Child maltreatment, Part 1: Physical abuse and neglect

Increasingly, child abuse is being recognized as a major source of morbidity and mortality for children around the world. It is a phenomenon that crosses all social, ethnic, religious, cultural, and professional lines. When a child presents to a hospital or a doctor’s office with symptoms suggesting abuse, the stakes are high and there is little margin for error.[1] For medical professionals who do not see seriously abused children regularly, the complexity of identification and diagnosis can be daunting. For professionals to intervene confidently, they must be able to recognize the common physical signs of abuse and neglect.

In 2001, results from the Canadian Incidence Study of Reported Child Abuse and Neglect were published. This was the first nationwide study to examine child maltreatment in Canada. The results indicated that in 1998 there were an estimated 21.52 investigations of child maltreatment per 1000 children in Canada. Forty-five percent of these investigations were substantiated. In 1999–2000, British Columbia child welfare authorities completed 24 321 child protection investigations. Neglect was the most common reason for initiating a child protection investigation.

In this first of a two-part issue about child maltreatment, we begin with a detailed description of British Columbia’s Suspected Child Abuse and Neglect (SCAN) teams, which provide consultation services in possible maltreatment cases. Two articles then discuss the leading causes of death from child maltreatment—abusive head trauma and neglect. A final article discusses the role of the medical expert witness in a child abuse trial and offers some tips for court testimony.

As the executive director of a children’s advocacy centre in the United States has stated, “Knowledge and education are our best weapons to fight child abuse.” All efforts must be made to increase the understanding of those on the front lines and make accurate diagnosis, assessment, and intervention more likely. With accurate, up-to-date information, physicians can help protect children from future harm and assist in holding those who abuse them accountable.

In the April issue, we will present four articles about child and youth sexual exploitation, abuse, and assault.

—Jean Hlady, MD
Director, Child Protection Service Unit, BC’s Children’s Hospital

References

1. Gove TJ. Report of the Gove Inquiry into Child Protection in British Columbia: Executive Summary. Victoria: Queen’s Printer, 1995. Full Text