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