National surveillance of child maltreatment is conducted annually through the National Child Abuse and Neglect Data System (NCANDS).2 In 1999, an estimated 826,000 children in the U.S. were maltreated (US DHHS, 2001a). The majority of victims (58.4 percent) suffered neglect, 21 percent suffered physical abuse, and 11 percent suffered sexual abuse (Figure 5-1). The remainder were victimized by other types of maltreatment including medical neglect, abandonment, threats of harm, and congenital drug addiction. The overall child victimization rate for 1999 was 11.8 per 1,000, with only small gender differences.3 Trends can be established by comparing this figure to annual figures dating back to 1990, when national surveillance began. The rate in 1990—at 13.4 per 1000— climbed by 1993 to a peak of 15.3 per 1000, and then gradually declined to 1999 (Figure 5-2). These rates are based on official records of children who come to the attention of child protective services.
Rates of physical and sexual abuse are much higher when measured in surveys of parents or victims. Surveys of parents find self-reported rates of child physical abuse that are 5–11 times higher than rates from official records (reviewed in Margolin and Gordis, 2000). In terms of cumulative prevalence, two recent community-based surveys of large