CHILD ABUSE & NEGLECT:
ESSENTIAL INFORMATION FOR
PRACTICING & PRESIDING IN CHILD
WELFARE CASES
KAREN T. CAMPBELL, MD
FORENSIC PEDIATRICIAN
MEDICAL DIRECTOR, CYFD/PS
CO-MEDICAL DIRECTOR UNM CART
Incidence and Prevalence
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There were approximately a million
victims of Child Maltreatment in
2005 in the United States.
The rate of victimization in the
United States is 12.1 children per
1000 children.
Further breakdown of statistics…
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In the United States• 54 % of the children suffered from neglect
• 23% were physically abused
• 12% were sexually abused.
• Highest victimization rates were in the 0-3
year age group.
In New Mexico
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The child population in
New Mexico was 489,482
in 2005
32,950 children were the
subject of a report for
abuse/neglect in 2005
During the same year the
rate of substantiation was
14.9 per 1000 children
12 children died as a
result of abuse/neglect
during 2005
Remember, every day in
America, four (4) children
die as a result of abuse and
neglect!
INJURIES IN CHILD ABUSE
Examples of External Injuries
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Contusions
Abrasions
Lacerations
Incisions
Thermal/Chemical/Scald Burns
Examples of Internal Injuries
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Fractures
Contusion
Laceration
Incision
Ischemia
Edema
Hemorrhage
Common sites of Accidental
Injuries
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Forehead
Forearms
Elbows
Spinal Prominences
Hips / Iliac Crest
Knees
Shins
Common sites of NonAccidental Injuries
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Face
Ears
Neck
Upper Arms
Back
Chest and Abdomen
Upper legs
Buttocks
Genitalia
Differentiating between
Accidental and Non-Accidental
Trauma
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Age and/or developmental capability of the
child
Parent/Caretaker explanation for how the
injury occurred
Type of Injury
Location of Injury
Risk Factors• Infant/Child and Parent/Caretaker
Child Abuse Work-up
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History
Complete Physical Exam
Skeletal Survey
Head CT Scan
Bone Scan
MRI/MRA of the Head and
Neck
Ophthalmology Exam
Chest/Abdominal CT Scan
Laboratory Studies
Genetics/Dysmorphology
Consult
ABUSIVE HEAD INJURY
NORMAL RETINA
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Corner
Metaphyseal
Fracture
FRACTURES
PATTERNED INJURIES
BURNS
CONDITIONS MISTAKEN
FOR
CHILD ABUSE
CHILD NEGLECT
DEFINITION OF NEGLECT:
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Historically, neglect has been difficult to
define
Definitions have varied across states,
disciplines, agencies, and individuals
Broadly stated, neglect is a condition where a
child’s basic needs are not being met by their
parent(s) or caretaker(s)
TYPES OF NEGLECT:
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Physical Neglect
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Inadequate food and housing
Adult substance abuse
Domestic violence
Failure to Thrive (FTT)
Educational Neglect
• Truancy and school absences
• Non-approved home schooling
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Emotional Neglect
Medical Neglect
• Lack of appropriate Well Child Care and immunizations
• Lack of appropriate medical care for acute and chronic
medical conditions
FAILURE TO THRIVE (FTT)
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Growth failure from malnutrition
Drop of 2 or more standard deviations on a
standard growth chart
Weight at less than the 3rd percentile
Can be “organic” or “non-organic”
Can be a combination of “organic” and “nonorganic”
RISK FACTORS IN
FAILURE TO THRIVE
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Medical
• Chronic medical conditions
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Illnesses, inborn errors of metabolism, heart disorders,
pulmonary disorders, kidney disorders, genetic disorders
• Congenital anomalies
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Poverty
Parent-child interactive disorders
Family dysfunction
Parental mental health disorders
Parental characteristics
Child characteristics
WORK-UP FOR
FAILURE TO THRIVE
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Complete history
• Birth history, maternal prenatal history, past
medical history of the child, family history,
feeding history, feeding behaviors
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Medical work-up as indicated by complete
history
If no “organic” etiology is indicated by
history, placing the child in the hospital, or
other environment, and following the child’s
weight on an age-appropriate diet
For further information or
questions, please feel free to
contact me at:
(505) 841-7755 office
(505) 540-9577 pager