Almost 4 decades have passed since Kempe and colleagues1 published in
THE JOURNAL their landmark description of the
battered child syndrome. There were 2 major findings in that study. The
first was a clinical description of children who had been physically
abused by their parents. Although the abuse and misuse of children had
been recognized for centuries2(pp3-28) and radiographic
findings in children thought to be caused by deliberate injuries had
been described,3,4 publication of the article by Kempe et
al1 in JAMA made it clear that injuries caused by
physical abuse were clinical problems that required the attention of
physicians. The second finding was the result of an epidemiological
survey in which 749 abused children—many of whom either had been
killed or had sustained permanent brain damage—were identified by 71
hospitals and 77 district attorneys in the United States. This large
number of cases suggested that serious child abuse was unlikely to
occur infrequently. However, no one in 1962 would have predicted that
in the United States in 1997, almost 3.2 million reports of child
maltreatment would be made to child protective service agencies. Of
these reports, approximately 1 million were confirmed, including
neglect (54%), physical abuse (22%), sexual abuse (8%), emotional
abuse (4%), and other (12%).5
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