Each week in the United States, child protective services and agencies receive reports of more than 50,000 suspected child abuse incidents. In 2002, 2.6 million incidents involving 4.5 million children were reported. Approximately four children die every day as a result of abuse or neglect.1 But numbers don’t tell the whole story. Behind every number is a child at risk.
“I can picture right now in my mind a young baby who was about six months of age with a belly that was protruded and distended,” says Erin R. Stucky, MD, a pediatric hospitalist at Children’s Hospital and Health Center San Diego, and an associate professor of pediatrics at the University of California San Diego. “[She had] no bowel sounds, and the arms and legs were so thin, had no fat whatsoever. The skin was rolling. The face looked dysmorphic, but it was simply because the eyes were so white, and there was no fat on the face at all. The baby had an irritated cry. The hair was thin. [She] had a look of anxiety, true anxiety [in her] eyes. It was impressive, as though this infant was saying, ‘Help me. I can’t speak.’ [She] was very socially engaged, but tired. If you had to qualify the look further, it would be something like, ‘I’m in pain. Protect me. Please don’t walk out the door.’
“The child had been admitted from the emergency department at an outside facility. They had been focused, appropriately to some extent, on the fact that the belly was distended and that the baby had no bowel sounds. They were focused on the fact that the parent’s history [of the child] was of vomiting during the day, but it clearly did not equate whatsoever with the way the child looked. It was immediately clear, simply looking at the baby while walking in the room, that something very bad was wrong and that the parents’ answers and explanations did not fit.”
What It Is
Child abuse manifests in many forms, including physical abuse, sexual abuse, emotional abuse, and neglect, with a “child” typically defined as a person under 18. Legal definitions of the forms of child abuse vary, but, in general, they reflect societal views of actions deemed improper and unacceptable because they place a child at risk of physical or emotional harm.2 The federal Child Abuse Prevention and Treatment Act (CAPTA) defines child abuse and neglect as:
- Any recent act or failure to act on the part of a parent or caretaker that results in death, serious physical or emotional harm, sexual abuse, or exploitation; or
- An act or failure to act that presents an imminent risk of serious harm.3
States must include these minimum standards in their statutes in order to receive federal funds.
Neglect is the most common form of child abuse.2 Although definitions of neglect vary by state, they share characteristics. Minnesota defines neglect as inadequate food, shelter, clothing, or medical care. California includes both overt acts and omissions in the definition of neglect, defining general neglect as a lack of food, clothing, or medical care and severe neglect as malnutrition, failure to thrive, or willfully putting a child in danger. And Rhode Island’s neglect definition goes even further, including the above acts and omissions as well as the failure to provide a minimum degree of care or proper supervision or guardianship due to unwillingness, social problems, mental incompetency, or the use of a drug, drugs or alcohol, desertion, or abandonment. Rhode Island also includes the failure to take financial responsibility for a child.4