Child Abuse: The Conflict of Underdetection and Overreporting

Abstract

In 1946, Caffey1 reported the association of multiple bone fractures and subdural hematomas in children and set the stage for the identification of what subsequently became known as the battered child syndrome. For the next 15 years, radiologists involved in the care of children added support to his observations and demonstrated that the lesions he described had a specificity that indicated physical trauma when a history of injury was lacking or even denied. These reports met with little response until Kempe and associates2 indicated, in a symposium at a meeting of the American Academy of Pediatrics in October 1961, the serious nature of the observations in relation to pediatric morbidity and mortality.