NEJM Resident360 > Rotation Prep > Child Abuse and Neglect > Introduction

Introduction

<div class="onepub-jats-front" id="10.1056/r360.i000939-front"><div class="onepub-jats-metadata two-column table"><div class="onepub-jats-row"><div class="onepub-jats-cell"><div class="onepub-jats-metadata-group"></div></div></div></div><div class="onepub-jats-metadata centered"></div></div><div class="onepub-jats-body" id="10.1056/r360.i000939-body"><div class="onepub-jats-section-container"><div class="onepub-introduction"><div class="onepub-jats-main-title"><h6 class="onepub-jats-title introduction">Introduction</h6></div><div class="onepub-jats-section-title"><h1 class="onepub-jats-title">Introduction</h1></div><p>Child maltreatment is <a href="https://www.who.int/news-room/fact-sheets/detail/child-maltreatment" class="onepub-link-primary" target="_blank">defined</a> by the World Health Organization as abuse and neglect that occurs to children under 18 years of age. In all its forms, child maltreatment represents a substantial <a href="https://www.nejm.org/doi/full/10.1056/NEJMcp1701446" class="onepub-link-primary" target="_blank">health burden</a> in children and society. Approximately 700,000 cases of child abuse and neglect are reported annually in the United States. More than half of cases each year are classified as general neglect, with smaller proportions classified as physical abuse, sexual abuse, psychological maltreatment, and medical neglect.</p><p><a href="https://www.childwelfare.gov/pubPDFs/define.pdf" class="onepub-link-primary" target="_blank">Child abuse and neglect</a> refers to any action or failure to act that causes serious physical or emotional harm or death or puts a child at imminent risk for such harm. Recognition and diagnosis of abuse requires careful history and thorough physical examination, paying attention to concordance between the child’s developmental abilities, the reported mechanisms of injury, and the injuries identified. When a differential diagnosis includes possible abuse or maltreatment, it is important to consider medical conditions that may predispose to injury or mimic abuse (e.g., when a child presents with unexplained bruising, differential diagnosis should include bleeding disorders).</p><div class="onepub-jats-section-title"><h3 class="onepub-jats-title">Number of Cases of Child Abuse in the United States in 2020</h3></div><p><a href="content_item_media_uploads/2020-Child-Abuse-Stats.jpg" class="onepub-link-primary onepub-image-fullsize" target="_self"><img src="content_item_media_uploads/2020-Child-Abuse-Stats.jpg" alt=""></a><b>(Reference: <a href="https://www.acf.hhs.gov/cb/report/child-maltreatment-2020" class="onepub-link-primary" target="_blank">Child Maltreatment 2020</a>. U.S. Department of Health &amp; Human Services, Administration for Children and Families, Administration on Children, Youth and Families Children’s Bureau 2020.)</b></p><p><b>Documentation</b> of the history leading to presentation should include endorsements and denials of trauma and should be detailed in the description of any trauma history. Many victims of abuse are too young, too ill, or too scared to disclose the abuse they have sustained, and, when required, interviewing children should be done in a sensitive, trauma-informed manner. Additionally, health care providers should recognize that investigative or forensic interviewing is not the role of the general medical provider and should be deferred to trained specialists. Clinicians should also recognize that medical charting is a medicolegal document in all situations, including cases in which there is concern for child maltreatment.</p><p><b>Mandatory reporting:</b> Physicians in all states are mandated by law to report suspected child abuse and neglect to the local child protective services or law enforcement agency.</p><p>This rotation guide covers the following topics:</p><ul class="onepub-jats-list-unordered"><li><p><a href="https://resident360.nejm.org/rotation-prep/child-abuse/neglect/fast-facts" class="onepub-link-primary" target="_blank">Neglect</a></p></li><li><p><a href="https://resident360.nejm.org/rotation-prep/child-abuse/physical-abuse/fast-facts" class="onepub-link-primary" target="_blank">Physical Abuse</a></p></li><li><p><a href="https://resident360.nejm.org/rotation-prep/child-abuse/sexual-abuse/fast-facts" class="onepub-link-primary" target="_blank">Sexual Abuse</a></p></li><li><p><a href="https://resident360.nejm.org/rotation-prep/child-abuse/medical-child-abuse/fast-facts" class="onepub-link-primary" target="_blank">Medical Child Abuse</a></p></li><li><p><a href="https://resident360.nejm.org/rotation-prep/child-abuse/legal-mandates-for-health-care-providers/fast-facts" class="onepub-link-primary" target="_blank">Legal Mandates for Health Care Providers</a><tt><br class="onepub-jats-br"></tt><tt><br class="onepub-jats-br"></tt></p></li></ul><p>Other topics related to child abuse and maltreatment are covered in the following rotation guides:</p><ul class="onepub-jats-list-unordered"><li><p><a href="https://resident360.nejm.org/rotation-prep/pediatric-emergency-medicine/trauma/fast-facts" class="onepub-link-primary" target="_blank">Trauma</a> (Pediatric Emergency Medicine)</p></li><li><p><a href="https://resident360.nejm.org/rotation-prep/pediatric-preventive-well-child-care/community-and-societal-pediatrics/fast-facts" class="onepub-link-primary" target="_blank">Adverse Childhood Experiences and Social Determinants of Health</a> (Preventive/Well Child Care)</p></li><li><p><a href="https://resident360.nejm.org/rotation-prep/adolescent-care/stis/fast-facts" class="onepub-link-primary" target="_blank">Sexually Transmitted Infections</a> (Adolescent Care)</p></li></ul><p>&nbsp;</p><div class="onepub-grayBox"><p>This rotation guide was developed by a collaborative team of contributors including:</p><p><b>Writer:</b>  Barbara H. Chaiyachati, MD, PhD  <tt><br class="onepub-jats-br"></tt><b>Peer Reviewers:</b> Sundes Kazmir, MD; Jessica Panks, MD; and Colleen Bennett, MD <tt><br class="onepub-jats-br"></tt><b>Section Expert:</b>  Cindy W. Christian, MD <tt><br class="onepub-jats-br"></tt><b>Senior Editor:</b>  Julie Ingelfinger, MD <tt><br class="onepub-jats-br"></tt><b>Last updated:</b> April 2022</p></div></div></div></div>