The Challenge and Complexities of Physical Abuse

The Challenge and Complexities of Physical AbuseAs a practising paediatrician, it is my impression that, in spite of overall increases in the volume of child protection work, we are actually seeing fewer cases of physical abuse, particularly in relation to severe and fatal physical abuse.If that is indeed the case, it is a cause for celebration, as it implies that we are more effectively protecting children from physical abuse, and perhaps that our societies are becoming less tolerant of physical violence to children.Several publications over recent years support this view, but it is not a uniform or consistent finding.Gilbert and colleagues (2012) examined trends in child maltreatment rates in six developed countries, and found a mixed picture, with stable or falling rates of violent child deaths in infants and children in all six countries.In contrast, only Sweden and Manitoba showed decreasing rates of maltreatment-related injury admissions.More detailed analyses of violent deaths in England and Wales showed decreases in both infants and children (Pritchard and Sharples, 2008;Sidebotham et al. 2012).Reporting on crosssectional population surveys in the USA, Zolotor et al. (2011) showed promising downward trends in the use of physical punishment (though not in the use of objects for hitting a child).The fourth US National Incidence Study found decreases in the rates of physical abuse of 23-29 per cent compared to the previous study a decade earlier (Sedlak et al., 2010).A 2009 study in the UK showed that fewer 18-24-year olds reported physical abuse than in a similar study in 1998 (Cawson et al., 2000; NSPCC, 2011).In contrast, researchers in The Netherlands found no change in the rates of physical abuse between 2005and 2010(Euser et al., 2013)).In understanding prevalence rates for maltreatment, the work of the Centre for Child and Family Studies in Leiden is exemplary (Stoltenborgh et al., 2011(Stoltenborgh et al., , 2013a(Stoltenborgh et al., , 2013b)).In this issue of Child Abuse Review, Marije Stoltenborgh and colleagues (2015) from the centre report on a series of meta-analyses that they have undertaken collating data from across the globe on all forms of maltreatment.They found an overall global prevalence of 226/1000 for self-reported physical abuse, and three per 1000 for informant reported.Self-reported prevalence varied by geographical region and between countries.Another paper in this issue looks at the prevalence of maltreatment in Nordic countries, systematically searching the published literature from 1990 (Kloppen et al., 2015).They found self-reported prevalence rates of severe physical violence of between three and nine per cent, and mild physical violence of between 13 and 72 per cent.Of note, studies in Finland and Sweden showed lower rates in more recent studies compared to those in the 1990s.

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