Physical Abuse of Children

TO THE EDITOR:

As an emergency physician who has treated the types of injuries described by Berkowitz too many times, I appreciate the clinical review regarding physical abuse in children. However, clinical presentations represent only a small fraction of the child abuse and neglect that occur in the United States. Self-reported survey data from children and caregivers indicate that one in seven children were victims of abuse or neglect in the preceding year.¹ Each adverse childhood experience can result in lifelong health issues, such as obesity, depression, drug abuse, and suicide. The Centers for Disease Control and Prevention (CDC) recently released the guide Preventing Child Abuse and Neglect: A Technical Package for Policy, Norm, and Programmatic Activities, which provides effective strategies for preventing violence against children.² Several model medical programs are highlighted, such as enhanced primary care programs that identify and address risk factors for child abuse and neglect, early childhood homevisitation programs that provide caregiver training, and trauma-focused cognitive behavioral therapy to lessen the harms of abuse. Although diagnosis and treatment are crucial, physicians also play a critical role in the prevention of child abuse and adverse childhood experiences.