Child Neglect: Developmental Consequences, Intervention, and Policy Implications

Childhood Neglect and Loneliness: The Unique Roles of Parental Figure and Child Sex

There is a well-supported link between experiences of childhood neglect and levels of loneliness in adulthood, with emotional neglect from caregivers being predictive of loneliness. However, current research has yet to explore additional, sex-linked factors that influence this relationship. This study investigates the impact of different neglect types on loneliness, with a focus on the parental figure involved and the child's sex. It was hypothesized that men who experienced emotional neglect from their fathers would score higher in loneliness compared to other parent-child combinations. The findings showed no significant differences in father-son relationships within the context of emotional neglect. However, there was a significant difference in father-son relationships in the context of supervision neglect and loneliness outcomes, relative to all other parent combinations. Consistent with existing research, emotional neglect emerged as the strongest predictor of loneliness. Additionally, sex differences were observed, with women experiencing greater levels of loneliness stemming from neglect compared to men. These findings help address the knowledge gap present in childhood neglect research, with the goal of understanding the long-term consequences of adverse childhood experiences.

Early Childhood Neglect Among 3- to 6-Year-Old Children in China: A Meta-Analysis

BACKGROUND

This review aims to estimate the prevalence of the neglect of 3- to 6-year-old children in China.

METHOD

We systematically searched both English- (Web of Science, PsychINFO, PubMed, and Cochrane Library) and Chinese-language databases (China National Knowledge Infrastructure, Wanfang, Weipu, and Biomedical Database). We extracted data related to the prevalence of early childhood neglect and its subtypes and pooled it using random effects models.

FINDINGS

We included 21 eligible studies, with a total of 35,175 3- to 6-year-old children, in the analyses. The pooled neglect prevalence was 32.1% at a 95% confidence interval (95% CI [27.0%, 37.2%]). The prevalence of physical, emotional, educational, security, and medical neglect was 15.2% (95% CI [11.9%, 18.5%]), 15.2% (95% CI [10.7%, 19.6%]), 10.4% (95% CI [7.4%, 13.4%]), 13.8% (95% CI [9.9%, 17.8%]), and 11.5% (95% CI [8.1%, 14.9%]), respectively. No gender or location differences were found to affect early childhood neglect or its subtypes.

INTERPRETATION

Our results revealed a high prevalence of early childhood neglect-including all its subtypes-among 3- to 6-year-old children in China. Improved child policies and prevention programs tailored to preschool children are needed to protect the well-being of younger children.

The Family Check-Up: Ecological Family-Based Assessments in the Context of Potential Child Abuse or Chaotic Home Environments

One percent of all children in the United States are estimated to be abused or neglected each year, equating to about 700,000 children per year. Limited parenting skills are one of the most robust risk factors for child abuse and neglect. The present paper describes the Family Check-Up (FCU), a trauma-informed, strengths-based and comprehensive family management intervention aimed at promoting positive parenting skills, reducing child maladaptive behaviors, and optimizing child and family outcomes. By evaluating various ecological and contextual factors, the FCU targets a range of parenting and child behavior difficulties to prevent child abuse/neglect, while improving long-term child and family outcomes.

Perceived social support and quality of life among adolescents in residential youth care: a cross-sectional study

BACKGROUND

Residential youth care (RYC) institutions aim to provide care and stability for vulnerable adolescents with several previous and present challenges, such as disrupted attachments, wide-ranging adverse childhood experiences, mental health problems, and poor quality of life (QoL). To the best of our knowledge, the present study is the first to provide knowledge of the associations between perceived social support and QoL and to explore the potential moderating effect of perceived social support on QoL for adolescents who have experienced maltreatment and polyvictimization.

METHODS

All RYC institutions with adolescents between the ages 12-23 in Norway were asked to participate in the study. A total of 86 institutions housing 601 adolescents accepted the invitation, from which 400 adolescents volunteered to participate. The Child and Adolescent Psychiatric Interview was used to gather information on maltreatment histories and degree of victimization; the Kinder Lebensqualität Fragebogen was used to measure QoL through several domains (overall QoL, physical well-being, emotional well-being, and self-esteem); and the Social Support Questionnaire was used to measure perceived social support. Linear regression and independent samples t-test were used to study the associations between perceived social support and QoL as well as the potential moderating effect of perceived social support in the association between maltreatment history and QoL.

RESULTS

Perceived social support was positively associated with QoL for both girls and boys, with domain-specific findings. A higher number of different types of support persons was associated with overall QoL, emotional well-being, and self-esteem for boys, but only with self-esteem for girls. Individual social support from RYC staff and friends was associated with higher QoL for girls. However, perceived social support did not moderate the association between maltreatment history and reduced QoL for either sex.

CONCLUSIONS

This study emphasizes the importance of maintaining social support networks for adolescents living in RYC, the crucial contribution of RYC staff in facilitating social support, and the potential value of social skills training for these vulnerable adolescents. Furthermore, a wider range of initiatives beyond social support must be carried out to increase QoL among adolescents with major maltreatment and polyvictimization experiences.

How effective is the early support program Babylotse-Plus for psychosocially burdened mothers and their infants? A comparative intervention study

Objectives

Our aim was to examine the effects of an early perinatal prevention program offered to mothers and families suffering from significant psychosocial burden.

Methods

All mothers giving birth in a Berlin university hospital during Jan-Aug 2013 were screened with a standardized 27-item questionnaire by trained staff. Mothers with a screening-score ≥ 3, who were not enrolled in other public support programs, were defined as psychosocially burdened. They received a detailed needs assessment and were followed up with counseling. When necessary, affected mothers were voluntarily guided through to specialized ‘early support’ institutions during the 12-month-intervention period. The historical control group (care-as-usual) consisted of children born at the same hospital the year before.

At 12 months postnatally, we interviewed mothers in both groups to assess their stress burden and coping skills by Parenting Stress Index and assessed the current childcare condition. Differences between the groups were compared by multivariable logistic regression analyses adjusting for potential confounders.

Results

The intervention group and the control group included 225 and 157 families, respectively. After 12-months, mothers in the ‘early support’ intervention group had significantly less often depression (adjusted odds ratio 0.25, 95%-confidence interval 0.07–0.94), less often a disturbed relationship with the parenting partner (0.34, 0.10–1.14) and reported reduced stress due to the child’s demands (0.40, 0.15–1.10) compared to the control group. Childcare indicators did not differ between the 2 groups.

Conclusions

In mothers at high psychosocial risk, the ‘early support’ intervention program Babylotse-Plus seemed to reduce the occurrence of depression and several stress indicators in the first postnatal year.

Examination of Child Placement, Emotional, Behavioral and Attachment Problems Among Children with Caregiver-Perpetrated Trauma Histories

Caregiver-perpetrated trauma (CPT) is associated with adverse consequences for youth, including out-of-home placement. Although promotion of kinship care placement has recently increased, effects on youth remain unclear. Psychosocial functioning of 1107 CPT-exposed youth ages 2 to 18 was compared across placement types using generalized mixed models. Youth remaining at home had increased Somatization symptoms compared to kinship (OR = .25, CI = 0.07-.88) and foster care (OR = .32, CI = 0.11-.98) youth. Both out-of-home placement types had higher odds of Attachment Problems (OR = 3.61, CI = 2.22-5.87 and 4.41, CI = 2.71-7.18 respectively). PTSD symptoms varied, youth in kinship care had increased self-reported re-experiencing symptoms (OR = 2.66, CI = 1.04-6.8), while youth in foster care had elevated clinician-rated PTSD (OR = 2.07, CI = 1.1.3-3.80). Given the limited differences between kinship and foster care, studies should continue to delineate the impact of child placement type to inform child welfare policy.

The Combination of Sibling Victimization and Parental Child Maltreatment on Mental Health Problems and Delinquency

This study examined how the combination of sibling victimization and parental child maltreatment is related to mental health problems and delinquency in childhood and adolescence. Co-occurrence, additive associations, and interactive associations of sibling victimization and parental child maltreatment were investigated using a sample of 2,053 children aged 5-17 years from the National Survey of Children's Exposure to Violence. The results provide primarily evidence for additive associations and only suggest some co-occurrence and interactive associations of sibling victimization and child maltreatment. Evidence for co-occurrence was weak and, when controlling for the other type of maltreatment, only found for neglect. Sibling victimization was related to more mental health problems and delinquency over and above the effect of child abuse and neglect. Moderation by sibling victimization depended on child age and was only found for the relation between both types of child maltreatment by parents and delinquency. For mental health, no interactive associations were found. These results highlight the unique and combined associations between sibling victimization on child development.

Childhood abuse and neglect and physical health at midlife: Prospective, longitudinal evidence

Previous research suggests that the experience of abuse and neglect in childhood has negative implications for physical health in adulthood. Using data from the Minnesota Longitudinal Study of Risk and Adaptation (N = 115), the present research examined the predictive significance of childhood physical abuse, sexual abuse, and physical/cognitive neglect for multilevel assessments of physical health at midlife (age 37-39 years), including biomarkers of cardiometabolic risk, self-reports of quality of health, and a number of health problems. Analyses revealed that childhood physical/cognitive neglect, but not physical or sexual abuse, predicted all three health outcomes in middle adulthood, even when controlling for demographic risk factors and adult health maintenance behaviors. We discuss possible explanations for the unique significance of neglect in this study and suggest future research that could clarify previous findings regarding the differential impact of different types of abuse and neglect on adult health.

The impact of child maltreatment on the risk of deliberate self-harm among adolescents: A population-wide cohort study using linked administrative records

Adolescents exposed to maltreatment have an elevated risk of deliberate self-harm (DSH). The aim of this study was to investigate longitudinally the effects of the number, timing, and type of maltreatment allegations on adolescent risk of having a DSH-related hospital admission, using linked data in Western Australia. A total of 351,372 children born between 1986 and 2000 were followed from birth up to the year 2010. Cox regression models were utilized, while controlling for a range of psychosocial covariates. Compared to children without allegations of maltreatment, children with unsubstantiated allegations only (aHR=1.04, 95%CI: 1.00-1.08, p<.01) and children with a substantiated allegation (aHR=1.10, 95%CI: 1.06-1.15, p<.001) all had significantly increased risk of DSH in adolescence. Among children with a substantiated allegation of maltreatment, the greater the number of allegations, the longer the exposure to maltreatment, and the more types of maltreatment experienced by a child, the higher the child's risk of DSH. However, this dose-response pattern was not found among children with unsubstantiated allegations only. This study calls for the early identification of children who are vulnerable to maltreatment, the better identification of the duration and severity of maltreatment experiences, and the provision of continued care and support, to reduce the child's DSH risk in adolescence.

Childhood Neglect, Internalizing Symptoms and Adolescent Substance Use: Does the Neighborhood Context Matter?

Childhood neglect is associated with risk behaviors in adolescence, including substance use. There is evidence that internalizing behaviors may serve as a mechanism linking childhood neglect and substance use; however, further research is needed to examine this developmental pathway. According to developmental and ecological approaches, the neighborhood context and the developmental timing of maltreatment should both be considered when examining the sequelae of childhood neglect. Hence, the present study uses a longitudinal sample of youth (N = 965, 49.1% female, 59.2% African-American) to examine the influence of timing in the relationship between childhood neglect and adolescent psychopathology, and to examine the indirect effects of child neglect on substance use via internalizing symptoms in adolescence. Furthermore, the role of neighborhood disorder in this indirect effect was tested. Five data collection time points were used: Time 1(M _age  = 4.557, SD _age  = .701), Time 2 (M _age  = 6.422, SD _age  = .518), Time 3 (M _age  = 12.370, SD _age  = .443), Time 4 (M _age  = 14.359, SD _age  = .452), and Time 5 (M _age  = 16.316, SD _age  = .615). The findings showed that internalizing problems mediated the link between the severity of neglect in early childhood and adolescent substance use, and this pathway was moderated by neighborhood disorder. These results have implications for preventative interventions aimed toward reducing substance use for at-risk adolescents.

The neurobiological impact of postpartum maternal depression: prevention and intervention approaches

The lasting negative impact of postpartum depression (PPD) on offspring is well established. PPD seems to have an impact on neurobiological pathways linked to socioemotional regulation, cognitive and executive function, and physiologic stress response systems. This review focus on examining the current state of research defining the effect of universal, selected, and indicated interventions for PPD on infant neurodevelopment. Given the established lasting, and potentially intergenerational, negative implications of maternal depression, enhanced efforts targeting increased identification and early intervention approaches for PPD that have an impact on health outcomes in both infants and mothers represent a critical public health concern.

The role of collaborations in sustaining an evidence-based intervention to reduce child neglect

Child neglect is the most prevalent form of child maltreatment and represents 79.5% of open child-welfare cases. A recent study found the evidence-based intervention (EBI) SafeCare(®) (SC) to significantly reduce child neglect recidivism rates. To fully capitalize on the effectiveness of such EBIs, service systems must engage in successful implementation and sustainment; however, little is known regarding what factors influence EBI sustainment. Collaborations among stakeholders are suggested as a means for facilitating EBI implementation and sustainment. This study combines descriptive quantitative survey data with qualitative interview and focus group findings to examine the role of collaboration within the context of public-private partnerships in 11 child welfare systems implementing SC. Participants included administrators of government child welfare systems and community-based organizations, as well as supervisors, coaches, and home visitors of the SC program. Sites were classified as fully-, partially-, and non-sustaining based on implementation fidelity. One-way analysis of variance was used to examine differences in stakeholder reported Effective Collaboration scores across fully-sustaining, partially-sustaining, and non-sustaining sites. Qualitative transcripts were analyzed via open and focused coding to identify the commonality, diversity, and complexity of collaborations involved in implementing and sustaining SC. Fully-sustaining sites reported significantly greater levels of effective collaboration than non-sustaining sites. Key themes described by SC stakeholders included shared vision, building on existing relationships, academic support, problem solving and resource sharing, and maintaining collaborations over time. Both quantitative and qualitative results converge in highlighting the importance of effective collaboration in EBI sustainment in child welfare service systems.

Early-adult correlates of maltreatment in girls with attention-deficit/hyperactivity disorder: Increased risk for internalizing symptoms and suicidality

We examined whether maltreatment experienced in childhood and/or adolescence prospectively predicts young adult functioning in a diverse and well-characterized sample of females with childhood-diagnosed attention-deficit/hyperactivity disorder (N = 140). Participants were part of a longitudinal study and carefully evaluated in childhood, adolescence, and young adulthood (M age = 9.6, 14.3, and 19.7 years, respectively), with high retention rates across time. A thorough review of multisource data reliably established maltreatment status for each participant (M κ = 0.78). Thirty-two (22.9%) participants experienced at least one maltreatment type (physical abuse, sexual abuse, or neglect). Criterion variables included a broad array of young adult measures of functioning gleaned from multiple-source, multiple-informant instruments. With stringent statistical control of demographic, prenatal, and family status characteristics as well as baseline levels of the criterion variable in question, maltreated participants were significantly more impaired than nonmaltreated participants with respect to self-harm (suicide attempts), internalizing symptomatology (anxiety and depression), eating disorder symptomatology, and well-being (lower overall self-worth). Effect sizes were medium. Comprising the first longitudinal evidence linking maltreatment with key young adult life impairments among a carefully diagnosed and followed sample of females with attention-deficit/hyperactivity disorder, these findings underscore the clinical importance of trauma experiences within this population.

From a "perfect storm" to "smooth sailing": policymaker perspectives on implementation and sustainment of an evidence-based practice in two states

Policymakers shape implementation and sustainment of evidence-based practices (EBPs), whether they are developing or responding to legislation and policies or negotiating public sector resource constraints. As part of a large mixed-method study, we conducted qualitative interviews with 24 policymakers involved in delivery of the same EBP in two U.S. states. We analyzed transcripts via open and focused coding techniques to identify the commonality, diversity, and complexity of implementation challenges; approaches to overcoming those challenges; and the importance of system-level contextual factors in ensuring successful implementation. Key findings centered on building support and leadership for EBPs; funding and contractual strategies; partnering with stakeholders; tackling challenges via proactive planning and problem solving; and the political, legal, and systemic pressures affecting EBP longevity. The policymaker perspectives offer guidance on nurturing system and organizational practice environments to achieve positive outcomes and for optimally addressing macro-level influences that bear upon the instantiation of EBPs in public sector child welfare systems.

Justification of Violence Beliefs and Social Problem-Solving as Mediators between Maltreatment and Behavior Problems in Adolescents

This study examined whether justification of violence beliefs and social problem solving mediated between maltreatment experiences and aggressive and delinquent behavior in adolescents. Data were collected on 191 maltreated and 546 nonmaltreated adolescents (ages 14 to 17 years), who completed measures of justification of violence beliefs, social problem-solving dimensions (problem orientation, and impulsivity/carelessness style), and psychological problems. Findings indicated that maltreated adolescents' higher levels of delinquent and aggressive behavior were partially accounted for by justification of violence beliefs, and that their higher levels of depressive symptoms were partially mediated by a more negative orientation to social problem-solving. Comparisons between boys and girls indicated that the model linking maltreatment, cognitive variables, and psychological problems was invariant.

An ecological analysis of infant neglect by adolescent mothers

To inform efforts to prevent child neglect, we investigated a wide range of risk factors that have been largely unexamined in relation to infant neglect, the most commonly occurring form of child maltreatment. Using an ecological model of child neglect, we assessed the influence of characteristics at the level of the child, the mother, the family, and broader childrearing contexts on adolescent mothers' likelihood of being a perpetrator in a substantiated case of neglect against their firstborn infants (n=383, M=12 months). Several factors were associated with infant neglect by young mothers: median block income, low infant birth weight, maternal smoking, maternal childhood history of neglect and of positive care, intimate partner violence (IPV) perpetrated by either the mother or her partner, and maternal use of mental health services. In multivariate models, income, a maternal childhood history of positive care, IPV by either a mother or her partner, and mental health service usage made significant contributions to the odds that a mother neglected her infant. Our findings suggest that these factors have particular salience to policymakers' and practitioners' efforts to identify high risk families and to intervene during the earliest months of life to prevent child neglect.

Social work and adverse childhood experiences research: implications for practice and health policy

Medical research on "adverse childhood experiences" (ACEs) reveals a compelling relationship between the extent of childhood adversity, adult health risk behaviors, and principal causes of death in the United States. This article provides a selective review of the ACE Study and related social science research to describe how effective social work practice that prevents ACEs and mobilizes resilience and recovery from childhood adversity could support the achievement of national health policy goals. This article applies a biopsychosocial perspective, with an emphasis on mind-body coping processes to demonstrate that social work responses to adverse childhood experiences may contribute to improvement in overall health. Consistent with this framework, the article sets forth prevention and intervention response strategies with individuals, families, communities, and the larger society. Economic research on human capital development is reviewed that suggests significant cost savings may result from effective implementation of these strategies.

Pathways of disadvantage: Explaining the relationship between maternal depression and children's problem behaviors

A large body of literature documents that children of depressed mothers have impaired cognitive, behavioral, and health outcomes throughout the life course, though much less is known about the mechanisms linking maternal depression to children's outcomes. In this paper, I use data from the Fragile Families and Child Wellbeing Study to estimate and explain the consequences of maternal depression for 5-year-old children's internalizing and externalizing problem behaviors. Ordinary least squared (OLS) regression models and propensity score models show that children exposed to both chronic and intermittent maternal depression have more problem behaviors than their counterparts with never depressed mothers. Results also show that economic resources and maternal parenting behaviors mediate much of the association between maternal depression and children's problem behaviors, but that relationships with romantic partners and social support do little to explain this association. This research extends past literature by illuminating some mechanisms through which maternal depression matters for children; by utilizing longitudinal measures of depression; by employing rigorous statistical techniques to lend confidence to the findings; and by using a large, diverse, and non-clinical sample of children most susceptible to maternal depression. Given that early childhood problem behaviors lay a crucial foundation for short- and long-term life trajectories, the social consequences of maternal depression may be far-reaching.

Supervisory neglect and risk of harm. Evidence from the Canadian Child Welfare System

OBJECTIVE

This study explores prevalence and characteristics associated with supervisory neglect and physical harm in children in the child welfare system in Canada.

METHODS

The sample included all substantiated primary maltreatment investigations in the 2008 Canadian Incidence Study of Reported Child Abuse and Neglect excluding cases where exposure to intimate partner violence was the sole reason for investigation (n=3,380). Bivariate tests were used to assess differences across types of maltreatments and to compare supervisory neglect cases with and without physical harm on factors related to child injury and supervision.

RESULTS

Supervisory neglect was the primary concern in an estimated 12,793 cases of substantiated maltreatment across Canada in 2008. Compared to other types of maltreatment, cases of supervisory neglect involved more overcrowded housing conditions and children who were younger and less likely to have any functioning issue. Injuries were noted in only 2% of cases supervisory neglect and half of these injuries were not severe enough to require medical treatment. Other physical health conditions were noted in 2% of supervisory neglect cases. Physical harm was noted most often for toddlers (1-2 years old) and adolescents (12-15 years old). Household and caregiver characteristics were not associated with greater rates of physical harm. In contrast, 7% of children with any risk factor suffered physical harm as a result of supervisory neglect mainly related to substance abuse, self-harming behavior, and multiple incidents of running from care.

CONCLUSIONS

Child risk factors are often present in cases of supervisory neglect with physical harm. Nonetheless, 96% of all cases of supervisory neglect substantiated by Canadian child welfare authorities do not involve physical harm. Clearer guidelines are needed for the assessment of supervisory neglect. Alternative response systems may be more suitable for low-risk cases.

Maltreatment prevention through early childhood intervention: A confirmatory evaluation of the Chicago Child-Parent Center preschool program

Increased recognition of the consequences associated with child maltreatment has led to greater emphasis on its prevention. Promising maltreatment prevention strategies have been identified, but research continues to suffer from methodological limitations and a narrow focus on select prevention models. This investigation uses data from the Chicago Longitudinal Study to examine mediating mechanisms that link the Chicago Child-Parent Center preschool program to a reduction in overall child maltreatment and, more specifically, child neglect. We use structural equation modeling to test child, family, and school measures hypothesized to mediate the effects of CPC participation on maltreatment and neglect. Results indicate that a substantial proportion of the program's impacts can be accounted for by family support processes, including increased parent involvement in school and maternal educational attainment as well as decreased family problems. The CPC program's association with reduced school mobility and increased attendance in higher-quality schools also significantly mediated its effects on maltreatment and neglect. Further, a decrease in troublemaking behavior contributed modestly to mediating the program's association with maltreatment but not neglect. We discuss the implications of these results for the field of maltreatment prevention.

Prevalence of maltreatment among youths in public sectors of care

Few studies have investigated the prevalence of maltreatment among youths in public sectors of care despite the critical public health concern and the burden of suffering on such youths. The current study examined the prevalence of multiple types of maltreatment across five public sectors of care. Youths aged 11-18 (n = 1,135) enrolled in one of five public sectors of care reported on their maltreatment history using the Childhood Trauma Questionnaire. Across all sectors, 78% of youth reported experiencing at least moderate levels of maltreatment with the majority (58%) reporting multiple types of maltreatment. The prevalence of maltreatment was highest for youths involved in the alcohol/drug (86%) and child welfare (85%) sectors, and lowest in the serious emotional disturbance sector (72%). Logistic regressions were conducted to examine differences in the likelihood of multiple types of maltreatment by sector affiliation, controlling for the effects of gender, race/ethnicity, and age. The results indicate that rates of maltreatment across sectors do not differ greatly from those in child welfare. The high incidence of maltreatment across all sectors, not solely child welfare, indicates that all youth in public sectors of care should be screened for a history of maltreatment when they enter into care.

Distinguishing neglect from abuse and accident: analysis of the case files of a hospital child protection team in Israel

The study compares the characteristics of children assessed as neglected, physically abused, or accident victims by a hospital child protection team (CPT) and identifies the information on which the CPT based its assessments. The comparison is based on content analysis of records of 414 children examined by the CPT in a major hospital in Israel between 1991 and 2006, of whom 130 (31.4%) were neglected, 54 (13.0%) were physically abused, and 230 (55.6%) were accident victims. Findings of three hierarchical logistic regressions show that the children classified as neglected had the most early development problems, but were the least likely to have received psychological treatment, and that that their families were the most likely to be receiving state financial support and to have had prior contact with the social services. They also show that the CPT had received the least information indicative of maltreatment about these children from the community and that their medical and physical examinations aroused the least suspicion. Finally, they show that the impressions the hospital staff and CPT had of the parents during the hospital visit had greater power to distinguish between the groups than the children's characteristics or the parents' socio-demographic background. The findings attest to the ability of the CPT to differentiate between neglect victims and physical abuse or accident victims. With this, they also point to ambiguities in the classification process that should be addressed by further research and training and to the need for detailed and thorough documentation of the information and observations on which the CPT's assessments are based.

Update on child maltreatment

PURPOSE OF REVIEW

Recent literature regarding assessment, management and prevention of child maltreatment will be considered. Unexplained infant and child death will also be reviewed.

RECENT FINDINGS

Controversies in the evaluation of unexpected infant death and inflicted traumatic brain injury are ongoing. Evidence continues to accumulate describing the serious long-term sequelae of child maltreatment. Studies have examined the earliest beginnings of these adverse outcomes commencing in childhood. Despite sustained efforts to develop a variety of training and intervention programs, the deployment of these efforts has been hampered by the lack of evidence that they make any difference in improving recognition of child abuse or in preventing recurrent maltreatment. There is a great need in the child abuse field for more formal, rigorous assessment of all manner of intervention programs.

SUMMARY

Efforts to improve the recognition of and management of child abuse need to be sustained. As our understanding of child maltreatment continues to grow, evidence-based interventions will likely improve outcomes for abused children and their families. General pediatricians are often the first to notice signs and symptoms of possible child maltreatment; collaboration with hospital-based Child Protection Teams is critical when considering the possibility of abuse or neglect.

Measuring the risk of physical neglect in a population-based sample

Child neglect accounts for the majority of officially substantiated cases of child maltreatment in this country, although population-based data are lacking. This study estimates the number of children at risk for specific subtypes of physical neglect, using results of an anonymous telephone survey administered to 1,435 mothers of children ages 0 to 17 years in North and South Carolina. Children were considered "at risk for neglect" from lack of enough food, lack of access to medical care when needed, and inadequate supervision. Demographic factors were significantly related to the outcomes of interest, including lower family income with lack of enough food and access to medical care. There was little overlap in children at risk for the different subtypes of neglect. Maternal self-report data can be used to improve researchers' understanding of children at risk for neglect and to explore gaps in knowledge that might be amenable to intervention and prevention efforts.