Overview/pathophysiology

The problem of child abuse and neglect, formerly called “battered child syndrome,” is now recognized as a serious threat to children in the United States. In 2007, 3.5 million children received child protective services (CPS) investigations or assessments. An estimated 794,000 children were found to be victims of child abuse or neglect with an estimated 1760 fatalities nationally, increased from 1530 in 2006 (Administration for Children and Families [ACF], 2007). Many more children are left permanently disabled, and thousands of victims are overwhelmed by this trauma for the rest of their lives. The national rate of children being investigated or assessed decreased from 2005 to 2007, but the death rate rose each year from 2002 to 2007 except for 2005 (ACF, 2007). More recent data from Reuters Health Information (2009) notes a spike in child abuse in the United States during a recession that is increasing stress on already overwhelmed families and cash-strapped child-protective agencies. Experts estimate the actual number of incidents of abuse/neglect is 3 times greater than those reported.

Child abuse and neglect occur in all cultural, ethnic, occupational, and socioeconomic groups. It is not usually a single event but rather a pattern of behavior that occurs over time. The following factors increase the likelihood of abuse or neglect occurring in families:

The highest incidence of child abuse and neglect occurs in children younger than 4 yr, with the highest rate of victimization occurring in children from birth to 1 yr. The rate declines as children get older except for sexual abuse. In 2007, 59% of victims suffered neglect, 10.8% suffered physical abuse, 7.6% were sexually abused, 4.2% suffered emotional or psychological maltreatment, and less than 1% were medically neglected. In addition, 13.1% were victims of multiple types of maltreatment, while 4.2% of the children experienced “other” types of maltreatment such as abandonment, threats of harm to the child, and congenital drug addiction (ACF, 2007). The perpetrators most often are one or both of the parents, with mothers the more frequent perpetrator. Terms include:

Health care setting

Primary care or emergency department with possible hospitalization resulting from complications. Abuse/neglect also may be found during hospitalization for other reasons.

Assessment

Note: History is critical in making a diagnosis. Frequently in child abuse/neglect cases, the history is inconsistent with injury severity, or it changes during evaluation. It is essential that the nurse taking the history be nonjudgmental and report factual information. This is difficult to do at times, and collegial support is beneficial. History and physical examination will determine needed diagnostic tests.

Stay updated, free articles. Join our Telegram channel

Join