Child Abuse

Medical Author:

John Mersch, MD, FAAP

John Mersch, MD, FAAP

Dr. Mersch received his Bachelor of Arts degree from the University of California, San Diego, and prior to entering the University Of Southern California School Of Medicine, was a graduate student (attaining PhD candidate status) in Experimental Pathology at USC. He attended internship and residency at Children's Hospital Los Angeles.

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Medical Editor:

William C. Shiel Jr., MD, FACP, FACR

William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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It was not until the 19th century that children were granted the same legal status as domesticated animals with regard to protection against cruelty and/or neglect. In 1962, the term "battered child syndrome" became part of the medical vocabulary and by 1976 all of the states in the United States had adopted laws mandating the reporting of suspected child abuse.

Child abuse is a worldwide problem affecting children from birth to 18 years of age. The most recent U.S. data dates from 2005, during which 3.3 million reports of abuse and neglect were filed. About 60% of these reports warranted investigation with one-half of these allegations substantiated. These data indicate the incidence of child abuse and neglect to be 12.1 per 1,000 children; 1,460 children (four children/day) died in 2005 as a result of inflicted trauma with more than 77% of these deaths in children less than 4 years of age.

While "reports" of alleged child abuse are not always substantiated during the investigation process, most authorities believe that a large underreporting bias is inherent in the data. There is much more child abuse than gets reported.

All ages of children suffer from child abuse and neglect. Research has shown, however, that risk factors exist making it more likely that certain children may be abused. These risk factors include

1. age: 67% of abused children are less than 1 year old; 80% are less than 3 years old;



2. past history of abuse: Repeated abuse has been shown to occur more than 50% of the time; repeatedly abused children have a 10% chance of sustaining a lethal event;



3. children with learning disabilities, speech/language disorders and mental retardation;



4. children with congenital anomalies (malformations) and chronic/recurrent conditions; and



5. adopted and foster children.

Complicating the collection of data is the general underreporting of child abuse. Very young children are incapable of verbally communicating the harm inflicted on them. Other factors such as fear, guilt, or confusion about the abuser's erratic behavior may also hinder younger children from informing on their abuser.