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The spectrum of parental feelings and behaviors toward children can extend from those that are positive and nurturing to those that are negative, harmful, and culturally unacceptable. At the negative extreme are behaviors that result in child maltreatment, including physical abuse, neglect, and sexual abuse. Although such negative behaviors are often viewed as deviant and separate from normal parenting, in fact, many “normal” parents have feelings and behaviors that may extend to those considered to be maltreatment. Thus, a parent’s anger at the child and use of physical punishment may border on physical abuse, ignoring the child and providing inadequate nurturance or supervision may border on neglect, and close bodily contact and sensual feelings toward the child may border on sexual abuse.

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Maltreatment of children includes physical abuse, neglect, sexual abuse, exploitation, and emotional maltreatment. Physical abuse is an act of commission toward the child by a parent or other caregiver that results in harm or intended harm to the child. It can include bruises from a beating, broken bones, or even death. Violence toward children may not result in a serious injury but is still a form of abuse.

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The World Health Organization defines physical abuse as “the intentional use of physical force against a child that results in—or has a high likelihood of resulting in—harm for the child’s health, survival, development, or dignity.”1Neglect is an act of omission, such as failure to provide adequate nutrition, shelter, clothing, or supervision; abandonment; or failure to ensure that the child receives adequate health care, dental care, or education. Physical abuse and neglect must be distinguished from unintentional or “accidental” injuries, and health neglect must be distinguished from less serious lapses in attending to a child’s medical care, such as poor adherence to medical recommendations or missing a few appointments for health care.

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Sexual abuse is the involvement of children or adolescents in sexual activities that they do not fully understand, to which they cannot give informed consent because of their developmental understanding, and that break societal or family taboos. It includes behaviors such as sexual intercourse, genital fondling, and exposing children to pornography. Exploitation is the use of a child in work or other activities for the benefit of others, such as child labor, commercial sexual exploitation of children, and child trafficking.

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Emotional maltreatment, which is the most difficult form of maltreatment to define, includes repeated verbal denigration, belittling, or scapegoating so that the child develops a sense of worthlessness and low self-esteem. Because emotional maltreatment often coexists with other forms of maltreatment, it is difficult to identify and enumerate as a separate type, and thus is substantially underreported. A degree of emotional maltreatment is a component of every form of child maltreatment.

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Epidemiology

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Although abuse of children and infanticide have occurred over the centuries, pediatric recognition of and concern about battered child syndrome did not ...

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