• Tanya S. Hinds
  • Angelo P. Giardino
Part of the SpringerBriefs in Public Health book series (BRIEFSPUBLIC)


Child physical abuse is the intentional use of physical force against a child that either results in or has the likelihood of resulting in harm to the child’s health, development or dignity. (International Center for Assault Prevention). Physical abuse is defined in straightforward language as occurring when a child suffers injury due to the actions of his or her caregiver. These injuries may be referred to as inflicted or nonaccidental injuries. In the United States, individual states and territories have both criminal and civil statues that specifically define actions that constitute child physical abuse (Child Welfare Information Gateway 2016a). Some states use broad definitions that encompass a wide range of injuries; other states use more narrow definitions that include specific signs and symptoms. Common to most of these definitions of physical abuse, however, is the presence of an injury that the child sustains at the hands of his or her caregiver. The more general terms, Child abuse and neglect and child maltreatment are interchangeable and refer to a major public health problem confronting children and families. Abuse manifests when the child or adolescent’s caregiver fails to provide for the youth’s health and well-being by either causing harm, or as in neglect, by not meeting a basic need. Child maltreatment is broadly categorized into (a) physical abuse, (b) sexual abuse, (c) emotional/psychological abuse, and (d) neglect. This monograph will address the current evidence, clinical practice and policy directions associated with physical abuse.


  1. American Medical Association (AMA) Council of Scientific Affairs. (1985). American Medical Association Diagnostic and Treatment Guidelines Concerning Child Abuse and Neglect. JAMA, 254;796–800.Google Scholar
  2. American Prosecutors Research Institute. (2003). Investigation and prosecution of child abuse (3rd ed.). Alexandria: Sage.Google Scholar
  3. Barr, R. G. (2014). Crying as a trigger for abusive head trauma: A key to prevention. Pediatric Radiology, 44(S4), 559–564. doi: 10.1007/s00247-014-3100-3.CrossRefGoogle Scholar
  4. Belsky, J. (1980). Child maltreatment: An ecological integration. American Psychologist, 35, 320–335.CrossRefPubMedGoogle Scholar
  5. Briere, J. N. (1992). Child abuse trauma: Theory and treatment of the lasting effect. Newbury Park: Sage.Google Scholar
  6. Bronfenbrenner, U. (1977). Toward an experimental ecology of human development. American Psychologist, 32, 513–531.CrossRefGoogle Scholar
  7. Bross, D. C., Krugman, R. D., Lenherr, M. D., et al. (1988). The new child protection team handbook. New York: Garland.Google Scholar
  8. Center for Disease Control and Prevention. (2016a). About behavioral risk factor surveillance system ACE data. Retrieved from
  9. Center for Disease Control and Prevention. (2016b). About the CDC-Kaiser ACE study.
  10. Center for Disease Control and Prevention. (2016c). Injury prevention & control: Division of violence prevention. Retrieved from
  11. Center for Disease Control and Prevention. (2016d). Adverse childhood experiences. Looking at how ACEs affect our lives and society.
  12. Center for Disease Control and Prevention. (2012). Press release. Retrieved from
  13. Center for Disease Control and Prevention. (2015). The social-ecological model: A framework for prevention.
  14. Chaffin, M., Kelleher, K., & Hollenberg, J. (1996). Onset of physical abuse and neglect: Psychiatric, substance abuse, and social risk factors from prospective community data. Child Abuse & Neglect, 20(3), 191–203. doi: 10.1016/s0145-2134(95)00144-1
  15. Child Welfare Information Gateway. (2008). Mandatory reporters of child abuse and neglect: summary of state laws. Washington, DC.
  16. Child Welfare Information Gateway. (2013). Long-term consequences of child abuse and neglect. Washington, DC: U.S. Department of Health and Human Services, Children’s Bureau.
  17. Child Welfare Information Gateway. (2016a). Child abuse and neglect fatalities 2014: Statistics and interventions. Washington, DC: U.S. Department of Health and Human Services, Children’s Bureau. Scholar
  18. Child Welfare Information Gateway. (2016b). Penalties for failure to report and false reporting of child abuse and neglect. Washington, DC: U.S. Department of Health and Human Services, Children’s Bureau.Google Scholar
  19. Christian, Committee on Child Abuse and Neglect. (2015). The evaluation of suspected child physical abuse. Pediatrics, 135(5), e1337–e1354. September 01, 2015.CrossRefGoogle Scholar
  20. Collishaw, S., Pickles, A., Messer, J., Rutter, M., Shearer, C., & Maughan, B. (2007). Resilience to adult psychopathology following childhood maltreatment: Evidence from a community sample. Child Abuse & Neglect, 31(3), 211–229.CrossRefGoogle Scholar
  21. Commission to Eliminate Child Abuse and Neglect. (2016). Fact sheet. Within our reach: A national strategy to eliminate child abuse and neglect fatalities.
  22. DeLaronde, S., King, G., Bendel, R., & Reece, R. (2000). Opinions among mandated reporters toward child maltreatment reporting policies. Child Abuse and Neglect, 24(7), 901–905.CrossRefPubMedGoogle Scholar
  23. Diderich, H. M., Fekkes, M., Verkerk, P. H., Pannebakker, F. D., Velderman, M. K., Sorensen, P. J. G., Baeten, P., Oudesluys-Murphy, A. M. (2013). A new protocol for screening adults presenting with their own medical problems at the emergency department to identify children at high risk for maltreatment. Child Abuse & Neglect, 37(12), 1122–1131. doi: 10.1016/j.chiabu.2013.04.005
  24. Dinsmore, J. (1993). Joint investigations of child abuse: Report of a symposium. Washington DC: U.S. Department of Health and Human Services, National Center on Child Abuse and Neglect.Google Scholar
  25. Ells, M. (2000). Forming a multidisciplinary team to investigate child abuse. Rockville: Office of Juvenile Justice and Delinquency. Scholar
  26. Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., Koss, M. P., & Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults -the adverse childhood experiences (ACE) study. American Journal of Preventive Medicine, 14, 245–258.CrossRefPubMedGoogle Scholar
  27. Finkelhor, D. (1990). Is child abuse Overreported? Public Welfare, 48(1), 22–29.Google Scholar
  28. Finkelhor, D., Saito, K. Jones, L. (2016). Updated trends in child maltreatment, 2014. Crimes against children research center.
  29. Flaherty, E. G. (2006). Analysis of caretaker histories in abuse: Comparing initial histories with subsequent confessions. Child Abuse & Neglect, 30(7), 789–798. doi: 10.1016/j.chiabu.2005.12.008.CrossRefGoogle Scholar
  30. Foreman, T., & Bernet, W. (2000). A misunderstanding regarding the duty to report suspected abuse. Child Maltreatment, 5(2), 190–196.CrossRefPubMedGoogle Scholar
  31. Giardino, A. P. & Harris, T. B. (2006) Child Abuse & Neglect: Posttraumatic Stress Disorder. eMedicine.
  32. Garbarino, J. (1977). The human ecology of child maltreatment: A conceptual model forresearch. Journal of Marriage and the Family, 39, 721–727.CrossRefGoogle Scholar
  33. Goldman, J., Salus, M., Wolcott, D., & Kennedy, K. (2003). In National Clearinghouse on Child Abuse and Neglect Information (Ed.), A coordinated response to child abuse and neglect: The foundation for practice. Washington, DC: Department of Health and Human Services. Administration for Children and Families. Children’s Bureau Office on Child Abuse and Neglect.Google Scholar
  34. Goodman, E., Slap, G. B., & Huang, B. (2003). The public health impact of socioeconomic status on adolescent depression and obesity. American Journal of Public Health, 93, 1844–1850.CrossRefPubMedPubMedCentralGoogle Scholar
  35. Hampton, R. L., & Newberger, E. H. (1985). Child abuse incidence and reporting by hospitals: Significance of severity, class, and race. American Journal of Public Health, 75(1), 56–60. doi: 10.2105/ajph.75.1.56
  36. Harris, T.B., Banu, S., Giardino, A.P. (2013). Posttraumatic stress disorders in children. Medscape LLC: New York, NY.Google Scholar
  37. Helfer, R. E. (1973). The etiology of child abuse. Pediatrics, 51, 777–779.Google Scholar
  38. Helfer, R. E. (1987). The developmental basis of child abuse and neglect: An epidemiological approach. In R. E. Helfer & R. S. Kempe (Eds.), The battered child (4th ed., pp. 60–80). Chicago: University of Chicago Press.Google Scholar
  39. Hobbs, C. J., Hanks, H. G. I., & Wynne, J. M. (1993). Child abuse and neglect: A clinician’s handbook. New York: Churchill Livingstone.Google Scholar
  40. Immunity for Reporters of Child Abuse and Neglect: Summary of State Laws (2008). Washington, DC: Child Welfare Information Gateway.
  41. IOM (Institute of Medicine) and NRC (National Research Council). (2012). Child maltreatment research, policy, and practice for the next decade: Workshop summary. Washington, DC: The National Academies Press.Google Scholar
  42. Jason, J., Andereck, N. D., Marks, J., & Tyler, C. W. (1982). Child abuse in Georgia: A method to evaluate risk factors and reporting bias. American Journal Public Health, 72(12), 1353–1358.Google Scholar
  43. Justice, B., Calvert, A., & Justice, R. (1985). Factors mediating child abuse as a response to stress. Child Abuse & Neglect, 9, 359–363.CrossRefGoogle Scholar
  44. Kaufman, J., & Ziegler, E. (1987). Do abused children become abusive parents? American Journal of Orthopsychiatry, 57, 186–192.CrossRefPubMedGoogle Scholar
  45. Krugman, S. D., Lantz, P. E., Sinal, S., De Jong, A. R., & Coffman, K. (2007). Forced suffocation of infants with baby wipes: A previously undescribed form of child abuse. Child Abuse & Neglect, 31(6), 615–621. doi: 10.1016/j.chiabu.2006.12.012
  46. Lane, W. G. (2002). Racial differences in the evaluation of pediatric fractures for physical abuse. JAMA, 288(13), 1603. doi: 10.1001/jama.288.13.1603
  47. Leventhal, J. M., Martin, K. D., & Gaither, J. R. (2012). Using US data to estimate the incidence of serious physical abuse in children. Pediatrics, 129(3), 458–464. doi: 10.1542/peds.2011-1277
  48. Lindberg, D. M., Blood, E. A., Campbell, K. A., Laskey, A. L., & Berger, R. P. (2013). Predictors of screening and injury in contacts of physically abused children. The Journal of Pediatrics, 163(3), 730–735.e3. doi: 10.1016/j.jpeds.2013.02.051
  49. Loder, R. T., & Feinberg, J. R. (2007). Orthopaedic injuries in children with nonaccidental trauma. Journal of Pediatric Orthopaedics, 27(4), 421–426. doi: 10.1097/01.bpb.0000271328.79481.07
  50. Ludwig, S., & Kornberg, A. E. (1992). Child abuse: A medical reference (2nd ed.). New York: Churchill Livingstone.Google Scholar
  51. Martin, J. A., & Elmer, E. (1992). Battered children grown up: A follow-up study of individuals severely maltreated as children. Child Abuse & Neglect, 16(1), 75–87.CrossRefGoogle Scholar
  52. Martin, A., & Volkmar, F. R. (2007). Lewis’s child and adolescent psychiatry: A comprehensive textbook (4th ed.). Philadelphia: Wolters Kluwer, Lippincott Williams & Wilkins.Google Scholar
  53. McGuigan, W. M., & Pratt, C. C. (2001). The predictive impact of domestic violence on three types of child maltreatment. Child Abuse & Neglect, 25(7), 869–883. doi: 10.1016/s0145-2134(01)00244-7
  54. Myers, J. E. B., Berliner, L., Briere, J., et al. (2002). The APSAC handbook on child maltreatment. In American professional society on the abuse of children (2nd ed.). Thousand Oaks: Sage.Google Scholar
  55. Naidoo, S. (2000). A profile of the oro-facial injuries in child physical abuse at a children’s hospital. Child Abuse & Neglect, 24(4), 521–534. doi: 10.1016/S0145-2134(00)00114-9
  56. National Research Council (NRC). (1993). Understanding child abuse and neglect. Washington, DC: National Academy Press.Google Scholar
  57. Norman, R. E., Munkhtsetseg, B., Rumma, D., Butchart, A., Scott, J., & Vos, T. (2012). The long-term health consequences of child physical abuse, emotional abuse, and neglect: A systematic review and meta-analysis. PLoS Medicine, 9(11), e10011349.CrossRefGoogle Scholar
  58. Panel on Research on Child Abuse and Neglect, National Research Council. (1993). Understanding child abuse and neglect. Washington, D.C: The National Academy of Sciences.Google Scholar
  59. Pence, D., & Wilson, C. (1994). Team investigation of child sexual abuse: The uneasy alliance. Thousand Oaks: Sage.CrossRefGoogle Scholar
  60. Robert Wood Johnson Foundation. (2013). The truth about aces.
  61. Scribano, P. V., Makoroff, K. L., Feldman, K. W., & Berger, R. P. (2013). Association of perpetrator relationship to abusive head trauma clinical outcomes. Child Abuse & Neglect, 37(10), 771–777. doi: 10.1016/j.chiabu.2013.04.011
  62. Sedlak, A. J., Mettenburg, J., Basena, M., Petta, I., McPherson, K., Greene, A., & Li, S. (2010). Fourth National Incidence Study of child abuse and neglect (NIS–4): Report to congress. Washington, DC: U.S. Department of Health and Human Services, Administration for Children and Families.Google Scholar
  63. Schnitzer, P. G. (2005). Child deaths resulting from inflicted injuries: Household risk factors and perpetrator characteristics. Pediatrics, 116(5), e687–e693. doi: 10.1542/peds.2005-0296
  64. Sieswerda-Hoogendoorn, T., Bilo, R. A. C., Duurling, L. L. B. M., Karst, W. A., Maaskant, J. M., van Aalderen, W. M. C., & van Rijn, R. R. (2013). Abusive head trauma in the Netherlands; evidence for multiple incidents of abuse. Tijdschrift voor Kindergeneeskunde, 81(S1), 107–107. doi: 10.1007/s12456-013-0104-0
  65. Stirling, J., & Amaya-Jackson, L. (2008). Understanding the behavioral and emotional consequences of child abuse. Pediatrics, 122, 667–673.CrossRefPubMedGoogle Scholar
  66. Tiapula, S., & Giardino, A. P. (2010). Legal issues and documentation. In A. P. Giardino, M. A. Lyn, & E. R. Giardino (Eds.), A practical guide to the Evalutation of child physical abuse and neglect (pp. 445–475). New York: Springer.CrossRefGoogle Scholar
  67. U.S. Department of Health & Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau. (2016). Child maltreatment 2014. Available from
  68. Wang, C. T., & Holton, J. (2007). Total estimated cost of child abuse and neglect in the United States. Economic impact study. Chicago, IL: Prevent Child Abuse America
  69. Widom, C. S., & Maxfield, M. G. (2001). An update on the “cycle of violence”. Washington, D.C: U.S. Department of Justice. Office of Justice Programs. National Institute of Justice.
  70. Widom, C. S., Czaja, S. J., & Paris, J. (2009). A prospective investigation of borderline personality disorder in abused and neglected children followed up into adulthood. Journal of Personality Disorders, 23(5), 433–446.CrossRefPubMedGoogle Scholar
  71. Widom, C. S., Czaja, S. J., Bentley, T., & Johnson, M. S. (2012). A prospective investigation of physical health outcomes in abused and neglected children: New findings from a 30-year follow-up. American Journal of Public Health, 102(6), 1134–1144.CrossRefGoogle Scholar
  72. Wilson, E. P. (1992). Multidisciplinary approach to child protection. In S. Ludwig & A. B. Kornberth (Eds.), Child abuse: A medical reference (2nd ed., pp. 79–84). New York: Churchill Livingstone.Google Scholar

Copyright information

© The Author(s) 2017

Authors and Affiliations

  • Tanya S. Hinds
    • 1
    • 2
  • Angelo P. Giardino
    • 3
    • 4
  1. 1.The Freddie Mac Foundation Child and Adolescent Protection CenterChildren’s National Health SystemWashington, DCUSA
  2. 2.The George Washington UniversityWashington, DCUSA
  3. 3.Texas Children’s HospitalHoustonUSA
  4. 4.Baylor College of MedicineHoustonUSA

Personalised recommendations