Child abuse—Controversies and imposters

Abstract

hild abuse and neglect continue to threaten children in the United States and around the world with awesome frequency. According to the Third National Incidence Study of Child Abuse and Neglect, 1,553,800 US children were harmed intentionally by either an abusive act or an omission of care in 1993. This represented a 67% increase over the number of victims determined by the Second National Incidence Study in 1986. Also disturbing is that the number of seriously injured victims has quadrupled. 1 One recent review reported that about 2000 children die annually in the United States as a result of child abuse and neglect. 2 Although we now have increasing abilities to detect inflicted injuries or neglect in both dead and surviving victims of child abuse, controversy exists among medical and other professionals around several issues, including the recognition, reporting, diagnosis, pathophysiology, and biomechanics of inflicted versus noninflicted trauma and sudden, unexpected deaths of children. Sometimes the controversy is valid, representing different theories based on an evolving science. At other times there is conflict generated by personal bias, speculation, or, at its worst, personal gain. At a basic level, controversy exists between physicians and other health care providers around the issue of participation in diagnosing and reporting child abuse and neglect. Commonly cited reasons for avoiding child abuse work include