Child Maltreatment: The Role of a Dental Professional

Course Number: 599

Defining the Problem: Child Maltreatment

The incidence of child maltreatment in America has increased between 2013 and 2017 according to statistics kept by the United States Department of Health & Human Services, Administration for Children and Families, published in January of 2019 (hereinafter DHHS Study).1 In 2017, 3.5 million children were the subjects of a child maltreatment investigation or other response by social service agencies. The number of children who received a child protection response increased by approximately 10% from 2013 to 2017.

For the purposes of the DHHS Study, evaluators collected data on neglect, physical abuse, and sexual abuse from investigations in all 50 states, the District of Columbia, and Puerto Rico. As a result, an estimated 674,000 children were substantiated victims of neglect, physical abuse, or sexual abuse in 2017. Of these victims, approximately 75% were neglected, 18% were physically abused, and 9% were sexually abused with some overlap occurring.1

In addition, approximately 7% of these victims experienced other types of maltreatment such as threatened abuse or neglect, caregiver drug/alcohol addiction, or lack of supervision. The victimization rate for boys (48.6%) was approximately the same as for girls (51%). Of the total number of substantiated maltreatment victims, approximately 1,720 children died; this represents an 11% increase in fatalities since 2013. Of the children who died, 75.4% suffered neglect and 41.6% suffered physical abuse alone or in combination with other maltreatment.

Child maltreatment occurs in all ethnic, cultural, and socioeconomic segments of American society. The DHHS Study identifies four caregiver risk factors for the perpetration of child maltreatment: Alcohol abuse, drug abuse, financial insecurity, and domestic violence involving other members of the household.1 While the DHHS Study identified these four risk factors, it’s important to note that often times the caregiver abuse occurs as a result of being overwhelmed by the stresses of everyday life. A victim may be maltreated multiple times by the same perpetrator or by several different perpetrators. Approximately 92% of victims are maltreated by primary caregivers, acting alone or together.

This course utilizes a broader definition of maltreatment than the DHHS Study. Child maltreatment as set out in the Child Abuse Prevention and Treatment Act of 1974 includes the following: “Any recent act or failure to act on the part of a parent or caretaker which results in death, serious physical or emotional harm, sexual abuse or exploitation; or an act or failure to act, which presents an imminent risk of serious harm.”2 Because states have different statutory definitions for physical abuse, sexual abuse, emotional or psychological abuse, and neglect, it is important for practitioners to know their states’ specific statutes.

Photo showing a child abuse victim with facial, head and neck, and shoulder injuries.

Figure 2A.

Child abuse homicide victim with facial, head and neck, and shoulder injuries.

Macro image of the possible bitemark pattern on the shoulder of the child abuse victim.

Figure 2B.

Macro image of the possible bitemark pattern on the shoulder of the child abuse victim in Figure 2A.

All states, the District of Columbia, and the territories have laws that mandate reporting of various types of maltreatment.3 Reporting was limited to physical abuse in the early 1970s, but in the early 1980s, reporting was expanded to include sexual abuse.4 When psychological or emotional maltreatment was recognized as a residual effect of neglect and also as a separate form of abuse, the reporting of neglect and psychological/emotional abuse was added to mandatory reporting statutes.5