Underreported, underacknowledged: child abuse can no longer be ignored.

Child abuse is a serious problem in Hong Kong, and the recent Tin Shui Wai tragedy and assault of a 7-year-old boy have caused considerable public concern. Over the past 5 years, the number of new child abuse cases reported to the Child Protection Registry (CPR) by the Social Welfare Department has been increasing, and has recently risen by more than 50% from 622 cases in 2004 to 406 cases in just the first 6 months of 2005. In fact, this represents a gross underestimate of the incidence of local child abuse. Using the Chinese version of the Conflict Tactics Scale, a study in 1998 found the base rate of physical child abuse in Hong Kong to be 526 per 1000 children for minor violence, and 461 per 1000 children for severe violence. A recent household survey conducted by the University of Hong Kong and commissioned by Social Welfare Department also showed that at least 29% of children had experienced physical maltreatment or severe physical maltreatment and 6% of adult respondents claimed that they had severely or very severely physically abused their children in the past 12 months. So each year, around 70 000 children under 18 years of age are being severely or very severely physically abused by their adult carers— not to mention other forms of abuse. The overall notification rate to the CPR is thus only 1% to 2%! Over a period of 2 years, 277 children were admitted to hospitals for substantiated physical child abuse and seven (1.2%) died as a result of their injuries. Child abuse, besides causing physical harm and mortality, also carries long-term consequences in terms of impaired brain development, poor physical health, poor mental and emotional health, and cognitive and social difficulties. The direct and indirect costs are enormous, amounting to 1% of gross domestic product in some countries, making prevention, early identification and intervention paramount public concerns.