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Preventing child maltreatment fits well with the goals and scope of pediatrics, as expressed by the American Academy of Pediatrics’ commitment to “prevention, early detection, and management of behavioral, developmental, and social problems as a focus in pediatric practice.”1 The prevention of child abuse and neglect has benefits at the level of the individual child, the family, the community, and the society at large. Sparing a child from the physical, cognitive, behavioral, and emotional problems associated with maltreatment2-6 is intuitively and morally preferable to intervening after the fact.

Beyond the individual child, the prevention of child maltreatment has at its heart the goal of strengthening families and enhancing childrearing. Effective interventions may achieve much more than the narrow goal of preventing maltreatment. Additional outcomes may include children’s cognitive, emotional, social, and behavioral gains; improved maternal health and communication with their children; decreased use of public assistance; and decreased involvement in the criminal justice system.7-10 Child maltreatment has significant costs, human and economic, that need to be weighed against the cost of prevention. Although more research is needed, several studies have demonstrated the cost effectiveness of specific child abuse prevention programs.11-13

To date, pediatric practice has focused primarily on the important issues of identifying abuse and neglect, reporting to the public agencies, and facilitating referrals for assessment and treatment. In order to fulfill their responsibility to help ensure 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 funding of programs that effectively promote family well-being. Because children and families generally enjoy excellent relationships with primary care pediatricians, pediatricians may play a role that other professionals cannot. Pediatricians are usually perceived as 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 much sensitive information.

Risk Factors for Maltreatment

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.14 Specific patterns of behavior observed within the parent-child dyad can serve as important indicators of possible physical abuse or neglect. 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.15,16 The relationship between parent and child in maltreating families may involve harsh, inattentive, and inconsistent parenting.17 Maltreating parents, particularly physically abusive ones, often report feeling “out of control” as parents. They frequently hold an external locus of control orientation, feeling that they have limited control over their actions.17-19 For a more detailed discussion of risk factors, see Chapter 35.

Research ...

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