: injury defined as harm or risk of injury (endangerment) to a child less than 18 yrs old
Physical Neglect
: harm or endangerment due to lack of supervision, medical care, nutrition, clothing, hygiene, etc.
50% of failure to thrive cases are due to neglect
Emotional Abuse
: verbal abuse, harsh non-physical punishment or threats; includes emotional neglect
Epidemiolgy
Incidence
(from 1996: National Incidence Study)
physical abuse Þ 5.7/1000
physical neglect Þ 5/1000
emotional abuse Þ 3/1000
emotional neglect Þ 3.2/1000
Variables
age
: physical abuse peaks at age 4-6; emotional abuse peaks at age 6-8
gender
: equal risk until adolescence, then females more likely abused (may be due to size and strength differences)
parental factors
: equal risk of death via abuse from mom and dad if < 13; if >13, more likely death from dad
parental risk factors: psychiatric or emotional disorder; ß cognition, substance abuse, domestic abuse, history of own abuse; financial state of the family is non-contributory to risk
Warning Signs
repeated injuries or ER visits; or multiple vague complaints
parents don’t visit an inpatient child
child is withdrawn
characteristic injuries
belts make characteristic mark
signs of choking on neck
bruises in multiple stages
Þ repeated injury
any bruise on the abdomen is suspicious
explanations - suspicious if
unable to adequately explain injury
parents may be hostile or defensive
child may not be able to explain injury
Psychiatric/Psychological Sequelae to Abuse and Neglect
Physical Abuse and Neglect
Interpersonal Problems
attachment disturbances/difficulties with intimacy
peer rejection: child is often blamed for abuse
revictimization/victimization of others: projection; lack of a developed conscience
limited social problem-solving/understanding affect skills: poor understanding of feelings and social skills