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.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Allasio, D., & Fischer, H. (1998). Torture versus child abuse: what’s the difference? Clinical Pediatrics, 37(4), 269–271. doi:10.1177/000992289803700410.
Allodi, F., & Cowgill, G. (1982). Ethical and psychiatric aspects of torture: a Canadian study. Canadian Journal of Psychiatry, 27(2), 98–102.
Amnesty International. (1975). Report on torture. New York: Farrar, Straus and Giroux.
Anda, R. F., Feletti, V. J., Bremner, J. D., Walker, J. D., Whitfield, C., Perry, B. D., . . . Giles, W. H. (2006). The enduring effects of abuse and related adverse experiences in childhood—a convergence of evidence from neurobiology and epidemiology. European Archives of Psychiatry and Clinical Neuroscience, 256, 174–186. doi:10.1007/s00406-005-0624-4.
Burgers, J. H., & Danelius, H. (1988). The United Nations Convention Against Torture: A handbook on the convention against torture and other cruel, inhuman or degrading treatment or punishment. Dordrecht: Martinus Nijhoff.
Campbell, T. A. (2007). Psychological assessment, diagnosis, and treatment of torture survivors: a review. Clinical Psychology Review, 27, 628–641. doi:10.1016/j.cpr.2007.02.003.
Cantwell, H. B. (1980). Child neglect. In R. E. Helfer & H. C. Henry Kempe (Eds.), The battered child (3rd ed., pp. 183–197). Chicago: University of Chicago Press.
Christian, C. W., Block, R., & Committee on Child Abuse and Neglect, American Academy of Pediatrics. (2009). Abusive head trauma in infants and children. Pediatrics, 123(5), 1409–1411. doi:10.1542/peds.2009-0408.
Cohn, J., Holzer, K. M. H., & Kock, L. (1981). Torture of children: an investigation of Chilean immigrant children in Denmark. Child Abuse & Neglect, 5(2), 201–203. doi:10.1016/0145-2134(81)90042.
den Otter, J. J., Smit, Y., dela Cruz, L. B., Ozkalipci, O., & Oral, R. (2013). Documentation of torture and cruel, inhuman or degrading treatment of children: a review of existing guidelines and tools. Forensic Science International, 224(1–3), 27–32. doi:10.1016/j.forsciint.2012.11.003.
Finkelhor, D., Turner, H., Ormrod, R., & Hamby, S. L. (2009). Violence, abuse, and crime exposure in a national sample of children and youth. Pediatrics, 124(5), 1411–1423. doi:10.1001/jamapediatrics.2013.42.
Finkelhor, D., Shattuck, A., Turner, H. A., Ormrod, R., & Hamby, S. L. (2011). Polyvictimization in developmental context. Journal of Child & Adolescent Trauma, 4(4), 291–300. doi:10.1080/19361521.2011.610432.
Goldfeld, A. E., Mollica, R. F., Pesavento, B. H., & Faraone, S. V. (1988). The physical and psychological sequelae of torture. Symptomatology and diagnosis. JAMA, 259(18), 2725–2729. doi:10.1001/jama.1988.03720180051032.
Green, C. (2007). Politically-motivated torture and child survivors. Pediatric Nursing, 33(3), 267–270.
Hart, S. N., Brassard, M. R., Davidson, H. A., Rivelis, E., Diaz, V., & Binggeli, N. J. (2011). Psychological maltreatment. In J. E. B. Myers (Ed.), The APSAC handbook on child maltreatment (pp. 79–102). Thousand Oaks: Sage.
Herman, J. L. (1992). Complex PTSD: a syndrome in survivors of prolonged and repeated trauma. Journal of Traumatic Stress, 5(3), 377–391. doi:10.1007/BF00977235.
Hibbard, R., Barlow, J., Macmillan, H., Child, A., & Committee on Child Abuse and Neglect American Academy of Pediatrics. (2012). Psychological maltreatment. Pediatrics, 130(2), 372–378. doi:10.1542/peds.2012-1552.
Hollingsworth, J., Glass, J., & Heisler, K. W. (2007). Empathy deficits in siblings of severely scapegoated children: a conceptual model. Journal of Emotional Abuse, 7(4), 69–88.
Kellogg, N. D., & Lukefahr, J. L. (2005). Criminally prosecuted cases of child starvation. Pediatrics, 116(6), 1309–1316. doi:10.1542/peds.2004-2616.
Kempe, C. H. (1978). Sexual abuse, another hidden pediatric problem: the 1977C. Anderson Aldrich lecture. Pediatrics, 62(3), 382–389. Retrieved from http://pediatrics.aappublications.org/content/62/3/382.
Kempe, C. H., Silverman, F. N., Steele, B. F., Droegemueller, W., & Silver, H. K. (1962). The battered-child syndrome. JAMA, 181, 17–24. doi:10.1001/jama.1962.03050270019004.
King, J., Diefendorf, D., Apthorp, J., Negrete, V. F., & Carlson, M. (1988). Analysis of 429 fractures in 189 battered children. Journal of Pediatric Orthopedics, 8(5), 585–589.
Knox, B. L., & Starling, S. (November 27, 2012). Child torture: Case reviews and analysis of institutional responses. Paper presented at the National District Attorneys Association National Center for the Prosecution of Child Abuse Investigation and Prosecution of Child Fatalities and Physical Abuse Conference, Honolulu, Hawaii.
Roesler, T., & Jenny, C. (2009). Medical child abuse: Beyond Munchausen syndrome by proxy. Elk Grove Village: American Academy of Pediatrics. doi:10.1016/B978-1-4160-6393-3.00061-0.
Rosenberg, D. A. (1987). Web of deceit: a literature review of Munchausen syndrome by proxy. Child Abuse & Neglect, 11(4), 547–563. doi:10.1016/0145-2134(87)90081-0.
Schmitt, B. D. (1987). Seven deadly sins of childhood: advising parents about difficult developmental phases. Child Abuse & Neglect, 11(3), 421–432. doi:10.1011/0145-2134(87)90015-9.
Steele, B. (1987). Psychodynamic factors in child abuse. In R. Helfer, C. H. Kempe, & R. S. Krugman (Eds.), The battered child (4th ed., pp. 81–114). Chicago: University of Chicago Press.
Stirling, J., Jr., & American Academy of Pediatrics Committee on Child Abuse & Neglect. (2007). Beyond Munchausen syndrome by proxy: identification and treatment of child abuse in a medical setting. Pediatrics, 119(5), 1026–1030. doi:10.1542/peds.2007-0563.
Stover, E., & Nightingale, E. (1985). Introduction: The breaking of bodies and minds. In E. Stover & E. Nightingale (Eds.), Breaking of bodies and minds: Torture, psychiatric abuse, and the health professions (pp. 1–26). New York: Freeman.
Tiapula, S., & Applebaum, A. (2011). Criminal justice and child protection responses to cases of severe child abuse: existing statutory frameworks for torture. National Center for the Prosecuton of Child Abuse Update, 23(1), 1–8.
Tournel, G., Desurmont, M., Becart, A., Hedouin, V., & Gosset, D. (2006). Child barbarity and torture: a case report. The American Journal of Forensic Medicine and Pathology, 27(3), 263–265. doi:10.1097/01.paf.0000233532.18076.14.
Welsh, J. (2000). Children and torture. Lancet, 356(9247), 2093. doi:10.1016/S0140-6736(00)03414-0.
World Medical Association (1975, revised 2006). Declaration of Tokyo-guidelines for physicians concerning torture and other cruel, inhuman or degrading treatment or punishment in relation to detention and imprisonment. Retrieved from World Medical Association website: http://www.wma.net/en/30publications/10policies/c18/index.html.
About this article
Cite this article
Knox, B.L., Starling, S.P., Feldman, K.W. et al. Child Torture as a Form of Child Abuse. Journ Child Adol Trauma 7, 37–49 (2014). https://doi.org/10.1007/s40653-014-0009-9
- Non-accidental trauma
- Physical abuse
- Psychological maltreatment