What is Child Physical Abuse and Neglect?
About one in four children go through some form of child abuse or neglect in their lives. Of these victims, 18% suffer physical abuse, 78% experience neglect, and 9% endure sexual abuse. The death rate from child maltreatment is 2.2 per 1000 children every year, making it the second leading cause of death in children below the age of one. Being exposed to violence as a child can leave lifelong effects on their health, leading to physical, emotional, and mental health problems.
Preventing these negative health outcomes is dependent on preventing, diagnosing, and treating physical child abuse. However, there’s a problem – physical child abuse often goes unnoticed and unreported by medical professionals.
What Causes Child Physical Abuse and Neglect?
Risk Factors: Children are more likely to experience physical abuse if they are younger, premature, have special needs, are part of a twin set, have colic or excessive crying, behavioral issues, or have bathroom accidents. It’s also likely if the abuser lives in poverty, uses drugs or alcohol, or if there is domestic violence in the house. In fact, it’s a parent who is the abuser 91% of the time.
Sentinel Injuries: Sentinel injuries are smaller injuries such as bruises or injuries inside the mouth that show up in babies who can’t move around on their own. These types of injuries often come before more serious abuse takes place. If doctors can correctly identify and address these injuries in time, they can prevent further abuse. Sentinel injuries are found in 25% of abused babies but are only reported 42% of the time.
Bruises: When a bruise is considered suspicious, it might be on a baby who can’t move around much yet, be shaped like a cord or bite, or show up in protected areas like the ears, buttocks, or genitals. It’s not possible to tell how old a bruise is exactly, and a lack of bruises doesn’t mean abuse hasn’t occurred. This is because significant internal injuries can occur even without visible bruises.
Head Trauma: The leading cause of death from physical abuse in children under the age of two is abusive head trauma (AHT), usually as a response to the child crying. Some kids might show severe symptoms like going into shock or falling into a coma, but others might have vague symptoms like irritability, sleepiness, fever, vomiting, trouble breathing, or periods of not breathing. Among AHT cases, one third involve the presence of a sentinel injury, 85% present with bleeding in the retina, and 30-70% have other injuries like fractures and bruises.
Fractures: Among children under one, 25% of fractures result from abuse. These could be fractures in a baby who doesn’t move around yet, multiple fractures with no clear explanation, fractures of different ages, specific types of fractures like bucket handle, rib fractures in kids under 1.5 years (70% of which are abusive) and leg or skull fractures in children under 1.5 years (33% of which are abusive).
Burns: The most common inflicted burns are from scalding or being dipped in the hot water. Burns that look the same all over, are deep, don’t affect the skin folds, and don’t look like they were caused by splashed on hot liquid could mean forced dipping in hot water. If a burn has distinct lines and doesn’t look like it resulted from a scraping action, it might indicate abuse. Things like chemical burns, skin peeling due to a severe reaction to medication, and burns from severe bacterial infections should also be considered.
Risk Factors and Frequency for Child Physical Abuse and Neglect
Child maltreatment, which includes various forms of abuse and neglect, is an issue that affects many children worldwide. A significant portion of adults, for instance, have reported experiencing physical abuse during their childhood. Childhood sexual abuse is also prevalent, with one in five females and one in thirteen males reporting such experiences. Emotional abuse and neglect are also common, with females particularly at risk for sexual violence, exploitation, and abuse.
In the United States, it’s estimated by Child Protective Services that out of every 1000 children, nine are victims of maltreatment. Neglect represents the majority of these cases.
- Around a quarter of all adults report having been physically abused as children.
- One in five females and one in thirteen males report experiencing sexual abuse in their childhood.
- Emotional abuse and neglect are common issues.
- Girls are more often subject to sexual violence, exploitation, and abuse.
- In the US, nine out of every 1000 children are victims of maltreatment.
- Neglect is the most common form of maltreatment, but physical and sexual abuse, and other types of maltreatment account for 18%, 9%, and 11% of cases respectively.
Signs and Symptoms of Child Physical Abuse and Neglect
If a child is suspected to be a victim of physical abuse, a medical evaluation is essential. The main goal of this medical evaluation is to get a comprehensive understanding of the child’s injuries, detect any hidden injuries, and check for any medical conditions that may make the child more susceptible to harm or that might be mistaken for signs of abuse.
During this evaluation, the doctor will document how and when the injury happened, inquire about the last time the child was healthy/uninjured, assess the child’s development stage, and evaluate for any abuse risk factors. The report provided by the guardian or caregiver might raise doubts about possible abuse if:
- There is no explanation provided for the child’s injuries
- There was an unexplained delay before medical care was sought
- The explanation given doesn’t match the injuries observed or isn’t consistent with what the child is developmentally capable of.
A comprehensive skin examination is necessary because some injuries might be hidden in areas covered by clothes or hair, or protected by the child. The child’s overall appearance, behavior, and growth patterns can provide clues about possible neglect. The doctor will also check the scalp for signs of trauma, examine the mouth and teeth for decay or other oral injuries, conduct an abdominal exam, evaluate the child’s range of movement to identify possible fractures or limited motion, and perform a neurologic exam to assess the child’s muscle tone and mental status.
Testing for Child Physical Abuse and Neglect
If doctors suspect abdominal injuries in a child under five years old, they often recommend tests to check how well the liver and pancreas are working, as well as a urine test. A physical exam alone can miss hidden injuries to the abdomen in young children. If these tests show abnormal results, a CT scan of the abdomen may be needed.
Doctors usually also recommend additional imaging for children under two as a way to check for hidden bone fractures and to assess the child’s overall bone health. Hidden fractures can often be found on these scans. For example, 11% of the time they are found on the first scan, in 50% of infants with bruising, in 46% of the follow-up scans, and in 12% of siblings of abused children.
The standard neurological exam doesn’t easily detect abusive head trauma (AHT). So for infants under six months old who may have been abused, a head CT scan is recommended. If the scan reveals concerning brain injuries, further examinations like an eye exam by a children’s eye specialist and an MRI or MRV scan of the brain and spine could be necessary. It might also be necessary to test for drug exposure in physically abused children under the age of 5, as it’s becoming more common to uncover this during investigations. However, not finding additional hidden injuries does not eliminate the suspicion of abuse.
For children with bruises or bleeding, doctors need to explore other possible causes besides abuse, like bleeding disorders. Part of this involves looking at where the bruises are, since children with bleeding disorders tend to have lots of bruises in places that are often bruised accidentally. Lab tests to check the blood’s ability to clot, how well the platelets function, and whether von Willebrand disease is present may also be carried out.
When looking into potential fractures, doctors should consider if there is a family history of bone disease and conduct tests to evaluate bone health, including checking for disorders that affect bone metabolism and mineral formation. Also, in cases where a child has a brain hemorrhage, medical conditions such as metabolic diseases, infections like meningitis, and vitamin K deficiency in newborns should also be taken into account.
Treatment Options for Child Physical Abuse and Neglect
If a healthcare professional suspects a child may have been physically abused, they are required to report this to child protection services or the police. They don’t have to be certain abuse has happened, just suspicious that it might have. They can consult with specialists or a team that deals specifically with child maltreatment to help guide them in assessing the situation and deciding what steps to take next.
What else can Child Physical Abuse and Neglect be?
- Blood clotting conditions (such as Hemophilia)
- Skin inflammation (Eczema)
- A genetic disorder affecting the skin and joints (Ehlers-Danlos syndrome)
- Traditional healing methods
- Blood vessel growths on the skin (Hemangiomas)
- A condition causing lower than normal platelet count in the blood (Idiopathic Thrombocytopenic Purpura or ITP)
- Cancer
- Blue or greenish birthmarks often seen in newborns (Mongolian spots)
- A rare bone disorder that causes the bones to break easily (Osteogenesis imperfect type 1)
- A skin condition caused by exposure to certain plants and sunlight (Phytophotodermatitis)
What to expect with Child Physical Abuse and Neglect
Kids who have suffered abuse and are sent back to harmful environments are at higher risk of continued abuse. Taking detailed personal histories and conducting thorough physical examinations can reveal warning signs and prevent more abuse through the right actions. Stopping the abuse early can lead to a better outcome. However, if abuse or neglect is not dealt with, it can have severe consequences.
Possible Complications When Diagnosed with Child Physical Abuse and Neglect
As mentioned before, the most severe complications can lead to fatalities in children. However, problems can also appear in less obvious ways, like triggered emotional or personality disorders. The range of possible complications is broad.
Preventing Child Physical Abuse and Neglect
In healthcare, it’s extremely important for all team members to stay alert and vigilant. This means they need to carry out detailed physical check-ups and take careful note of health histories in order to accurately analyze the patient’s condition. This is especially important when dealing with children’s health, so they must always be ready to detect any potential issues or concerns.