common form of a childhood injury that is usually not associated with abuse. Immersion burns have characteristic sharp lines of demarcation that often involves the genitals and lower extremities in a symmetric pattern, and this is highly suspicious for abuse.

Abusive Head Trauma

Abusive head trauma (AHT), also known as the shaken baby syndrome, is a form of child physical abuse with the highest mortality rate (greater than 20%). Symptoms may be as subtle as vomiting, or as severe as lethargy, seizures, apnea, or coma. Findings suggestive of AHT are retinal hemorrhages, subdural hematomas, and diffuse axonal injury. An infant with abusive head trauma may have no neurologic symptoms and may be diagnosed instead with acute gastroenteritis, otitis media, GERD, colic and other non-related entities. Often, a head ultrasound is used as the initial evaluation in young infants. However, it not the test of choice in the emergency setting. In the assessment of AHT, the ophthalmologic examination should be performed, preferably by a pediatric ophthalmologist.

Skeletal Trauma

The second most common type of child abuse after neglect is physical abuse. Eighty percent of abusive fractures occur in non-ambulatory children, particularly in children younger than 18 months of age. The most important risk factor for abusive skeletal injury is age. There is no fracture pathognomonic for abuse, but there are some fractures that are more suggestive of abuse.  These include posterior or lateral rib fractures and “corner” or “bucket handle” fractures, which occur at the ends of long bones and which result from a twisting mechanism. Other highly suspicious fractures are sternal, spinal and scapular fractures.

Abdominal Trauma

Abdominal trauma is a significant cause of morbidity and mortality in abused children. It is the second most common cause of death from physical abuse, mostly seen in infants and toddlers. Many of these children will not display overt findings, and there may be no abdominal bruising on physical exam. Therefore, screening should include liver function tests, amylase, lipase, and testing for hematuria. Any positive result can indicate the need for imaging studies, particularly an abdominal CT scan.

Sexual Abuse

If a child demonstrates behavior such as undressing in front of others, touching others' genitals, as well as trying to look at others underdressing, there may be a concern for sexual abuse. It is important to understand that a normal physical examination does not rule out sexual abuse. Indeed, the majority of sexual abuse victims have a normal anogenital examination. In most cases, the strongest evidence that sexual abuse has occurred is the child’s statement.

Physical examination may not only demonstrate signs of physical abuse but may show signs of neglect. The general examination may show poor oral hygiene with extensive dental caries, malnutrition with significant growth failure, untreated diaper dermatitis, or untreated wounds.

All healthcare providers are mandated reporters, and, as such, they are required to make a report to child welfare when there is a reasonable suspicion of abuse or neglect. One does not need to be certain, but one does need to have a reasonable suspicion of the abuse. This mandated report may be lifesaving for many children. an interprofessional approach with the inclusion of a child-abuse specialist is optimal.

Any child younger than two years old for whom there is a concern of physical abuse should have a skeletal survey. Additionally, any sibling younger than two years of age of an abused child should also have a skeletal survey. A skeletal survey consists of 21 dedicated views, as recommended by the American College of Radiology. The views include anteroposterior (AP) and lateral aspects of the skull; lateral spine; AP, right posterior oblique, left posterior oblique of chest/rib technique; AP pelvis; AP of each femur; AP of each leg; AP of each humerus; AP of each forearm; posterior and anterior views of each hand; AP (dorsoventral) of each foot. If the findings are abnormal or equivocal, a follow-up survey is indicated in 2 weeks to visualize healing patterns.

Laboratory evaluation may be performed to rule out other diseases as causes of the injuries. These can including bone (calcium, magnesium, phosphate, alkaline phosphatase), hematology (CBC), coagulation (PT, PTT, INR), metabolic (glucose, BUN, creatinine, albumin, protein), liver (AST, ALT), pancreatic (amylase and lipase), and bleeding diathesis (von Willebrand antigen, von Willebrand activity, Factor VIII, Factor IX and platelet function assays).

One should take into consideration that the most common differential diagnosis of non-accidental injury is an accidental injury. [8] [9] [10]

• Treatment / Management

Initial management of an abused child involves stabilization, including assessing the patient’s airway, breathing, and circulation. Once ensured that the patient is stable, a complete history and physical examination is required. With the suspicion for any form of child abuse, CPS needs to be informed. If there is a child abuse specialist at the pediatric center, their involvement would be optimal. If the patient is seen in an outpatient setting, there may be a need to transfer the patient to a hospital for laboratory and radiologic evaluation as well as the appropriate continuation of care. Even if a child was transferred to another physician or facility, the physician first involved with the patient care still has the responsibility of being a mandated reporter. It is not the responsibility of the physician to identify the perpetrator, but it is to recognize potential abuse. The physician can continue to advocate for the child, ensuring that the patient receives the appropriate follow-up services.

Victims of sexual abuse should have their physical, mental, and psychosocial needs addressed. Baseline sexually transmitted infection (STI) and pregnancy testing should be performed as well as empiric treatment for HIV, gonorrhea, chlamydia, trichomonas, and bacterial vaginosis infection for the adolescent victims. This management is possible if the patients present within 72 hours of the incident to receive appropriate care as well as emergency contraception if desired. Prepubertal patients are not provided with the prophylactic treatment due to the low incidence of STIs in this age group. Urgent evaluation is beneficial in the patients who need prophylactic treatment, those with anogenital injury, for forensic evidence, optimally in less than 72 hours, for urgent child protection, and in those having suicidal ideation or any other form of symptom and/or injury requiring urgent medical care. [11] [12] [13]

• Differential Diagnosis
• Idiopathic thrombocytopenic purpura
• Vascular malformations
• Collagen vascular disorder 
• Osteogenesis imperfecta
• Complications
• Disfigurement
• Emotional trauma
• Mental retardation
• Consultations
• Psychiatrist
• Orthopedic surgeon  
• Neurologist
• Child protective services
• Pearls and Other Issues

Child abuse is a public health problem that leads to lifelong health consequences, both physically and psychologically. Physically, those who undergo abusive head trauma may have neurologic deficits, developmental delays, cerebral palsy, and other forms of disability. Psychologically, child abuse patients tend to have higher rates of depression, conduct disorder, and substance abuse. Academically, these children may have poor performance at school with decreased cognitive function.

It is important as physicians to have a high index of suspicion for child maltreatment since early identification may be lifesaving.

• Enhancing Healthcare Team Outcomes

Child abuse is a public health problem that leads to lifelong health consequences, both physically and psychologically. Physically, those who undergo abusive head trauma may have neurologic deficits, developmental delays, cerebral palsy, and other forms of disability. Psychologically, child abuse patients tend to have higher rates of depression, conduct disorder, and substance abuse. Academically, these children may have poor performance at school with decreased cognitive function. It is important as clinicians to have a high index of suspicion for child maltreatment since early identification may be lifesaving. Nurses, doctors, pharmacists, and all other healthcare workers should not hesitate to report child abuse.

When it comes to child abuse, all healthcare workers have a legal, medical and moral obligation to identify the problem and report it to CPS. The majority of child abuse problems present to the Emergency Department; hence nurses and physicians are often the first ones to notice the problem. The key is to be aware of the problem; allowing abused children to return back to their parents usually leads to more violence and sometimes even death. Even if child abuse is only suspected, the social worker must be informed so that the child can be followed as an outpatient. The law favors the clinician for reporting child abuse, even if it is only a suspicion. On the other hand, failing to report child abuse can have repercussions on the clinician. Unfortunately, despite the best practices, many children continue to suffer from child abuse. [14] [15] [16] (Level V)

Evidence-based outcomes

Child abuse is a serious problem in many countries. While there is an acute awareness of the problem, many children fail to be referred to CPS and consequently continue to suffer abuse, sometimes even death. In a busy emergency room, signs of child abuse are missed, and thus healthcare workers must be vigilant of abuse in any child who presents with injuries that are out of place. [2] [17] (Level V)

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Disclosure: Dulce Gonzalez declares no relevant financial relationships with ineligible companies.

Disclosure: Arian Bethencourt Mirabal declares no relevant financial relationships with ineligible companies.

Disclosure: Janelle McCall declares no relevant financial relationships with ineligible companies.

This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ), which permits others to distribute the work, provided that the article is not altered or used commercially. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.

• Cite this Page Gonzalez D, Bethencourt Mirabal A, McCall JD. Child Abuse and Neglect. [Updated 2023 Jul 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

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“mimics” of injuries from child abuse: case series and review of the literature.

1. Introduction

2. materials and methods, 4. discussion, 5. conclusions, author contributions, institutional review board statement, informed consent statement, data availability statement, conflicts of interest.

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Focardi, M.; Gori, V.; Romanelli, M.; Santori, F.; Bianchi, I.; Rensi, R.; Defraia, B.; Grifoni, R.; Gualco, B.; Nanni, L.; et al. “Mimics” of Injuries from Child Abuse: Case Series and Review of the Literature. Children 2024 , 11 , 1103. https://doi.org/10.3390/children11091103

Focardi M, Gori V, Romanelli M, Santori F, Bianchi I, Rensi R, Defraia B, Grifoni R, Gualco B, Nanni L, et al. “Mimics” of Injuries from Child Abuse: Case Series and Review of the Literature. Children . 2024; 11(9):1103. https://doi.org/10.3390/children11091103

Focardi, Martina, Valentina Gori, Marta Romanelli, Francesco Santori, Ilenia Bianchi, Regina Rensi, Beatrice Defraia, Rossella Grifoni, Barbara Gualco, Laura Nanni, and et al. 2024. "“Mimics” of Injuries from Child Abuse: Case Series and Review of the Literature" Children 11, no. 9: 1103. https://doi.org/10.3390/children11091103

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Child Trauma: Determining Accidental Injury From Intentional Abuse

Abuse is the leading cause of trauma-related fatalities in children younger than four years old. [1] However, recognizing physical abuse in pediatric patients can be difficult. Young children sustain injuries, including bruises and broken bones, during normal age-appropriate activities such as learning to walk or riding a bicycle. Differentiating expected accidental injuries from nonaccidental injuries (i.e., child abuse) is challenging for the medical and medicolegal communities.

The National Institute of Justice (NIJ) has funded academic institutions and medical examiners’ offices to research the determination of intentional versus accidental trauma in infants and children. These studies have focused on modeling skull fractures, applying biomechanical engineering techniques to determine fracture potential, identifying bruising patterns, and using advanced imaging technologies to capture minute injuries from suspected head trauma.

Skull Fractures

Accidental skull fractures are common in young children and tend to be easily treated in emergency departments. [2] However, skull fractures resulting from nonaccidental injury are often life-threatening. Differentiating between accidental and nonaccidental skull fractures is critical to accurately recognize victims of abuse.

NIJ has supported several research projects on identifying skull fracture patterns associated with nonaccidental injury. NIJ funded the University of Louisville to develop a statistical model that predicts the probability of head injury occurring as the result of a fall. [3] This project furthers NIJ-funded research at the university that gathered force mechanics data from accelerometers worn by children at a childcare center. [4]

NIJ funding also helped the University of Utah develop a fracture-simulation framework to estimate fall height and impact location from fracture images. [5] Information from these studies allows practitioners to compare a child’s injury to the history a caretaker provides. Then practitioners can evaluate whether the injury and history are consistent or whether they raise concerns about a nonaccidental event.

In addition, NIJ funded a Michigan State University study to investigate the biomechanics associated with skull fractures. [6] Using porcine models, researchers impacted crania with various rigid and soft surfaces at a known force to measure fracture biomechanics and identify recurring fracture patterns.

Bruises are common at any age, but specific bruising patterns can be an indicator of nonaccidental injury, especially in infants. NIJ funded the University of Louisville to develop a model to predict bruising patterns associated with accidental household falls (for example, falling from a bed). [7] The researchers developed a virtual bruising detection system using a three-dimensional computer simulation model representing a 12-month-old child to show differences in bruising patterns between accidental and nonaccidental injury.

Injury Identification and Documentation in Autopsies

Identifying and documenting injuries in deceased victims of child abuse is critical to proper adjudication. NIJ has supported research in advanced imaging technologies to augment standard autopsy procedures. NIJ funded the University of New Mexico to evaluate the value of magnetic resonance imaging (MRI) and computed tomography (CT) in death investigations of children with suspected head trauma. The team hypothesized that using postmortem CT in conjunction with standard autopsy will increase the rate of injury identification in deceased children, as it has for adults. The team also investigated the use of three-dimensional postmortem MRI to visualize bleeding within a child’s spinal tissue, a potential mechanism of death. [8]

Since 2007, NIJ has invested more than $11 million to further understand and determine intentional versus accidental trauma, along with cause and manner of death, in infants and children. Such research remains a high priority for NIJ’s Forensic Science Research and Development Technology Working Group. [9] Through these investments, NIJ continues to develop tools that help the forensic science community identify child abuse and advance justice for victims.

About the Article

This article was published as part of NIJ Journal issue 286 .

This article discusses the following awards:

• “ Development of a Probability Model To Predict Head Injury Risk in Pediatric Falls ,” award number 2019-DU-BX-0029
• “ Biomechanical Characterization of Video Recorded Short Distance Falls in Children ,” award number 2017-DN-BX-0158
• “ Forensic Tool To Identify Fall Characteristics in Infant Skull Fracture, ” award number 2020-75-CX-0014
• “ A Forensic Pathology Tool To Predict Pediatric Skull Fracture Patterns ,” award number 2007-DN-BX-K196
• “ Pediatric Fracture Printing: Creating a Science of Statistical Fracture Signature Analysis ,” award number 2011-DN-BX-K540
• “ Utility of Postmortem X-ray Computed Tomography (CT) in Supplanting or Supplementing Medicolegal Autopsies ,” award number 2010-DN-BX-K205
• “ Investigation of Post-Mortem Magnetic Resonance Imaging for the Detection of Intraneural Hemorrhage ,” award number 2013-DN-BX-K004
• “ Improving and Evaluating Computed Tomography and Magnetic Resonance Imaging in the Investigation of Fatalities Involving Suspected Head Trauma ,” award number 2016-DN-BX-0173
• “ Understanding the Pathology of Homicidal Pediatric Blunt Neurotrauma Through Correlation of Advanced Magnetic Resonance Images With Histopathology ,” award number 2017-DN-BX-0145
• “ Development of a Computer Simulation Model To Describe Potential Bruising Patterns Associated With Common Childhood Falls ,” award number 2014-DN-BX-K006

[note 1] Gina Bertocci et al., “ Development of a Probability Model To Predict Head Injury Risk in Pediatric Falls ,” Final report to the National Institute of Justice, award number 2019-DU-BX-0029, May 2023, NCJ 306560.

[note 2] Ailbhe McGrath and Roger S. Taylor, “ Pediatric Skull Fractures ,” National Library of Medicine, National Center for Biotechnology Information, accessed March 30, 2023.

[note 3] National Institute of Justice funding award description, “ Development of a Probability Model To Predict Head Injury Risk in Pediatric Falls ,” at the University of Louisville, award number 2019-DU-BX-0029.

[note 4] National Institute of Justice funding award description, “ Biomechanical Characterization of Video Recorded Short Distance Falls in Children ,” at the University of Louisville, award number 2017-DN-BX-0158.

[note 5] National Institute of Justice funding award description, “ Forensic Tool To Identify Fall Characteristics in Infant Skull Fracture ,” at the University of Utah, award number 2020-75-CX-0014.

[note 6] National Institute of Justice funding award description, “ A Forensic Pathology Tool To Predict Pediatric Skull Fracture Patterns, ” at Michigan State University, award number 2007-DN-BX-K196; and National Institute of Justice funding award description, “ Pediatric Fracture Printing: Creating a Science of Statistical Fracture Signature Analysis ,” at Michigan State University, award number 2011-DN-BX-K540.

[note 7] Gina Bertocci, “ Development of a Computer Simulation Model To Describe Potential Bruising Patterns Associated With Common Childhood Falls ,” Final report to the National Institute of Justice, award number 2014-DN-BX-K006, September 2020, NCJ 255338.

[note 8] National Institute of Justice funding award description, “ Utility of Postmortem X-ray Computed Tomography (CT) in Supplanting or Supplementing Medicolegal Autopsies ,” at the University of New Mexico Health Sciences Center, award number 2010-DN-BX-K205; National Institute of Justice funding award description, “ Investigation of Post-Mortem Magnetic Resonance Imaging for the Detection of Intraneural Hemorrhage ,” at the University of New Mexico Health Sciences Center, award number 2013-DN-BX-K004; National Institute of Justice funding award description, “ Improving and Evaluating Computed Tomography and Magnetic Resonance Imaging in the Investigation of Fatalities Involving Suspected Head Trauma ,” at the University of New Mexico, award number 2016-DN-BX-0173; and National Institute of Justice funding award description, “ Understanding the Pathology of Homicidal Pediatric Blunt Neurotrauma Through Correlation of Advanced Magnetic Resonance Images With Histopathology ,” at the University of New Mexico, award number 2017-DN-BX-0145.

[note 9] National Institute of Justice, Forensic Science Research and Development Technology Working Group: Operational Requirements , April 4, 2024.

About the author

Jennifer Love , Ph.D., is a physical scientist who formerly worked in NIJ’s Office of Investigative and Forensic Sciences. Danielle McLeod-Henning , M.F.S., is a physical scientist in NIJ’s Office of Investigative and Forensic Sciences.

Cite this Article

Related awards.

• Development of a Probability Model to Predict Head Injury Risk in Pediatric Falls
• Biomechanical Characterization of Video Recorded Short Distance Falls In Children
• Pediatric Fracture Printing: Creating a Science of Statistical Fracture Signature Analysis
• A Forensic Pathology Tool to Predict Pediatric Skull Fracture Patterns
• Utility of Postmortem X-ray Computed Tomography (CT) in Supplanting or Supplementing Medicolegal Autopsies
• Investigation of Post-Mortem Magnetic Resonance Imaging for the Detection of Intraneural Hemorrhage
• Improving and Evaluating Computed Tomography and Magnetic Resonance Imaging in the Investigation of Fatalities Involving Suspected Head Trauma
• Understanding the Pathology of Homicidal Pediatric Blunt Neurotrauma through Correlation of Advanced Magnetic Resonance Images with Histopathology
• Development of a Computer Simulation Model to Predict Potential Bruising Patterns Associated with Common Childhood Falls

This copy is for your personal, non-commercial use only. To order presentation-ready copies for distribution to your colleagues, clients or customers visit http://www.djreprints.com.

https://www.barrons.com/news/malaysia-widens-probe-into-horror-care-home-child-abuse-b0570edd

• FROM AFP NEWS

Malaysia Widens Probe Into 'Horror' Care Home Child Abuse

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Police rescued 400 children from alleged abuse at care homes in Malaysia, in one of the worst such cases to hit the country

ADDS Selangor state government

Malaysian police expanded their probe Friday into a major conglomerate with links to a banned Islamic sect, after hundreds of children were rescued from alleged abuse at care homes believed to be run by the group.

Investigators stormed 20 charity shelters across two Malaysian states on Wednesday, arresting 171 suspects including religious studies teachers and caregivers, and bringing to safety over 400 children.

In what is believed to be the worst such case to hit Malaysia in decades, police suspect the victims -- aged from one to 17 -- had been subjected to sexual and physical attacks.

They were also allegedly forced by the care home staff to abuse each other.

Investigators were "working towards" further raids and arrests as the probe on the organisation called Global Ikhwan Services and Business (GISB) continued, said police inspector-general Razarudin Husain.

Investigations and health checks so far show that at least 13 minors had been sexually abused, Razarudin said at a press conference.

The children, who are temporarily being housed in a police training centre in Kuala Lumpur among other locations, are still undergoing medical examinations, added the police chief.

Razarudin had said on Wednesday that children as young as five were burnt with hot spoons, while others who were ill were not allowed to seek treatment until their condition became critical.

"The caretakers also touched the children's bodies as if to carry out medical checks," he said.

GISB has denied the allegations and said they do not run the care homes raided in the states of Selangor and Negeri Sembilan.

"It is not our policy to do things that go against Islam, and the laws," the group said in a statement this week.

Prime Minister Anwar Ibrahim said he has urged relevant authorities to "investigate thoroughly" without delay.

"This concerns the faith of the community. It is important and a serious matter, involving abuse of power, misuse of religion," he told reporters after performing Friday prayers.

The Selangor state government said they were going to "conduct regular checks" at religious schools to ensure there was no abuse and urged residents to contact the authorities if they had any information.

Multi-ethnic Malaysia has a dual-track legal system, with Muslims subject to sharia (Islamic law) in certain areas.

Global Ikhwan Services and Business (GISB) has long faced controversy over its links to the banned Al-Arqam sect

GISB has long been controversial for its links to the now-defunct Al-Arqam sect and has faced scrutiny by religious authorities in the Muslim-majority country.

Al-Arqam was banned by the authorities in 1994 for deviant teachings, while GISB members had in 2011 set up an "Obedient Wives Club" that called on women to be "whores in bed" to stop their husbands from straying.

According to its website, GISB says it is an Islamic company that runs businesses from supermarkets to restaurants, and operates in several countries including Indonesia, France and the United Kingdom.

Police believe the 402 minors in the care homes were all children of GISB members, Razarudin told AFP on Thursday.

"We feel that there's a need for DNA samples to be taken."

Religious authorities in Selangor state said this week they were closely monitoring GISB's activities.

"(We) remain vigilant about any facts leading to deviations from true Islamic teachings," they said.

The United Nations children's agency underlined the "unimaginable horror" faced by the victims.

The children "will need long-term professional medical and psychosocial support," said Robert Gass, UNICEF's Malaysia representative.

The case has also rattled locals.

"This incident is very shocking and sudden," said Uzair Abdul Aziz, 37, a Selangor resident.

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Malaysia widens probe into 'horror' care home child abuse.

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Malaysian police to summon Islamic firm GISB over child sex abuse allegations

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• Police cite evidence of neglect, physical, emotional injuries
• GISB denies sexual abuse, running charity homes
• Minors mostly children of GISB members
• PM urges swift investigation

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Mother, relatives charged over 8-year-old girl's killing in Turkey

A Turkish court on Friday jailed pending trial the mother and brother of a murdered eight-year-old girl whose body was found in a sack hidden under rocks in a case that horrified the nation and triggered protests since her disappearance three weeks ago.

Prague Police Chief and Wife in Shock Arrest, Accused of Vile Abuse and Rape Against Foster Kids

In a shocking turn of events, Prague Police Department assistant chief Jeffrey Louis Frisbie and his wife, Kimberly Ann Frisbie, have been arrested on grave charges involving the abuse of foster children placed in their care. According to OKC FOX , Jeffrey Frisbie stands accused of 22 counts of lewd acts with a child under 16 and two counts of rape in the first degree, after investigation of allegations that he sexually abused three girls between the ages of 8 and 10, who were living as foster children in the Frisbie household.

Kimberly Frisbie is alleged to have committed multiple acts of physical abuse, with the Lincoln County District Attorney's Office noting her arrest on 17 complaints of physical child abuse. These allegations, as reported by News 9 , include hitting, kicking, and an attempted strangulation on one of the children. The reports of misconduct initiated an investigation by the District 23 District Attorney's Office on August 3, followed by forensic interviews with the victims at a Children’s Advocacy Center in Shawnee.

The details that have emerged are disturbing. "The fact that the arrested was a member of law enforcement, in a position of trust within the community, is both disappointing and appalling," Lincoln County District Attorney Adam R. Panter explained in a statement, one that underlines the heinous betrayal of trust at the heart of these charges. The reported acts of abuse occurred over an extended period, with one of the foster children being forced to stand against the wall for hours and another elaborating on the inappropriate contact from Jeffrey Frisbie, as reported by News 9 .

The case has garnered significant attention, and a brief statement from Beks on their X account outlines the charges against Jeffrey Frisbie: 22 counts of lewd acts with a child under 16 and 2 counts of first-degree rape. Meanwhile, the foster children have been removed from the Frisbies' home and are now in a safe environment, away from the trauma they experienced.

Jeffrey Louis Frisbie, 55, Prague Police Department assistant chief, has been charged w 22 counts of lewd acts with a child under 16 and 2 counts of rape in the 1st degree. https://t.co/nqO2LBl2SY pic.twitter.com/UjpvySdN6Z — 𝐁𝐞𝐤𝐬 (@antifaoperative) September 11, 2024

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