Nature and severity of physical harm caused by child abuse and neglect: results from the Canadian Incidence Study.
BACKGROUND
Despite growing public concern about child maltreatment, the scope and severity of this significant public health issue remains poorly understood. This article examines the nature and severity of the physical harm associated with reports of child maltreatment documented in the Canadian Incidence Study of Reported Child Abuse and Neglect (CIS).


METHODS
The CIS collected information directly from child welfare investigators about cases of reported child abuse or neglect. A multistage sampling design was used to track child-maltreatment investigations conducted at selected sites from October to December 1998. The analyses were based on the sample of 3780 cases in which child maltreatment was substantiated.


RESULTS
Some type of physical harm was documented in 18% of substantiated cases; most of these involved bruises, cuts and scrapes. In 4% of substantiated cases, harm was severe enough to require medical attention, and in less than 1% of substantiated cases, medical attention was sought for broken bones or head trauma. Harm was noted most often in cases of physical abuse compared to other forms of maltreatment.


CONCLUSIONS
Rates of physical harm were lower than expected. Current emphasis on mandatory reporting, abuse investigations and risk assessment may need to be tempered for cases in which physical harm is not the central concern.
Centre of Excellence for Child Welfare, Faculty of Social Work, University of Toronto, Toronto, Ont. nico.trocme@utoronto.ca
Nico
N
Trocmé
Harriet
H
MacMillan
Barbara
B
Fallon
Richard
R
De Marco
D000293:Adolescent; D017677:Age Distribution; D002170:Canada / Q000453:epidemiology; D002648:Child; D002649:Child Abuse / Q000145:classification / Q000706:statistics & numerical data*; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D015601:Injury Severity Score; D008297:Male; D017678:Sex Distribution