Update on child maltreatment.
OBJECTIVE
The authors explore the literature published in the past year addressing child maltreatment issues, including sexual abuse, physical child abuse, inflicted head trauma, and child abuse prevention.


RESULTS
The body of knowledge about child abuse and its mimics continues to expand. Evident in this year's literature is the challenge which the diagnosis of child abuse creates for clinicians. Although further strides are being made toward universal education of providers, it is clear that there is still a reluctance to report abuse to child welfare agencies. The legal repercussions of diagnosing abuse can be extensive, and there has been a proliferation of medical defense experts who disagree with the commonly accepted tenets of abusive injury and who are vocal in the literature.


CONCLUSIONS
It remains the responsibility of pediatric providers to consider child maltreatment in the differential diagnosis of any unexplained injury or medical problem. Several studies document the high rate of spanking, slapping or shaking children, and primary care clinicians may be the first professionals in a position to begin the evaluation for possible child maltreatment. Despite the natural hesitancy to diagnose abuse, clinicians have an ethical and moral obligation to address this issue both in their practice and in their communities. The short-term and long-term costs to individuals who experience family violence have been well demonstrated and include not only emotional repercussions, but also chronic health conditions, which result in significant cost to society.
Newton
Alice W
AW
Department of Pediatrics, Harvard Medical School, and Child Protection Program, Children's Hospital, 300 Longwood Ave., Boston, MA 02115, USA. alice.newton@childrens.harvard.edu
Vandeven
Andrea M
AM
D001930:Brain Injuries; D002648:Child; D002649:Child Abuse; D002675:Child, Preschool; D006801:Humans; D019221:Mandatory Reporting; D011314:Preventive Health Services