The abuse and neglect of children II: Recognizing child abuse

Child abuse is a highly significant problem for children and their families. Almost three million reports of child abuse were filed in 1992; 65% of these were substantiated. This is the second in a series of three articles regarding abuse. The first, "The Abuse and Neglect of Children," published in the last edition of Medical Update for Psychiatrists, describes the epidemiology of abuse, characteristics of high-risk victims and perpetrators, and important issues regarding the reporting of abuse and interacting with families. This second article focuses on recognising child abuse. The hallmark of intentional, abusive injury to a child is a discrepant history, unreasonable given the age of the child and the nature of the wound or circumstances surrounding the injury. Specific injuries such as fractures, bruises, burns, and blunt trauma may have characteristic patterns suggesting abuse. Neglect is the failure of the care-giver to provide for adequate child care in health, education, supervision, and physical needs of the child. Munchausen by proxy is the diagnosis given to deceptive action taken by a parent to simulate illness in a child, that is detrimental to the child and for which secondary gain is derived by the parent in the medical process. Sexual abuse will be the subject of the third and last article, which is to follow in the next issue of Medical Update for Psychiatrists. An awareness of the classic features of child abuse will help the physician recognize abuse, and thus may protect a child from further abuse and provide a family with badly needed services.