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I'm Rob Logan, Ph.D. senior staff National Library of Medicine substituting this week for Donald Lindberg, M.D, the Director of the U.S. National of Medicine.

Here is what's new this week in MedlinePlus.

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A recent series in The Lancet provides illuminating and sobering insights about the frequency of child maltreatment in the U.S. and some other high income nations.

In a comprehensive overview of the evidence about child maltreatment, six authors from the U.S., U.K., Sweden, and New Zealand note between four to 16 percent of children in some high income nations are physically abused and one in ten is neglected, or psychologically abused.  

The authors define childhood maltreatment as: (and we quote) 'any acts of commission or omission by a parent or other caregiver that result in harm, potential for harm, or threat of harm to a child…even if harm is not the intended result' (end of quote). The authors explain the following four types of maltreatment are assessed: physical abuse, sexual abuse, psychological abuse (which is sometimes called emotional abuse), and neglect. A 'child' is defined as anyone under 18 years old.

The authors' definition of childhood maltreatment is similar to MedlinePlus.gov's definition of 'child abuse,' which is provided on MedlinePlus.gov's child abuse health topic page. We will say more about MedlinePlus' child abuse health topic page later.

Here are a few of the sobering statistics that the authors report.

Allegations of childhood maltreatment were investigated by governmental agencies for an estimated five percent of all children in the U.S. in 2006. In the U.K., an estimated 1.5 percent of all children were referred to social services for alleged abuse. Incidentally, governmental social welfare investigations (including allegations of abuse) occurred for about one of every 20 children in Britain in 2007.

In Canada, allegations of childhood maltreatment were investigated for an estimated 2.1 percent of all Canadian children in 2003. In Australia, allegations for childhood maltreatment were referred to government agencies for more than three percent of all Australian children in 2002-03.

These numbers all reflect the frequencies reported by various governmental branches that supervise children's health and welfare, which the authors note are low estimates since most incidents are not investigated. On the other hand, the authors explain the frequency of maltreatment findings are more consistent with occurrences when estimates are based on child or parent self-reports.

For example, self-reported studies from the U.K., U.S., New Zealand, Finland, Italy, and Portugal suggest that from about four to 16 percent of children experience severe parental violence, which places a child at risk of harm. Some of the self-reported violence used in these studies include: kicking, biting, plus threatening or using a knife, or weapon, on a child. Interestingly, the authors note that slapping and hitting are not counted as severe parental violence in the studies from the six aforementioned nations.

To provide a comparison between high income and less developed nations, the authors note the annual frequency of self-reported physical abuse ranges between 12 to about 30 percent of all children in: Macedonia, Moldova, Latvia, and Lithuania. The   prevalence of child or parental reported physical abuse of children in Siberia, Russia, and Romania is between 24-29 percent.

In the U.S. one in ten children is the recipient of child or parental self- reported psychological abuse (which is defined as unwanted verbal abuse).  From four to nine percent of Swedish, American, and British children are the recipients of more severe emotional abuse -- again self-reported by children or parents. In contrast, the prevalence of severe or moderate self-reported psychological abuse in Macedonia, Moldova, Latvia, and Lithuania, is between 12 to 33 percent of all children.

While the study's six authors note there are reliability and validity problems in compiling, comparing, and contrasting national and international child maltreatment statistics, aggregate studies suggest that child maltreatment remains under-reported by government agencies.

Overall, the study's authors note about 80 percent of child maltreatment is perpetrated by parents or parental guardians. However, the authors add sexual abuse is mostly perpetrated by acquaintances or other relatives -- rather than parents, or guardians.

The authors also note other studies from several nations report significant associations between childhood maltreatment and a likelihood of future mental health problems, which include:

• Behavioral problems as a child or adult
• Post traumatic stress disorder
• Depression
• Attempted suicide
• And alcohol-related difficulties.

The authors note other research demonstrates a very strong association between child maltreatment and the likelihood of future criminal behavior. For instance, child maltreatment doubles a girl's risk of being arrested for a violent crime.

The associations between child maltreatment and poor physical health are less clear. Similarly, there is mixed international evidence about child maltreatment and the likelihood of teenage pregnancy, plus child mistreatment and development of chronic pain in adult years, obesity, use of health care services, and perceived quality of life.

The Lancet, which is a refereed medical journal published in the U.K., addresses a range of issues in other articles, including research about interventions to prevent child treatment.

The authors of the child maltreatment overview article conclude child maltreatment is a serious and often underappreciated global health issue. By any reckoning, The Lancet's series illuminates child maltreatment's frequency, reports the latest international findings, and suggests some care strategies.
   
To read and understand more about child maltreatment, we suggest MedlinePlus.gov's child abuse health topic page. Among MedlinePlus.gov's child abuse health topic page's useful resources is a link to a website provided by the Children's Bureau, which provides tips to recognize some signs of child abuse and neglect. The site is called 'Recognizing child abuse and neglect: Signs and symptoms.' It is in the 'start here' section of MedlinePlus.gov's child abuse health topic page.

MedlinePlus.gov's child abuse health topic page includes information about child abuse prevention/screening, and coping information for affected family members.

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