Frequently Asked Questions About Child Abuse and Neglect

The healthcare provider that suspects a child may have injuries consistent with non-accidental trauma should consider ordering a CT and/or MRI of the head, skeletal survey, genital and skin examination, head-to-toe physical examination with documentation of growth parameters, liver and pancreatic enzyme levels, urinalysis, complete blood count, clotting studies, dentistry and ophthalmological consultation and imaging studies of the chest/abdomen and pelvis.

Experts determine causes of head trauma within the context of comprehensive data collection, including thorough history and clinical evaluation. There are differences in the frequency of certain types of injury patterns and clinical evidence in abuse and accidental cases. Literature supports there is a greater frequency of complex intracranial injuries in abuse cases versus accidental cases. Epidemiologic studies show infants and children fall commonly and this rarely results in complex head injury patterns. Motor vehicle crashes more commonly cause head injuries in children due to acceleration-deceleration and sudden deceleration mechanisms. Child death from a short fall is rare and should prompt investigation into possible child abuse.  

Yes, it is very important to consider the age of the child at the time the child suffers a fractured bone. Fractured bones in infants is usually related to child abuse unless there is a disease of the bone itself. Some authorities think that spiral fractures are highly suspicious for child abuse, but it is important to remember that transverse fractures may also occur in child abuse cases. Fractured bones in non-mobile children and infants is an indicator of child abuse.   

Major traumatic child abuse may involve spinal fractures. Spinal injuries usually involve injuries caused by hyperflexion and hyperextension that happens with shaking and blunt trauma. Infants suffer spinal injuries more frequently than children of any other age group. The presentation of spinal injury in an infant is indicative of child abuse when no reasonable mechanism of injury is known to have occurred.   

The second most common type of fracture that occurs in child abuse cases are skull fractures. No fracture type is 100% diagnostic of child abuse. The injury must be evaluated within the context of the child's developmental stage, the physical injury and reported mechanism of injury. Complicated skull fractures and skull fractures that cross the midline are more likely the result of child abuse than simple skull fractures that correlate with witnessed mechanism of injury.   

There are several general types or categories of child maltreatment. The types or categories of child maltreatment include emotional, physical, sexual abuse, and neglect.
Emotional abuse includes patterns of behavior that destroy the emotional development and self-esteem of a child. Emotional abuse involves lack of attention, love, guidance and verbalization of threats and insults.  
Physical abuse include acts of commission and proactively engaging in activity that is intended to cause physical harm to the child.  
Sexual abuse involves the sexual exploitation of a child by an older child or adult. Sex abuse involves sexual acts inflicted or forced upon a child for exhibitionism, child pornography, prostitution, profit or sexual stimulation. Sexual contact involves anal or vaginal penetration of a child with objects or body parts. It also involves inappropriate touching, kissing and fondling. 
Neglect generally involves acts of omission. It is the failure of a parent or caregiver to meet basic needs of a child including lack of education, healthcare, nutrition, clothing, supervision, safety and shelter.

CAPTA is a federal law that supports individual state programs which focus on the identification and prevention of child abuse through community-based, preventative and public awareness programs. The goal of CAPTA is the provision of comprehensive care to victims, or potential victims, of child abuse with the integration of services provided by a variety of agencies; including legal, educational, mental health and social service organizations.   

Yes, children with disabilities are two-times more likely to be victims of child abuse, or child maltreatment, than children with no disabilities.

There are both direct and indirect costs imposed on society as a result of child abuse and child maltreatment. Child maltreatment and child abuse directly increases the incidence of infant and child mortality. Child abuse increases the need for special education programs, protective agencies and services, foster care services, juvenille and adult criminal agencies, jails and psychiatric services. Prevention of child abuse not only lowers the overall burden to society but reduces criminal activity in communities.     

The conceptual frameworks that enhance understanding of child abuse, as outlined by some child abuse experts, include the epidemiological and ecological frameworks.

Briefly, the epidemiological framework describes both long-term and short-term consequences of child abuse on normal childhood development. Individuals that grow up in abusive environments suffer from social dysfunction that prevent them from interpreting their environment with healthy coping skills. Child abuse is perpetuated in families because abused children are at increased risk to grow up and become abusive adults. Circumstances that contribute to child abuse include dysfunctional child-rearing styles, lack of available social support systems, dysfunctional stress management styles, and nature of parent-child relationships. 

The ecological framework describes how child abuse occurs when parent-child relationships are dysfunctional. The likelihood of child abuse increases during stressful family situations. Child abuse is more likely to occur when parents with histories of victimization from child abuse encounter stress and increased conflict.