Child Abuse, Physical

Child Abuse, Physical is a topic covered in the 5-Minute Pediatric Consult.

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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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