Child maltreatment

Kimon Bekelis MD (Dr. Bekelis of Dartmouth-Hitchcock Medical Center has no relevant financial relationships to disclose.)
Robert J Singer MD (Dr. Singer of Dartmouth-Hitchcock Medical Center/Geisel School of Medicine at Dartmouth has no relevant financial relationships to disclose.)
Bernard L Maria MD, editor. (Dr. Maria of Thomas Jefferson University has no relevant financial relationships to disclose.)
Originally released June 12, 2006; last updated January 4, 2016; expires January 4, 2019
Notice: This article has expired and is therefore not available for CME credit.

This article includes discussion of child maltreatment, child abuse, child neglect, and Munchausen by proxy syndrome. The foregoing terms may include synonyms, similar disorders, variations in usage, and abbreviations.


Child maltreatment, which includes child abuse and neglect, is a major public health concern that can lead to significant lifelong psychological and medical consequences. Child maltreatment is now recognized to be part of a continuum of family violence that includes child maltreatment, intimate partner violence, and the abuse of the elderly and of animals (Stroud and Petersen 2012). Research literature on child maltreatment has increased significantly in the past 2 decades. In the 1980s, approximately 8000 medical and psychological articles were published in the areas of child abuse and neglect; by the first decade of the 21st century, that number had risen to nearly 25,000 (Stroud and Peterson 2012; Widom 2012). Maltreated children frequently come to the attention of medical professionals, and it is essential that medical professionals have skills to recognize suspicious patterns of injuries. In the United States, 60,000 incidents of child maltreatment are reported to authorities each week. According to the U.S. Department of Health and Human Services, during federal fiscal year 2010, an estimated 3.3 million referrals were received by Child Protective Service agencies (US Department of Health and Human Services 2010). These reports involved the alleged maltreatment of approximately 5.9 million children. Of these referrals, 60.7% were screened in. Of the 1,739,724 reports that received an investigation, 436,321 were substantiated.

Most states recognize 4 major types of maltreatment: physical abuse, sexual abuse, emotional abuse, and neglect. Although any of the forms of child maltreatment may be found separately, they may also occur in combination. As in previous years, neglect was the most common form of abuse: 78.3% of the children suffered neglect, 17.6% suffered physical abuse, and 9.2% suffered sexual abuse. Approximately 4 children die each day due to abuse and neglect (1560 in 2010, and 80% of these were less than 4 years of age) (US Department of Health and Human Services 2010). Despite these statistics, the estimated number of victims is much higher; in one retrospective cohort study of 8613 adults, 26.4% reported that they were pushed, grabbed, or slapped; had something thrown at them; or were hit so hard they got marks or were injured at some time during their childhood (Dube et al 2003; Kellogg 2007). In short, violence against children has a significant impact on children, parents, families, and society.

Historically, child physical abuse has included what is termed here as “general physical abuse.” However, special severe cases of child physical abuse have also come to the attention of professionals. Pediatric condition falsification or medical child abuse, previously known as Munchausen syndrome by proxy and abusive head trauma (previously shaken baby syndrome), respectively, are 2 such cases. In this article, the authors discuss the various forms of child abuse and neglect as well as these special cases. Within each section, the authors define a type of abuse and discuss its impact on victims. They then present known etiological factors and epidemiology. Finally, they discuss strategies for management and treatment of general and special cases of abuse.

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