Preventing child neglect and physical abuse: a role for pediatricians.

Abstract

1. Howard Dubowitz, MD, MS* 1. *Professor of Pediatrics, University of Maryland School of Medicine, Baltimore, Md After completing this article, readers should be able to: 1. Describe the importance of preventing child abuse and neglect. 2. Identify key risk and protective factors for child abuse and neglect. 3. Delineate useful principles and practical guidance for pediatricians on screening, brief assessment, and initial management of problems related to child abuse and neglect. Preventing child abuse and neglect spares a child pain and suffering, both physical and psychological. This is intuitively and morally preferable to intervening “after the fact.” Further, early intervention or prevention may be more effective than later intervention. For example, the time when a family has a new baby often is described as “a window of opportunity,” and early efforts to support the family and strengthen their parenting abilities may be particularly effective and cost-effective. Child maltreatment is not a rare phenomenon. Data from the 3rd National Incidence Study of Child Abuse and Neglect revealed that approximately 1% of children were identified as abused and 1.5% as neglected in 1993, and these rates are likely the “tip of the iceberg.” A number of studies have found that as many as one in four girls and one in ten boys has been sexually abused during childhood. Another reason for preventing child abuse and neglect is its immense morbidity and significant mortality rates. Research has documented the multiple physical, cognitive, behavioral, social, and emotional sequelae of child maltreatment. Brain damage, learning problems, aggression, juvenile delinquency and adult criminal behavior, depression, and parenting difficulties are a few of the potential long-term problems. The goal of preventing child maltreatment fits well with the goals and scope of pediatrics. “As physicians who assume a responsibility for children’s physical, mental, and emotional progress from conception to maturity, pediatricians must be concerned with social and environmental influences, which have a major impact on the health …