Some Facts and Figures about Child Abuse

Child abuse is a relatively common problem in our society, and it takes many different forms. It can include physical abuse (broken bones, brain injury, bites, burns), sexual abuse, psychological abuse, and, most commonly, neglect. It is estimated that 4 million
children a year are abused in some manner in the U.S., although probably less than half of all cases are reported. At least two thousand children die each year as a result of abuse (Council on Scientific Affairs: AMA diagnostic and treatment guidelines concerning
child abuse and neglect. JAMA 1985; 254:1483-1486; US Dept of Health and Human Services , The Third National Incidence Study of Child Abuse and Neglect; 1996,
Washington, US Government Printing Office).

Injuries seen in abuse are often distinctive because they are inflicted by adults (and may therefore be significantly more violent or purposeful than injuries sustained during normal childhood activities). The history given to explain the injury may hold the key to the abusive nature of the injury, especially if the injury and the given history seem implausible. For example, a 4 year old presenting with multiple cigaret burns is unlikely to have perpetrated this on himself (too painful), or to have allowed another similiar-age
child to inflict the burns. Consideration of the history is always inportant in any childhood injury. History must be correlated with the developmental stage of the infant or child. A two month old baby cannot, by himself, fall down stairs. This is not because he can't fall (he can), but rather because part of falling is getting oneself to the edge of the surface from which the fall occurred. A 2-month old isn't likely to crawl well enough (and for long enough) to get to the top of the stairs entirely under his own power. A baby could
certainly unintentionally be dropped down the stairs, but a well-intentioned caretaker who accidentally drops his child will usually describe the accident as it happened ("I accidentally dropped him while I was carrying him downstairs"), whereas an abusive caretaker may give an evasive, inaccurate, and implausible history such as "she was at the top of the stairs and rolled down." When we consider this history, it becomes obvious
how implausible it is (young age of the infant). Similarly, consider this reason cited for a 4 year old's skull fracture: an 18 month old sibling hit him with a baseball bat. Swinging a bat (even being able to lift it) forcibly enough to break a skull demonstrates
considerable force and muscular coordination - probably more than an 18 month old toddler can manage.

In addition to considering the history in childhood injuries, we should also consider the nature of the injury itself, for there are some injuries and injury patterns that are highly suggestive of abuse. If such injuries are discovered and acted upon, these children
can be spared further trauma, as can their siblings. A thorough physical evaluation, including radiographs, is a critical part of the abuse evaluation, and may be what first identifies the child as a victim of abuse.

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