Physical and sexual abuse of children

Goals and objectives To understand the spectrum of child abuse that exists and may be seen by the clinician To better identify, manage, and refer the child or adolescent who may have been neglected or physically abused To better identify, manage, and refer the child or adolescent who may have been sexually abused Introduction Children and adolescent victims of physical abuse, sexual abuse, and/or neglect may initially present to an emergency department or primary care office. The patient-health care provider encounter may have significant emotional, legal, forensic, and medical implications for a child/adolescent and his/her family. In general, the emergency department setting is not ideal for the comprehensive, multidisciplinary assessment of the child/adolescent who may have been abused. Whenever and wherever possible, a coordinated, protocol-based collaboration between an emergency department and the nearest child advocacy center or program is recommended. Nonetheless, the emergency department provider should have a thorough understanding of the detection, triage, management, documentation, and treatment of the maltreated child or adolescent. Epidemiology The U.S. Department of Health and Human Services reports that approximately 872, 000 children were victims of child maltreatment in 2004. Their report is based on national data collected from child protective services (CPS) agencies in the United States, which were analyzed by the National Child Abuse and Neglect Data System, the Children’s Bureau, Administration on Children, Youth, and Families in the Administration for Children and Families, and the U.S. Department of Health and Human Services.