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THE IMPORTANCE OF PREVENTION
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Preventing child abuse and neglect (ie, maltreatment) fits well with the goals and scope of pediatrics, as expressed by the commitment of the American Academy of Pediatrics (AAP) to “prevention, early detection, and management of behavioral, developmental, and social problems as a focus in pediatric practice.” The prevention of child maltreatment has benefits at the level of the individual child, the family, the community, and society at large. Sparing a child from the physical, cognitive, behavioral, emotional, and social problems associated with maltreatment is intuitively and morally preferable to intervening after the fact.
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Beyond the individual child, the prevention of child maltreatment has at its heart the goal of supporting parents, strengthening families, and enhancing childrearing. Effective interventions may achieve much more than the narrow goal of preventing maltreatment. Additional outcomes may include enhancing children’s cognitive, emotional, social, and behavioral development; improving maternal health and communication with the children; decreasing use of public assistance; and decreasing involvement in the criminal justice system. Child maltreatment has significant costs, human and economic, that need to be weighed against the cost of prevention. Though more research is needed, several studies have demonstrated the cost-effectiveness of specific child maltreatment preventive strategies.
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ROLES OF PEDIATRIC HEALTHCARE PROVIDERS
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Pediatric practice has focused primarily on the important issues of identifying abuse and neglect, providing medical care, reporting to the public agencies, and facilitating referrals for assessment and treatment. In order to fulfill their responsibility to promote children’s health and well-being, pediatricians should also focus on preventing maltreatment. Pediatricians can do so by identifying and helping to manage child and family risk and protective factors, referring families to effective community-based services, and advocating for the development of policies and programs that promote family well-being. As primary care pediatricians generally enjoy excellent relationships with children and families, they may play a role that other professionals cannot. Pediatricians are usually perceived as credible, supportive, and caring, without the stigma often attached to social work and mental health. This rapport can facilitate a remarkable entrée into families’ lives, with sharing of sensitive information.
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RISK FACTORS FOR MALTREATMENT
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The ecological framework of child maltreatment posits that physically abusive and/or neglectful behavior derives from the complex set of interactions between the child, parent, community, and society. Child characteristics, such as difficult temperament or chronic physical or mental health problems, may challenge parents, heighten parental stress, and increase the risk of maltreatment. Specific patterns of behavior observed within the parent–child dyad can serve as important indicators of possible physical abuse or neglect. The relationship between parent and child in maltreating families may involve harsh, inattentive, and inconsistent parenting. Maltreating parents, particularly physically abusive ones, have often reported feeling “out of control” as parents.
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Research has identified strong associations between parental problems and child maltreatment. For example, maternal depression has been ...