[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Conditions](https://durgical.com/en/conditions/) › Child maltreatment (physical abuse, abusive head trauma, neglect)

[Conditions](https://durgical.com/en/conditions/) · [Pediatrics and neonatology](https://durgical.com/en/conditions/)

# Child maltreatment (physical abuse, abusive head trauma, neglect)

Child maltreatment is abuse or neglect of anyone under 18 by a caregiver. Health workers must recognise its signs and report it to protect the child.

Updated 2026-11-01

## Structures involved

Tap one to see what it is and open it in 3D.

- [Parietal bones](https://durgical.com/en/anatomy/parietal-bone/)
- [Retina](https://durgical.com/en/anatomy/retina/)
- [Dura mater](https://durgical.com/en/anatomy/cranial-dura/)
- [Superior sagittal sinus](https://durgical.com/en/anatomy/superior-sagittal-sinus/)
- [White matter](https://durgical.com/en/anatomy/white-matter-of-telencephalon/)
- [Ribs (back part)](https://durgical.com/en/anatomy/ribs/)
- [Humerus](https://durgical.com/en/anatomy/humerus/)
- [Femur](https://durgical.com/en/anatomy/femur/)
- [Skin](https://durgical.com/en/anatomy/skin/)

## Why it happens

- [Mechanical and electrical injury: abrasion, contusion, laceration, wounds](https://durgical.com/en/general-pathology/mechanical-and-electrical-injury-abrasion-contusion-laceration-wounds/)
- [Sudden infant death syndrome: what is known](https://durgical.com/en/general-pathology/sudden-infant-death-syndrome-what-is-known/)

## What it is

Any abuse or neglect of a person under 18 years by a parent, caregiver or other person in a position of responsibility, trust or power that causes actual or potential harm to the child's health, survival, development or dignity. It includes physical, sexual and emotional abuse, neglect and exploitation.

## Who gets it

Very common worldwide: WHO estimates that about 6 in 10 children under 5 regularly receive physical punishment or psychological violence at home, and 1 in 5 women and 1 in 7 men report sexual abuse in childhood. In Colombia, violence against children is a national public health priority; cases are notified to the public health surveillance system and to child-protection authorities, and under-reporting is common.

## Causes

- Physical abuse: inflicted injury, such as hitting, shaking, burning or throwing
- Abusive head trauma (including shaken baby syndrome): violent shaking and/or blunt impact to an infant's head
- Neglect: failure to meet basic needs (food, hygiene, supervision, health care, schooling, emotional care)
- Emotional abuse and sexual abuse (covered in specific protocols)

## Risk factors

- Child: age under 1 year (highest risk of severe and fatal injury), prematurity, disability or chronic illness, persistent crying
- Caregiver: young age, depression, substance use, own history of maltreatment, unrealistic expectations of the child
- Family: intimate partner violence, social isolation, poverty and stress
- Community: armed conflict and displacement, social norms that accept physical punishment

## Pathophysiology

In abusive head trauma, acceleration-deceleration forces from shaking (with or without impact) tear bridging veins between the brain and dura, causing subdural haemorrhage, and shear the [retina](https://durgical.com/en/anatomy/retina/) and brain tissue, causing multilayered retinal haemorrhages and diffuse brain injury with hypoxic-ischaemic swelling. Typical skeletal injuries come from squeezing the [chest](https://durgical.com/en/anatomy/region/chest/) (posterior rib fractures) and pulling or twisting limbs (metaphyseal corner fractures). Chronic neglect causes growth failure and developmental delay.

## Classification

- Physical abuse, including abusive head trauma
- Sexual abuse
- Emotional (psychological) abuse
- Neglect: physical, medical, educational, supervisory, emotional
- Exploitation (child labour, commercial sexual exploitation)

## Symptoms and signs

- An injury that does not match the history, the child's developmental stage or a history that changes
- Delay in seeking care
- Bruises in non-mobile infants, or on the ears, neck, torso, buttocks or genitals; patterned bruises (hand, belt, cord)
- Patterned or immersion burns (glove-and-stocking, cigarette burns)
- Abusive head trauma in infants: irritability, vomiting, poor feeding, lethargy, seizures, apnoea, a bulging fontanelle or rapidly growing head
- Neglect: poor growth, poor hygiene, untreated illness or dental caries, missed vaccinations, developmental delay
- Behaviour changes: withdrawal, fear of caregivers, aggression, school problems

## Red flags

- Any bruise in an infant who is not yet cruising (the TEN-4-FACESp rule flags bruises to the torso, ears or neck in children under 4, or any bruise under 4 months)
- An infant with altered consciousness, seizures or apnoea without a clear cause
- Posterior rib fractures, metaphyseal fractures, multiple fractures at different stages of healing
- Retinal haemorrhages with subdural haemorrhage
- A sentinel injury (e.g. small bruise or intraoral injury) in a young infant

## Diagnosis

**Clinical**
Careful, non-judgemental history recorded in the caregiver's own words, a full head-to-toe [skin](https://durgical.com/en/anatomy/skin/) and genital examination, growth plotting and developmental assessment; precise documentation with body diagrams and photographs. Dilated fundus examination by an ophthalmologist in suspected abusive head trauma.

**Tests**
Complete blood count and coagulation studies to exclude bleeding disorders; [liver](https://durgical.com/en/anatomy/liver/) enzymes, amylase and lipase and urinalysis to look for occult abdominal injury; calcium, phosphate, alkaline phosphatase and vitamin D when fractures are present; toxicology when indicated.

**Imaging**
Skeletal survey in children under 2 years with suspected physical abuse, often repeated after about 2 weeks; head CT acutely and brain MRI in suspected abusive head trauma; abdominal CT when liver enzymes are raised.

## Differential diagnosis

- Accidental injury consistent with development and history
- Bleeding disorders (haemophilia, von Willebrand disease, vitamin K deficiency)
- Osteogenesis imperfecta and rickets
- Congenital dermal melanocytosis (blue-grey spots), cultural practices such as cupping or coining
- Glutaric aciduria type 1 or benign enlargement of subarachnoid spaces (for subdural collections)

## Goal of treatment

Treat the injuries, make the child safe, and meet the legal duty to report; the clinician's role is to recognise, document and notify, not to investigate or prove guilt.

## Treatment

**Acute**
Stabilise and treat injuries (airway, breathing, circulation, neurosurgical care for intracranial bleeding, fracture care).

**Procedure**
Report and notify: in most countries health workers have a legal duty to report reasonable suspicion to child-protection services. In Colombia the Code of Childhood and Adolescence (Law 1098 of 2006) makes the family, society and the State, health services included, co-responsible for protecting children and reporting maltreatment to the competent authorities (ICBF, family commissioners, police), and cases are also notified to public health surveillance. Reporting requires reasonable suspicion, not proof.

**Conservative**
Ensure a safe discharge plan, involving social work and the multidisciplinary child-protection team; protect siblings, who may also be at risk.

**Follow-up**
Nursing priorities: objective documentation using the caregiver's and child's own words, neurological observation, safe environment, calm supportive communication with the child, and follow-up of development and mental health.

## Complications

- Death (abusive head trauma is a leading cause of fatal child abuse in infants)
- Permanent brain injury: epilepsy, cerebral palsy, intellectual disability, blindness
- Growth failure and developmental delay from neglect
- Post-traumatic stress, anxiety, depression, substance use and suicidal behaviour
- Cycle of violence across generations

## Prognosis

Depends on the type and severity of abuse and on how early the child is protected. About 1 in 4 infants with abusive head trauma dies and most survivors have lasting disability; the psychological effects of all forms of maltreatment often persist into adulthood without support.

## Prevention

- Home-visiting and parenting support programmes for high-risk families
- Education about normal infant crying (crying peaks around 6–8 weeks) and coping strategies: place the baby in a safe place and step away
- Recognising and acting on sentinel injuries
- Laws and social norms against physical punishment

## Test yourself

Think of the answer, then tap the question to see it.

## Which triad suggests abusive head trauma in an infant?

Subdural haemorrhage, multilayered retinal haemorrhages and encephalopathy (with or without fractures).

## Which imaging study is recommended in a child under 2 years with suspected physical abuse?

A full skeletal survey (often repeated about 2 weeks later).

## Which fractures are highly specific for physical abuse in infants?

Posterior rib fractures and classic metaphyseal (corner or bucket-handle) fractures.

## Must a health worker prove abuse before reporting it?

No. A reasonable suspicion is enough; investigation belongs to child-protection and legal authorities.

## What is a sentinel injury?

A minor injury, such as a bruise or mouth injury, in a young infant that may precede more severe abuse.

[Add to my cards (5)](https://durgical.app/estudiar/?add=/en/conditions/child-maltreatment/)

## Related conditions

- [Subdural haematoma](https://durgical.com/en/conditions/subdural-haematoma/)
- [Traumatic brain injury](https://durgical.com/en/conditions/traumatic-brain-injury/)
- [Rib fractures](https://durgical.com/en/conditions/rib-fractures/)
- [Osteogenesis imperfecta](https://durgical.com/en/conditions/osteogenesis-imperfecta/)
- [Epilepsy and seizures](https://durgical.com/en/conditions/epilepsy-and-seizures/)
- [Cerebral palsy](https://durgical.com/en/conditions/cerebral-palsy/)
- [Sudden infant death syndrome (SIDS)](https://durgical.com/en/conditions/sudden-infant-death-syndrome/)

Educational information, not medical advice. For any symptom, see a health professional.

Sources: [Child maltreatment](https://www.who.int/news-room/fact-sheets/detail/child-maltreatment) (World Health Organization, 2026); [About Abusive Head Trauma](https://www.cdc.gov/child-abuse-neglect/about/about-abusive-head-trauma.html) (Centers for Disease Control and Prevention (CDC), 2026); Ley 1098 de 2006, Código de la Infancia y la Adolescencia (Congreso de la República de Colombia, 2006).

[← All conditions](https://durgical.com/en/conditions/)

## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake

Representative model, for educational purposes only.

---
Source: https://durgical.com/en/conditions/child-maltreatment/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/child-maltreatment/