Pediatric Surgery NaT
Child Abuse and Maltreatment
Introduction
Since Ambroise Tardieu’s publication in 1860 of the first important article describing child abuse, “Étudemédico-légalesurlessévices et mauvaistraitementsexercéssurdesenfants” (Forensic study on cruelty and the ill treatment of children), our awareness and understanding of child maltreatment has evolved greatly [1]. But even as early as Dr. Tardieu’s first treatise on the subject, he recognized the duality of injuries caused both directly and indirectly. “But it is not only by means of physical blows that children are mistreated. They are subjected to all kinds of privation: physical neglect, malnutrition and even starvation, sequestration in dark cellars and tiny cells, lack of exercise, and exposure to cold.” [1]
What is the difference between child maltreatment, nonaccidental trauma and neglect?
Multiple definitions for child maltreatment and its forms have been established. Definitions vary slightly according to the application for which the definition is to be utilized. A common thread among all of the definitions is that child maltreatment is the broad umbrella under which intentional acts of harm and acts of omission resulting in harm are combined.
Definitions of nonaccidental trauma (NAT) must consider cultural norms of child rearing and the care of children when considered on a global scale [2]. Nevertheless, definitions are not standardized in the literature.
A recent collaborative document by the World Health Organization and the International Society for Prevention of Child Abuse and Neglect (ISPCAN) defined child maltreatment as “all forms of physical and/or emotional ill-treatment, sexual abuse, neglect or negligent treatment or commercial or other exploitation, resulting in actual or potential harm to the child’s health, survival, development or dignity in the context of a relationship of responsibility, trust or power." [2] Child maltreatment refers to either acts of commission (deliberate or intentional inflicted injury, also referred to as nonaccidental trauma) or omission (failure to provide for a child’s needs resulting in harm or injury, also referred to as neglect) [3].
The Centers for Disease Control and Prevention (CDC) has developed a standardized definition of child maltreatment with the aim of providing a common lexicon to facilitate surveillance, research and prevention. The CDC definition of child maltreatment is “any act or series of acts of commission or omission by a parent or other caregiver that results in harm, potential for harm, or threat of harm to a child” [3]. Children are defined as those under the age of 18 years and the perpetrator can be a primary caregiver (i.e. parent) or a secondary caregiver (e.g. clergy, coaches and teachers). Acts of commission include physical, sexual and psychological abuse. Nonaccidental trauma and child abuse are often used interchangeably. It is important to note that the intentionality refers only to the action of the caregiver (hence the term nonaccidental trauma), not the consequences of the action. The term nonaccidental trauma can seem like a euphemism for child abuse but using such specific language facilitates care for the injured using language that is factual and precise. The second category of maltreatment, acts of omission, are typically referred to as neglect. The CDC definition includes failures to provide for the child and supervise the child. Federal law in the United States, The 2010 Child Abuse Prevention and Treatment Act (CAPTA), has established a standard legal definition - “any recent act or failure to act on the part of a parent or caretaker which results in death, serious physical or emotional harm, sexual abuse or exploitation; or an act or failure to act, which presents an imminent risk of serious harm,” upon which states have based their own definitions of child abuse and neglect [4]. Similar to the CDC definition, acts of commission and omission are included. Importantly, all 50 states, the District of Columbia, and the U.S. Territories have child abuse and neglect reporting laws requiring that certain professionals and institutions report suspected maltreatment [4].
content in this topic is referenced in SCORE Nonaccidental Injuries: Diagnosis, Evaluation, Legal Issues overview
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