had been seriously injured or who had died because of abuse. The article described some of the key clinical features of child maltreatment, including the discrepancy between clinical findings and the historical data, some of the physical and radiographic findings of abuse, and why physicians would have difficulty believing parents can hurt their children. The publication of the article was a “landmark” for the field of child abuse and neglect, said John Leventhal, professor of pediatrics at Yale University School of Medicine and an attending pediatrician at Yale-New Haven Children’s Hospital. Many problems it described are still problems today.

Challenges in the Assessment of Maltreatment

One such problem involves the diagnosis of maltreatment, noted Leventhal. Diagnoses of maltreatment are based on a combination of clinical features rather than a single diagnostic test. Furthermore, these diagnoses have major implications for children and families related to safety, placement, and possible termination of parental rights. Pediatricians continue to struggle with this diagnosis, said Leventhal. “Many of us know physicians who have made the wrong diagnosis and have sent abused children home, and sometimes those children come back with more serious injuries due to abuse or even die from an abusive injury. We take these problems very seriously.”

An additional problem cited by Leventhal is that some so-called experts in court continue to deny that abuse has occurred and propose specious theories of causation, such as vitamin deficiencies or reactions to vaccines.

In contrast to the 750 children described in the 1962 article, Leventhal and his colleagues have estimated that in the United States about 4,500 children annually enter the hospital with serious injuries due to abuse (Leventhal et al., 2012). The majority of these children are younger than age 3, and most of those are less than a year old. The mortality rate for these children is very high, at around 6 percent in the hospital.

Changes in the Assessment of Maltreatment

Partly in response to the problems he identified, the assessment of maltreatment has undergone major changes over the past two decades, Leventhal observed.



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