Child Abuse and Neglect

Excerpt

Child maltreatment, as defined by the World Health Organization (WHO), includes physical, emotional, or sexual abuse, as well as neglect and exploitation, that can harm or threaten a child’s health, development, or dignity. These acts occur within relationships characterized by responsibility, trust, or power. Abuse is considered an act of commission, while neglect is an act of omission in the care of a child, potentially leading to actual harm.

A comprehensive approach to understanding child abuse involves examining its risk factors, epidemiology, diagnosis, treatment, and prevention, while highlighting the critical role of the interprofessional healthcare team in managing this adverse childhood experience, which can have lifelong physical and psychological consequences. As abuse and neglect may be perpetrated by parents, family members, acquaintances, teachers, coaches, clergy, and other adults, the term "caregiver" will be used to refer to adults responsible for a child's welfare.

Caring for abused and neglected children presents a significant challenge for clinicians, but advocating for these children can save lives and reduce the risk of associated complications. Healthcare providers must remain vigilant and maintain a high index of suspicion to ensure the early and accurate detection of child neglect or abuse.

Neglect is the most prevalent form of child maltreatment, substantiated in over half of confirmed cases. This accounts for nearly 3-quarters of child fatalities resulting from maltreatment, including incidents like drowning, home fires, and being left unattended in hot vehicles. Neglect involves the failure to provide adequate healthcare, supervision, protection from environmental hazards, and basic necessities such as food, clothing, and shelter. Emotional neglect occurs when children are exposed to family or intimate partner violence or substance abuse. Educational neglect is evident through truancy or failure to comply with school enrollment requirements.

Physical abuse includes actions such as beating, shaking, burning, and biting. The distinction between corporal punishment and abuse often remains ambiguous and may vary with cultural norms. Rib fractures are the most common injuries associated with physical abuse, but the spectrum of injuries includes severe abdominal and head injuries, which may be fatal.

Psychological or emotional abuse involves repeated behavioral patterns that humiliate, demean, or frighten a child, potentially leading to lifelong psychological disorders. The absence of physical findings makes detection more challenging than with physical abuse, and its identification may depend on interpretation and context. The distinction between suboptimal parenting and abuse can be unclear, making it difficult to determine when it crosses into abuse.

Sexual abuse is defined as "the involvement of dependent, developmentally immature children and adolescents in sexual activities that they do not fully comprehend, to which they are unable to give consent, or that violate the social taboos of family roles." Sexual abuse does not necessarily involve oral, anal, or vaginal penetration. This includes exposure to sexually explicit materials, oral-genital contact, genital-to-genital contact, genital-to-anal contact, and genital fondling. Sexual abuse is an underreported public health issue that can potentially lead to long-term medical and psychological consequences. The Centers for Disease Control and Prevention (CDC) estimates that 1 in 4 girls and 1 in 13 boys may experience sexual abuse. In 90% of cases, the perpetrator is known to the family. Confirming sexual abuse can be challenging, as a normal or negative physical examination does not rule out its occurrence. Please see StatPearls companion resource, "Child Sexual Abuse and Neglect," for more information.