Child Maltreatment
Anna D. Jarvis
Introduction
Child maltreatment is a complex syndrome that includes deliberate injury, inappropriate sexual contact, neglect, failure to provide the necessities of life, and/or emotional maltreatment of a child
Occurs in all segments of population, frequently undetected until a child dies
In US: ˜ 2.5% of all children are abused or neglected annually
Adult surveys: 20% of women and 5-10% of men report childhood sexual abuse
Must be alert to the possibility of child maltreatment at each clinical encounter
If suspect child abuse, required by law to report to Child Protection Services for investigation
Note: Child maltreatment is the current preferred descriptive terminology for child abuse
Types of Maltreatment
Physical: varies from harsh discipline to torture
Sexual
Neglect: 70% of failure to thrive in infancy is nonorganic
Emotional
Munchausen Syndrome
Deliberate injury of a child by poisoning, physical means, or interference with medical care so that the child presents sick or unwell or with “repeated life-threatening events”
Result is repeated and escalating medical investigation and intervention
Various Presentations
Unexplained electrolyte disturbances
Sepsis and unusual infecting organisms
Positive toxicology tests without history of ingestion
Vulnerable Child: Risk Factors
Premature
Colic
Physical/emotional challenges
Special needs
Demanding child
Delayed bowel/bladder control
Note: Only one child in a family may be victimized
Predicting Child Maltreatment
A very high proportion of children who experience abuse grow up to be abusers: the “cycle of abuse”
Social and Environmental Factors
History of childhood maltreatment in perpetrator
Alcohol/substance dependency
Crisis situation in perpetrator’s life
Spousal and domestic violence
Mental illness/depression in caregiver
Suspected Child Maltreatment
Consider possibility of maltreatment with all injuries
Explore exact mechanism and circumstance of injury
Ask, “Does the story make sense?” given the age and development of the child
Check past records for repeated or unusual injuries
Consider possibility of neglect or inappropriate supervision
Accident prevention information and teaching should be an integral part of acute injury care
Suspicious History
No history on mechanism of injury
Partial history
History changes
History is developmentally unrealistic
Delay in seeking care
Unrealistic expectations of child
