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

• Of those cases reported to child protective service agencies in the United States in 2019, 656,000 children were victims of abuse and neglect.
  • Child abuse rate was 8.9 per 1,000 children in 2019.
  • 15.5% of children experienced two or more forms of maltreatment.
  • >10% of abused children were found to be victims of physical abuse alone.
  • >1,840 child deaths were attributed to maltreatment in 2019, of which >44% resulted from physical abuse.
  • Nearly 70% of all child maltreatment fatalities occurred in children <3 years of age.
• Abuse can happen in any family regardless of race, ethnicity, or socioeconomic class.
• Children of color, particularly those who are Black or Native American, are more likely to be reported, have their case substantiated, and then be placed in foster care.
• Not all child maltreatment is reported. Implicit biases may influence if maltreatment is suspected and if suspicions for maltreatment are reported. In a nationally representative sample of >4,000 children, >18% reported experiencing maltreatment in their lifetime.

RISK FACTORS

• 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
  • Caregiver with unreasonable developmental expectations
  • Parental history of childhood victimization
  • Parental substance abuse
  • Parental mental illness
  • Poverty and unemployment
  • Family violence
  • Unrelated male caregiver in the home

GENERAL PREVENTION

• Offering or connecting families with supportive resources
• 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
• Advocating for policies and programs that help families provide safe, stable, and nurturing relationships and environments for their children

COMMONLY ASSOCIATED CONDITIONS

• Emotional abuse
• Neglect
• Sexual abuse
• Domestic violence exposure
• Chronic runaway status
• Domestic sex trafficking
• Post-traumatic stress disorder
• Depression
• Anxiety disorder