Child Abuse Much More Common Than Official Statistics Indicate

Lancet Series Shines a Spotlight on Child Maltreatment

Caroline Cassels

December 05, 2008

December 5, 2008 — Child abuse in high-income countries is far more common than official statistics show, with just 10% of suspected cases investigated and substantiated annually, new research suggests.

Published online December 4 in the Lancet, the study, led by Ruth Gilbert, MD, from University College London Institute of Child Health, in the United Kingdom, is 1 of a series of 4 papers in this issue of the Lancet that highlight the issue of childhood maltreatment.

According to the study, 4% to 16% of children are physically abused and 1 in 10 is neglected or psychologically abused every year. In addition, between 5% and 10% of girls and up to 5% of boys are exposed to penetrative sexual abuse, and up to 3 times this number are exposed to any type of sexual abuse. However, the investigators note that official rates for substantiated child maltreatment indicate less than a tenth of this burden.

The impact of child maltreatment can have devastating and long-lasting consequences that persist into adulthood. For instance, the authors note that maltreated children are at increased risk for criminal behavior, are more likely to engage in risky sexual behavior, and are at significantly higher risk for drug and alcohol abuse.

"The most tragic manifestation of the burden of child maltreatment is the thousands of child deaths every year due to murder or neglect," the authors write.

According to the World Health Organization, worldwide, 155,000 children younger than 15 years die annually as a result of abuse or neglect. Biological parents are responsible for 80% of cases and stepparents for 15%.

In the United Kingdom, 35% of child murder victims are younger than 1 year. It is estimated that in the European Union, 4 in every 1 million children die from homicide or manslaughter every year. In Central and Eastern Europe and the newly independent states, the rate is 3 times greater, the authors report.

Abuse Significantly Underreported

A second study, also conducted by Dr. Gilbert and colleagues, shows that in most settings child abuse is significantly underreported — even by schools and community-health services that have continuous contact with children.

However, this phenomenon also extends to professionals in primary care, mental health, and law enforcement.

Reasons for underreporting, say the authors, include lack of awareness about the signs of maltreatment and the processes for reporting to child-protection agencies and the perception that reporting might do more harm than good.

However, even when maltreatment is suspected, the authors note, professionals often do not report the case unless they have a high level of certainty that maltreatment has occurred.

To illustrate the extent of uncertainty about maltreatment, the researchers highlight a prospective study from the United States that showed that doctors suspected about 10% of 15,000 child-injury visits were due to maltreatment. However, only 6% of cases were reported (Flaherty EG et al. Pediatrics 2008;122:611-619).

"Professionals who have continuous contact with children, such as people working in schools and community health services, can have a leading role in recognizing, responding to, and supporting maltreated children. Their scarce reporting to child-protection agencies is a cause for concern, and we need to find out whether maltreatment is being recognized and dealt with in other ways. Doubts are widespread that the benefits of reporting suspected cases of maltreatment to child-protection services outweigh the harms," the authors conclude.

In an accompanying editorial, Richard Horton, MB, editor of the Lancet, and senior editor Richard Turner, MD, express hope that this series of articles will raise awareness about child abuse and will help guide clinicians and other professionals who come in contact with children who might be abuse victims.

"It is to clinicians and other professionals responsible for caring for children that the Lancet's Child Maltreatment Series is aimed, with the intention of providing them with a rigorous and up-to-date summary of scientific evidence and conceptual work on this complex and demanding topic," they write.

The researchers have disclosed no relevant financial relationships.

Lancet. Published online December 4, 2008.

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