Child Abuse, Physical

Basics

Description

Physical abuse is an act inflicted on a child or youth by a parent or caregiver resulting in mucocutaneous, musculoskeletal, visceral, or intracranial injury and/or death. Although a medical diagnosis, physical abuse is also defined legally in state statutes.

Epidemiology

Incidence

Of those cases reported to child protective service agencies in the United States in 2014, 702,000 children were victims of abuse and neglect.
- Child abuse rate was 9.4 per 1,000 children per year.
- 17% of abused children were found to be victims of physical abuse.
- >1,500 child deaths were attributed to maltreatment in 2014, of which nearly 42% resulted from physical abuse.
- Nearly 70% of all child maltreatment fatalities occurred in children age of <3 years.
Abuse can happen in any family regardless of race, ethnicity, or socioeconomic class.

Prevalence

Not all child maltreatment is reported. In a nationally representative sample of >4,000 children, >18% reported experiencing maltreatment in their lifetime.

General Prevention

Assessing risk (parental history of mental illness or childhood victimization, parental substance abuse, economic stressors, difficult child temperament, unreasonable developmental expectations, children living with single mothers and an unrelated male)
Screening for family violence (intimate partner violence)
Providing anticipatory guidance regarding infant crying/toddler tantrums, toileting, and discipline techniques
Nurse home visitation for at-risk families
Parenting classes for all parents, although classes usually only target at-risk parents of young children

Etiology

Although child abuse occurs in families regardless of race, ethnicity, or socioeconomic status, there are individual, family, community, and societal factors that place children at increased risk for maltreatment.
Examples of risk factors include the following:
- Difficult temperament
- Parental history of childhood victimization
- Parental substance abuse
- Parental mental illness
- Poverty and unemployment
- Family violence
- Unrelated male caregiver in the home

Commonly Associated Conditions

Emotional abuse
Neglect
Sexual abuse
Domestic violence exposure
Chronic runaway status
Domestic sex trafficking
Posttraumatic stress disorder
Depression
Anxiety disorder

ALERT
Pitfalls

Failing to consider abuse in the differential diagnosis of all pediatric trauma
Failing to consider abuse in the differential diagnosis of all infants and toddlers with mental status changes (especially brief resolved unexplained events [BRUEs]), even without bruising
Failing to recognize the significance of subconjunctival hemorrhages and bruises in locations on the body atypical for accidental trauma
Failing to consider trauma as a cause for bloody CSF
Failing to consider alternative medical diagnoses in children for whom you suspect abuse
Failing to document the history, physical findings, and assessment clearly

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