Battered child syndrome occurs as the result of long-term physical violence against a child or adolescent. According to the National Center for Child Death Review (link http://www.childdeathreview.org/home.htm)
an estimated 2,000 children die each year in the United States from confirmed cases of physical abuse and 14,000 more are seriously injured. The battering takes many forms, including lacerations, bruises, burns, and internal injuries. In addition to the physical harm inflicted, battered children are at risk for an array of behavioral problems, including school difficulties, drug abuse, sexual acting out, running away, suicide, and becoming abusive themselves. Dissociative identity disorder, popularly known as multiple personality, is also common among abused children.

Detecting and preventing battered child syndrome is difficult because society and the courts have traditionally left the family alone. Out of fear and guilt, victims rarely report abuse. Nearly one-half of child abuse victims are under the age of one and therefore unable to report what is happening to them. The parents or guardians who bring a battered child to a hospital emergency room rarely admit that abuse has occurred. Instead, they offer complicated, often obscure, explanations of how the child hurt himself. However, a growing body of scientific literature on pediatric injuries is simplifying the process of differentiating between intentional and accidental injuries. For instance, a 1991 study found that a child needs to fall from a height of 10 ft (3m) or more to sustain the life-threatening injuries that accompany physical abuse. Medical professionals have also learned to recognize a spiral pattern on χ rays of broken bones, indicating that the injury was the result of twisting a child's limb.

Once diagnosed, the treatment for battered children is based on their age and the potential for the parents or guardians to benefit from therapy. The more amenable the parents are to entering therapy themselves, the more likely the child is to remain in the home. For infants, the treatment ranges from direct intervention and hospital care to foster care to home monitoring by a social service worker or visiting nurse. Ongoing medical assessment is recommended in all types of treatment. For the preschool child, treatment usually takes place outside the home, whether in a day care situation, a therapeutic preschool, or through individual therapy. The treatment includes speech and language therapy, physical therapy, play therapy, behavior modification, and specialized medical care.

By the time the child enters school, the physical signs of abuse are less visible. Because these children may not yet realize that their lives are different from those of other children, very few will report that their mothers or fathers are subjecting them to gross physical injury. It is at this stage that psychiatric and behavioral disorders begin to surface. In most cases the children are removed from the home, at least initially. The treatment, administered through either group or individual therapy, focuses on establishing trust, restoring self-esteem, expressing emotions, and improving cognitive and problem-solving skills.

Recognizing and treating physical abuse in the adolescent is by far the most difficult. By now the teen is an expert at hiding bruises. Instead, teachers and health care professionals should be wary of exaggerated responses to being touched, provocative actions, extreme aggressiveness or withdrawal, assaulting behavior, fear of adults, self-destruction, inability to form good peer relationships, alertness to danger, and/or frequent mood swings. Detection is exacerbated by the fact that all teenagers exhibit some of these signs at one time or another.

Abused teens do not evoke as much sympathy as younger victims, for society assumes that they are old enough to protect themselves or seek help on their own. In truth, all teenagers need adult guidance. The behavior that the abused adolescent often engages in—delinquency, running away, and failure in school—usually evokes anger in adults but should be recognized as symptoms of underlying problems. The abused teen is often resistant to therapy, which may take the form of individual psychotherapy, group therapy, or residential treatment.

While reporting child abuse is essential, false accusations can also cause great harm. It is a good idea for anyone who suspects that a child is being physically abused to seek confirmation from another adult, preferably a non-relative but one who is familiar with the family. If the second observer concurs, the local child protective services agency should be contacted. The agency has the authority to verify reports of child abuse and make decisions about protection and intervention.

Unlike many other medical conditions, child abuse is preventable. Family support programs can provide parenting information and training, develop family skills, offer social support, and provide psychotherapeutic assistance before abuse occurs.

The following organizations operate hotlines or provide advice for family members where there are problems related to physical or other abuse.

• Childhelp National Abuse Hotline Telephone: toll-free (800) 422-4453
• National Coalition Against Domestic Violence Telephone: (303) 839-1852
• National Council on Child Abuse and Family Violence Telephone: toll-free (800) 222-2000
• National Victim Center Telephone: toll-free (800) FYI-CALL [394-2255]
• National Runaway Switchboard Telephone: toll-free (800) 621-4000

Ackerman, Robert J., and Dee Graham. Too Old to Cry: Abused Teens in Today's America. Blue Ridge Summit, PA: TAB Books, 1990.

Helfer, Ray E. M.D., and Ruth S. Kempe, MD., eds. The Battered Child. Chicago: The University of Chicago Press, 1987.

Arbetter, Sandra. "Family Violence: When We Hurt the Ones We Love," Current Health 22, November 1995, p. 6.

National Committee for Prevention of Child Abuse
Address: 332 S. Michigan Avenue Chicago, IL 60605
Telephone: (312) 663-3520