Physical and Sexual Child Abuse

There are many aspects of child abuse, among them the most common forms are physical and sexual abuse, emotional or physical neglect and Munchausen by proxy syndrome. However, all aspects of intentional or unintentional malnutrition and hunger in childhood on the one side, as well as excess of everything possible on the other should be included in the list of child abuse. In this chapter we refer primarily to the symptoms, clinical signs, diagnostic procedures in children suspicious for physical or sexual child abuse and for the Munchausen by proxy syndrome.

The real incidence of child abuse is diffi cult to estimate due to the rather high number of unreported cases, especially when sexual abuse occurs. UNICEF has estimated that maltreatment leads to 3,500 death/year, and more than 800 are infants aged 0–11 months—resulting in an annual mortality rate of 6.1/100,000. The total number of cases of maltreatment is estimated to be 150–2,000 times higher than the number of deaths. A study of the US Department Health and Human Services estimated 903,000 children as victims of child abuse. Fifty-seven percent were neglected, 19% were physically abused, 10% were sexually abused, 7% were psychologically maltreated, and 2% experienced medical neglect. Parents were the perpetrators in 77% of child fatalities. The study showed that in 2001 approximately 1,300 death were attributed to child neglect or abuse. Of these deaths, 41% occurred in children under 1 year of age, and 85% occurred in children under 6 years of age. Factors which are typically associated with maltreatment are low socioeconomic status, violence in the family, breakdown of families, child morbidity, parental mental ill-health, and parents who were abused during their own childhood.