A group of physical and mental symptoms arising from long-term physical violence against a child.
Detecting and preventing battered child syndrome is difficult because society and the courts have traditionally not interfered with families. The syndrome came to public attention only comparatively recently, when C. Henry Kempe (1922–1984) and several of his colleagues published a landmark 1962 article in the Journal of the American Medical Association titled “The Battered Child Syndrome.” It was followed by a book that went into five editions by 1997. Dr. Kempe's efforts to protect as well as treat battered children led eventually to the passage of laws against child abuse in all 50 states.
Nonetheless, the physical abuse of children is an ongoing problem in North America. The Children's Bureau's Office of Child Abuse and Neglect estimates that 37% of physically abused children develop a disability or special need as a direct result of parental violence. Out of fear and guilt, however, victims rarely report the battering. Nearly one-half of child abuse victims are under the age of one year and therefore unable to tell others what is happening to them. The parents or guardians who bring a battered child to a hospital emergency room rarely admit that abuse has occurred. Instead, they offer complicated or vague explanations of how the child hurt himself. However, a growing body of scientific literature on pediatric injuries is simplifying the process of differentiating between intentional and accidental injuries. For instance, one study found that a child needs to fall from a height of 10 ft. (3 m) or more to sustain the lifethreatening injuries that accompany physical abuse. Medical professionals have also learned to recognize a spiral pattern on x rays of broken bones, indicating that the injury was the result of twisting a child's limb.
Parents or caregivers who batter children generally have one or more of the following characteristics:
Once diagnosed, the treatment for battered children is based on their age and the potential for the parents or guardians to benefit from therapy. The more amenable the parents are to entering therapy themselves, the more likely the child is to remain in the home. For infants, the treatment ranges from direct intervention and hospital care to foster care to home monitoring by a social service worker or visiting nurse. Ongoing medical assessment is recommended in all types of treatment and careful monitoring of the situation is warranted. For the preschool child, treatment usually takes place outside the home, whether in a day care situation, a therapeutic preschool, or through individual therapy. The treatment can include speech and language therapy, physical therapy, play therapy, behavior modification, and specialized medical care.
By the time the child enters school, the physical signs of abuse are less visible. Because these children may not yet realize that their lives are different from those of other children, very few will report that their mothers or fathers are subjecting them to gross physical injury. It is at this stage that psychiatric and behavioral disorders begin to surface. In most cases the children are removed from the home, at least initially. The treatment, administered through either group or individual therapy, focuses on establishing trust, restoring self-esteem, expressing emotions in a healthy way, and improving cognitive and problem-solving skills. Family therapy may also be utilized if appropriate.
Since the initial publication of Dr. Kempe's article, pediatricians, child psychologists, and school teachers have become aware that child abuse is not limited to physical battering. Neglect, defined as a parent or caregiver's failure to provide the child with sufficient food, clothing, shelter, or medical care to prevent harm, is even more common in the United States than physical battering. Signs that a child is neglected may include a dirty or unwashed appearance, clothing that is inadequate for cold weather, physical evidence of malnutrition (including dental problems), begging for or stealing food, unexplained absences from school, and the like. Psychological or emotional abuse can occur whereby the child is berated, criticized, and told he or she is worthless.
Recognizing and treating physical abuse in the adolescent is by far the most difficult. By now the teen is an expert at hiding bruises. Instead, teachers and health care professionals should be wary of exaggerated responses to being touched, provocative actions, extreme aggressiveness or withdrawal, assaulting behavior, fear of adults, self-destruction, inability to form good peer relationships, alertness to danger, and/or frequent mood swings. Detection is exacerbated by the fact that many teenagers may exhibit some of these signs at one time or another.
Abused teens do not evoke as much sympathy as younger victims, for society assumes that they are old enough to protect themselves or seek help on their own. In truth, all teenagers need adult guidance. The behavior that the abused adolescent often engages in—delinquency, running away, and failure in school—usually evokes anger in adults but should be recognized as symptoms of underlying problems. The abused teen is often resistant to therapy, which may take the form of individual psychotherapy, group therapy, or residential treatment.
While reporting child abuse is essential, false accusations can also cause great harm. It is a good idea for anyone who suspects that a child is being physically abused to seek confirmation from another adult, preferably a non-relative but one who is familiar with the family. If the second observer concurs, the local child protective services agency should be contacted. The agency has the authority to verify reports of child abuse and make decisions about protection and intervention.
Unlike many other medical conditions, child abuse is preventable. Family support programs can provide parenting information and training, develop family skills, offer social support, and provide psychotherapeutic assistance before abuse occurs.
See also Child abuse ; Child development .
Giardino, Angelo P., Michelle A. Lyn, and Eileen R. Giardino, eds. A Practical Guide to the Evaluation of Child Physical Abuse and Neglect, 2nd ed. New York: Springer, 2010.
Helfer, Mary Edna, Ruth S. Kempe, and Richard D. Krugman. The Battered Child, 5th ed. Chicago: University of Chicago Press, 1997.
Kleinman, Paul K. Diagnostic Imaging of Child Abuse, 3rd ed. New York: Cambridge University Press, 2015.
Krugman, Richard D., and Jill E. Korbin, eds. C. Henry Kempe: A 50-year Legacy to the Field of Child Abuse and Neglect. New York: Springer Verlag, 2013.
Allareddy, V., et al. “Hospital-based Emergency Department Visits Attributed to Child Physical Abuse in United States: Predictors of In-hospital Mortality.” PLoS One 9 (June 11, 2014): e100110.
Leventhal, J.M., and R.D. Krugman. “‘The Battered Child Syndrome’ 50 Years Later: Much Accomplished, Much Left to Do.” Journal of the American Medical Association 308 (July 4, 2012): 35–36.
Oates, K. “Some Reflections from the Past and Some Ideas for the Future: The 2014 Kempe Oration.” Child Abuse and Neglect 43 (May 2015): 1–7.
Sheybani, E.F., et al. “Pediatric Nonaccidental Abdominal Trauma: What the Radiologist Should Know.” Radio-graphics 34 (January-February 2014): 139–153.
Skellern, C.Y. “Child Protection: A 50-year Perspective.” Journal of Paediatrics and Child Health 51 (January 2015): 87–90.
American Academy of Child and Adolescent Psychiatry (AACAP). “Child Abuse Resource Center.” https://www.aacap.org/aacap/Families_and_Youth/Resource_Centers/Child_Abuse_Resource_Center/Home.aspx (accessed August 24, 2015).
Children's Bureau. “Child Maltreatment 2013.” This is a compilation of the most recent statistics on child abuse in the United States. http://www.acf.hhs.gov/sites/default/files/cb/cm2013.pdf (accessed August 24, 2015).
Giardino, Angelo P. “Physical Child Abuse.” Medscape Reference. http://emedicine.medscape.com/article/915664-overview (accessed August 24, 2015).
American Academy of Child and Adolescent Psychiatry (AACAP), 3615 Wisconsin Avenue, N.W., Washington, DC, United States, 20016-3007, (202) 966-7300, Fax: (202) 966-2891, http://www.aacap.org/ .
Children's Bureau, Child Abuse and Neglect, 370 L'Enfant Promenade, S.W., Washington, DC, United States, 20447, http://www.acf.hhs.gov/programs/cb/focusareas/child-abuse-neglect .
Kempe Center for the Prevention and Treatment of Child Abuse and Neglect, Gary Pavilion at Children's Hospital Colorado, 13123 East 16th Avenue, B390, Aurora, CO, United States, 80045, (303) 864-5250, Fax: (303) 864-5367, Kempe.Center@ucdenver.edu,