Current and emerging concepts in child abuse.

Within the three decades since Henry Kempe first popularized the concept of "the battered child syndrome," much has been learned not only about physical abuse but also neglect and sexual abuse. More recently, physicians with an interest in child abuse have expanded their focus to include child death review and other prevention strategies. Despite the increasing specialization of child abuse evaluation and management, all physicians working with children are likely to encounter child abuse in their practice. In 1994, more than 3.1 million reports of child abuse were made, of which more than 1 million had enough evidence to substantiate the allegations. Approximately one-half of all substantiated child abuse reports were for neglect. Physical abuse was involved in 21% and sexual abuse in about 11%. In 3% of the cases, the newer category of mental injury (emotional abuse/neglect) also was present. Despite the increase in the reporting of child abuse, the percentage of adults who have experienced child maltreatment (approximately 25% to 33%) probably has not changed significantly during this century. Most people who are victims of child abuse still never come to the overt attention of physicians, social workers, or other professionals, but the hidden emotional consequences have a considerable impact on the mental and medical health care systems. This article will briefly review the following three major categories of child abuse to highlight some of the thinking behind recent advances: Neglect; Physical Abuse; and Sexual Abuse. We will also discuss Prevention.