Child Abuse, Physical
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.
- 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.
Not all child maltreatment is reported. In a nationally representative sample of >4,000 children, >18% reported experiencing maltreatment in their lifetime.
- 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
- 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
- Sexual abuse
- Domestic violence exposure
- Chronic runaway status
- Domestic sex trafficking
- Posttraumatic stress disorder
- Anxiety disorder
- 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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