Learning Objective:
Recognize the clinical features, red flags, and mandatory reporting responsibilities in cases of child neglect, physical, sexual, and emotional abuse.
Child abuse refers to intentional or unintentional harm inflicted on a child by a caregiver.
It includes neglect, physical abuse, sexual abuse, and emotional abuse.
⚠️ All suspected cases must be reported to local child protective services—even if evidence is incomplete.
1. Neglect
| Feature | Description |
|---|---|
| Definition | Failure to provide adequate food, shelter, supervision, education, or affection. |
| Signs | Poor hygiene, malnutrition, withdrawn affect, impaired social/emotional development, failure to thrive. |
| Key Point | The most common form of child maltreatment. |
| Consequence | Growth and developmental delay. |
🩺 Clinical Clue: A child with poor school attendance, underweight, and poor hygiene may be experiencing neglect.
2. Physical Abuse
| Feature | Description |
|---|---|
| Definition | Nonaccidental trauma such as fractures, bruises, or burns. |
| Findings | Injuries in various stages of healing; patterns resembling implements (e.g., belt, handprint). |
| Specific Syndrome | Shaken Baby Syndrome → Subdural hematomas, retinal hemorrhages. |
| Suspicious Behavior | Caregivers delay medical attention or give inconsistent explanations. |
| Statistics | ~40% of deaths related to child abuse/neglect occur in children <1 year old. |
⚠️ USMLE Tip: Multiple fractures in different stages of healing = highly suspicious for abuse.
3. Sexual Abuse
| Feature | Description |
|---|---|
| Definition | Sexual activity with a child, including inappropriate exposure or contact. |
| Physical Findings | STIs, UTIs, genital/anal/oral trauma (often absent). |
| Behavioral Signs | Sexual knowledge or behavior is incongruent with developmental age. |
| Peak Age | 9–12 years old. |
🚨 Note: Absence of physical signs does not rule out sexual abuse.
4. Emotional Abuse
| Feature | Description |
|---|---|
| Younger Children | Lack of attachment with caregiver, overly affectionate with strangers, anxiety, and aggression toward others. |
| Older Children | Emotional lability, somatic complaints without medical cause, social withdrawal, and anger. |
| Long-term Impact | ~80% develop ≥1 psychiatric illness by age 21. |
💬 Key Point: Emotional abuse often leads to lifelong psychiatric morbidity.
Mandatory Reporting
- Physicians are legally obligated to report suspected (not confirmed) cases.
- Reporting is not a breach of confidentiality.
- Failure to report can result in legal penalties and harm to the child.
Key Points Summary
| Type | Key Finding | USMLE Highlight |
|---|---|---|
| Neglect | Most common type | Poor hygiene, failure to thrive |
| Physical | Injuries in various healing stages | Subdural hemorrhage, retinal bleed |
| Sexual | May lack physical signs | STIs, precocious sexual behavior |
| Emotional | Psychiatric impact later | Somatic complaints, mood changes |
