How is physical child abuse defined?

Updated: Apr 24, 2017
  • Author: Angelo P Giardino, MD, MPH, PhD; Chief Editor: Caroly Pataki, MD  more...
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The federally funded Fourth National Incidence Study (NIS-4) is a congressionally mandated effort of the United States Department of Health and Human Services to provide updated estimates of the incidence of child abuse and neglect in the United States and measure changes in incidence from the earlier studies. [5] NIS defines physical abuse as a form of maltreatment in which an injury is inflicted on the child by a caregiver via various nonaccidental means, including hitting with a hand, stick, strap, or other object; punching; kicking; shaking; throwing; burning; stabbing; or choking to the extent that demonstrable harm results. [6]

The advantage to a narrow definition is that it objectively states what is and is not physical abuse; however, such a clear delineation of circumstances likely fails to identify all possible cases of physical abuse (eg, pulling the child's hair, biting the child's skin). Definitions may also attempt to characterize the seriousness of injury; however, characterization is difficult because injuries vary greatly from mild redness on the buttocks that fades over several hours to injuries so severe that the child dies. Recent medical definitions focus more on the effect of the injury on the child and less on the perceived intention of the caregiver.

Additionally, newer definitions also consider the sociocultural context in which the injury occurs; folk healing practices may cause the appearance of nonaccidental injury to the child. Finally, the effect of the physical abuse may not be limited to just the immediate injury findings. The National Center on Child Abuse and Neglect (NCCAN) estimated that 37% of children with maltreatment injuries developed a disability or special need, directly from the abusive actions or omissions of the child's caregivers. [7] Furthermore, NCCAN estimated that incidence of disabilities caused by or likely to have been caused by maltreatment was 147 per 1000 maltreated children.

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