Journal of Child & Adolescent Trauma

, Volume 7, Issue 1, pp 37–49 | Cite as

Child Torture as a Form of Child Abuse

  • Barbara L. KnoxEmail author
  • Suzanne P. Starling
  • Kenneth W. Feldman
  • Nancy D. Kellogg
  • Lori D. Frasier
  • Suzanna L. Tiapula
Original Article


This paper describes clinical findings and case characteristics of children who are victims of severe and multiple forms of abuse; and proposes clinical criteria that indicate child abuse by torture. Medical records, investigation records, and transcripts of testimony regarding a non-consecutive case series of 28 children with evidence of physical abuse, neglect, and psychological maltreatment, such as terrorizing and isolation, were reviewed for types of injuries, duration of maltreatment, medical and physical neglect, social and family history, and history of prior Child Protective Services (CPS) involvement. The median age was 7.5 years (9 months to 14.3 years). Thirty-six percent died. Duration of abuse ranged from 3.5 months to 8 years (median 3 years). Ninety-three percent of children were beaten and exhibited cutaneous injury; 21 % had fractures. There were 25 victims of isolation (89 %), as well as 61 % who were physically restrained and 89 % who were restricted from food or water. All of the children were victims of psychological maltreatment; 75 % were terrorized through threats of harm or death to themselves or loved ones and 54 % were degraded and/or rejected by caregivers. Nearly all children were medically neglected. Half had a history of prior referrals to CPS. The children in this case series were physically abused, isolated, deprived of basic necessities, terrorized, and neglected. We define child torture as a longitudinal experience characterized by at least two physical assaults or one extended assault, two or more forms of psychological maltreatment, and neglect resulting in prolonged suffering, permanent disfigurement or dysfunction, or death.


Non-accidental trauma Physical abuse Psychological maltreatment Neglect Starvation 


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Copyright information

© Springer International Publishing 2014

Authors and Affiliations

  • Barbara L. Knox
    • 1
    Email author
  • Suzanne P. Starling
    • 2
  • Kenneth W. Feldman
    • 3
  • Nancy D. Kellogg
    • 4
  • Lori D. Frasier
    • 5
  • Suzanna L. Tiapula
    • 6
  1. 1.Department of PediatricsUniversity of Wisconsin School of Medicine and Public Health, American Family Children’s HospitalMadisonUSA
  2. 2.Eastern Virginia Medical SchoolChildren’s Hospital of The King’s DaughtersNorfolkUSA
  3. 3.University of Washington, and Seattle Children’s HospitalSeattleUSA
  4. 4.University of Texas Health Science Center at San AntonioSan AntonioUSA
  5. 5.Primary Children’s Medical CenterUniversity of UtahSalt Lake CityUSA
  6. 6.National Center for Prosecution of Child AbuseAlexandriaUSA

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