The incidence of child abuse is difficult to ascertain, but it is a prevalent social issue that has serious short and long-term consequences. The CDC estimated that 1 in 7 children in any year are abused, and 1750 children died in 2020 of abuse and neglect (CDC, 2022a). In addition, child abuse statistics can be deceiving because a child who is abused would be considered one case, but that child is likely to be abused many times.
Child abuse can be physical, sexual, emotional, psychological, or in the form of neglect. Munchausen syndrome by proxy is another form of child abuse in which the caregiver fabricates illnesses or makes the child sick (Kaneshiro, 2021). The CDC identifies many risk factors for child abuse (CDC, 2022b), including individual characteristics, caregiver and family risk factors, and community risk factors.
There are many characteristic signs, symptoms, and patterns of injury associated with the physical abuse of a child, such as bruises, burns, specific fractures, and head trauma, all of which may be indicators of child abuse (Colbourne, 2020). For screening and detection purposes, clinicians should also keep in mind that the emotional and psychological condition of the child and the history surrounding possible incidents of child abuse are important. When considering the possibility of child abuse, consider these three issues.
- Child-caregiver interaction: Is the child agitated, fearful, or emotionally or psychologically upset when interacting with the caregiver? What are the caregiver’s attitudes and behaviors towards the child? Are they attentive, concerned, cold, disinterested, and harsh?
- Frequent or suspicious injuries: Does the caregiver’s story of how and why the injury occurred make sense? Did the caregiver delay getting help for an injured child? Has the child had previous injuries or the same injury before? Are the injuries increasing in frequency and severity? Does the child have an injury or a medical condition that could not happen to a child, like genital trauma, a sexually transmitted disease, or physical trauma that could not happen to a child, given their age, body weight, and level of physical activity? Does the child have bruises or fractures that are days, weeks, or months old, but the caregiver claims that the child was recently injured?
- General well-being of the child: Is the child well nourished? Do they have frequent illnesses or injuries? Is the child withdrawn, apathetic, or fearful?
Healthcare professionals must report child abuse according to professional ethics codes, the standards of healthcare facilities, and state and local statutes. In the United States, mandatory reporting laws vary by state and will describe what populations are covered and under what situations. Typically, this will include children, the disabled, and the elderly, including neglect and abuse (Thomas & Reeves, 2023). State reporting laws will also indicate which individuals are mandated to report, such as childcare providers, clergy, coaches, counselors, healthcare providers, lay enforcement, and educational staff such as principals and teachers.
The CDC’s publication Preventing Child Abuse and Neglect: A Technical Package for Policy, Norm, and Programmatic Activities, 2016, provides guidelines, plans, and resources for preventing child abuse (Fortson et al., 2016). The publication can be accessed using this link. Other information from the CDC on this topic is on their website.