Daley Sharon F., Gonzalez Dulce, Bethencourt Mirabal Arian, Afzal Muriam, Doerr Chaddie
Cape Cod Hospital, Hyannis, MA
Lincoln Hospital
The World Health Organization (WHO) defines child maltreatment as “all forms of physical and emotional ill-treatment, sexual abuse, neglect, and exploitation that results in actual or potential harm to the child’s health, development or dignity.” There are four main types of abuse: neglect, physical abuse, psychological abuse and sexual abuse. Abuse is defined as an act of commission and neglect is defined as an act of omission in the care leading to potential or actual harm. Neglect may include inadequate health care, education, supervision, protection from hazards in the environment, and unmet basic needs such as clothing and food. Neglect is the most common form of child abuse. Physical abuse may include beating, shaking, burning, and biting. The threshold for defining corporal punishment as abuse is unclear. Rib fractures are found to be the most common finding associated with physical abuse. Psychological abuse includes verbal abuse, humiliation, and acts that scare or terrorize a child, which may result in future psychological illness of the child. Sexual abuse is defined as “the involvement of dependent, developmentally immature children and adolescents in sexual activities which they do not fully comprehend, to which they are unable to give consent, or that violate the social taboos of family roles.” Some cases of sexual abuse do not need to involve oral, anal, or vaginal penetration and may include exposure to sexually explicit materials, oral-genital contact, genital-to-genital contact, genital-to-anal contact, and genital fondling. A significant amount of child abuse cases frequently are missed by healthcare providers. For the diagnosis of child abuse to be made, there needs to be a high index of suspicion.[3]
世界卫生组织（WHO）将儿童虐待定义为“所有形式的身体和情感虐待、性虐待、忽视及剥削，这些行为会对儿童的健康、发展或尊严造成实际或潜在的伤害”。虐待主要有四种类型：忽视、身体虐待、心理虐待和性虐待。虐待被定义为一种作为行为，而忽视被定义为在照顾过程中导致潜在或实际伤害的不作为行为。忽视可能包括医疗保健不足、教育缺失、监管不力、未能保护儿童免受环境危害以及未满足诸如衣物和食物等基本需求。忽视是最常见的儿童虐待形式。身体虐待可能包括殴打、摇晃、灼烧和咬伤。将体罚界定为虐待的界限尚不明确。肋骨骨折被发现是与身体虐待相关的最常见体征。心理虐待包括言语虐待、羞辱以及惊吓或恐吓儿童的行为，这可能导致儿童未来出现心理疾病。性虐待被定义为“受抚养的、发育未成熟的儿童和青少年参与他们无法完全理解、无法同意或违反家庭角色社会禁忌的性活动”。一些性虐待案例不一定涉及口交、肛交或阴道插入，可能包括接触露骨的色情材料、口交接触、生殖器与生殖器接触、生殖器与肛门接触以及抚摸生殖器。大量的儿童虐待案例常常被医疗服务提供者漏诊。要做出儿童虐待的诊断，需要有高度的怀疑指数。
