A study in the August 4, 1999, issue of The Journal of the American Medical Association (Herman-Giddens et al) reports that the number of deaths of children under 11 years of age who die as a result of child abuse are greatly underreported in the United States. Over a 10-year period, a review of medical examiners' reports in North Carolina showed the state vital records system underreported by almost 60 percent the number of deaths due to battering or abuse.

Types of Abuse:

• Physical abuse - Infliction of physical injury as a result of punching, beating, kicking, biting, burning, shaking, or otherwise physically harming a child.

• Child neglect - Failure to provide for a child's basic needs, physically, emotionally, medically, and educationally.

• Sexual abuse - Includes fondling a child's genitals, intercourse, incest, rape, sodomy, exhibitionism, and commercial exploitation through prostitution or the production of pornographic materials.

• Emotional abuse - Acts or omissions by the parents or other caregivers that have caused, or could cause, serious behavioral, cognitive, emotional, or mental disorders.

The U.S. Child Abuse Prevention and Treatment Act defines child abuse and neglect as, at a minimum:

• Any recent act or failure to act resulting in imminent risk of serious harm, death, serious physical or emotional harm, sexual abuse, or exploitation...

• of a child (a person under the age of 18, unless the child protection law of the state in which the child resides specifies a younger age for cases not involving sexual abuse)...

• by a parent or caretaker (including any employee of a residential facility or any staff person providing out-of-home care) who is responsible for the child's welfare.

If you suspect a child is being abused, contact the local child protective service agency or department of human services in your state, county, or local jurisdiction.

Signs of Abuse:

• A poor self-image
• Sexual acting out
• Aggressive, disruptive, and sometimes illegal behavior
• Anger and rage, or feelings of sadness or other symptoms of depression
• Self-destructive or self-abusive behavior, suicidal thoughts
• Passive or withdrawn behavior
• Anxiety or fears, or flashbacks and nightmares
• School problems or failure
• Drug and alcohol abuse

• National Clearinghouse on Child Abuse and Neglect Information
  A Nation's Shame: Fatal Child Abuse and Neglect in the United States
  (800) 394-3366
  

• American Academy of Child & Adolescent Psychiatry Public Information
  (800) 333-7636
  

• Prevent Child Abuse America
  (800) CHILDREN
  

Mi Young Hwang, Writer
Richard M. Glass, M.D., Editor
Jeff Molter, Director of Science News

(JAMA. 1999; 282:500)

Published in JAMA: August 4, 1999