The Challenges of Recognizing Child Abuse:  Seeing Is Believing

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