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INTRODUCTION

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ESSENTIALS OF DIAGNOSIS & TYPICAL FEATURES

  • Forms of maltreatment:

    • Physical abuse

    • Sexual abuse

    • Emotional abuse and neglect

    • Physical neglect

    • Medical care neglect

    • Medical child abuse (Munchausen syndrome by proxy)

  • Common historical features in child abuse cases:

    • Implausible mechanism provided for an injury

    • Discrepant, evolving, or absent history

    • Delay in seeking care

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

    • History of abuse in the caregiver’s childhood

    • Inappropriate affect of the caregiver

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

    • Social or physical isolation of the child or the caregiver

    • Stress or crisis in the family or the caregiver

    • Unrealistic expectations of caregiver for the child

    • Behavior changes of child

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In 2015, an estimated 4 million referrals were made to child protective service agencies, involving the alleged maltreatment of approximately 7.2 million children. Policies about how to screen incoming calls regarding abuse concerns and how to investigate suspicious cases varies among states. Some states investigate every case that is referred while others may screen out referrals based on certain criteria. More and more states are using an “alternative response” system to handle screened-in reports that are deemed low or moderate risk. While traditional investigative methods focus on identifying whether a child has been maltreated, these alternative response models prioritize services needs of the family over determining victimization. Data collection strategies have been altered to capture both forms of assessment.

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Children 3 years of age and younger have the highest rates of maltreatment. The total number of children confirmed as maltreated by child protective services was estimated to be 683,000 in 2015, yielding an abuse victimization rate of 9.2 per 1000 American children. This statistic is referred to as the “unique count” where a child is counted only once regardless of the number of times the child is substantiated as a victim. Sexual abuse rates continue to decline. Rates for physical abuse and neglect increased slightly from the immediate past few years; however, all forms of child maltreatment have declined during the preceding decade. Neglect, again the most common form of abuse, was substantiated in 75.3% of cases, while 11.5% of cases involved physical abuse, and 10% involved sexual abuse. Overall, rates are down compared to prior decades. This parallels the trend in lower crime rate but other factors such as improvements in education, reporting, and system responses have also likely played a role in the reduction.

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There were 1670 victims of fatal child abuse in 2015 from 50 states, resulting in a rate of 2.25 child abuse deaths per 100,000 children, slightly higher than the 2014. Fatalities occur with relatively low frequency, so rates are sensitive to changes in reporting and fluctuations in child population. The topic has garnered national attention, and in 2016 a national commission created by Congress completed a report outlining recommendations to reduce child deaths from abuse.

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