Henry Kempe and his colleagues provided the first comprehensive description of child physical abuse in the seminal 1962 paper titled “The Battered-Child Syndrome.” According to Kempe, battered child syndrome (BCS) is the clinical evidence of injuries resulting from no accidental trauma in children, usually perpetrated by a parent or caretaker. In general, the explanations given for the injuries are improbable. Victims of BCS are usually very young and frequently exhibit signs of chronic neglect, such as malnutrition. Kempe illuminated the gravity of the problem by assigning physical child abuse a name and providing data on the prevalence, etiology, and consequences of child battery. Subsequently, the trauma resulting from physical child abuse became known as the battered child syndrome.
The abuse that causes BCS is often chronic in nature and directed at children under the age of 3, although the syndrome can be evident after a single incident and in children of any age. The symptoms of BCS vary considerably depending on the severity and method of abuse. Characteristic injuries include bruises, burns, fractures, and head trauma, as well as retinal damage resulting from the child being shaken. Since children are often handled by their arms and legs, injuries to the appendages are prevalent among battered children. Less frequently, children may be deliberately exposed to or made to ingest toxins. Severe abuse can lead to brain damage, disability, and death. Evidence of multiple injuries in various stages of healing is likely indicative of chronic abuse, and is often detected through radiographic investigation.
Regardless of the type of trauma sustained, a hall-mark feature of BCS is that the child’s injuries are incongruent in nature and severity with the alleged source of the trauma (e.g., a bruise from a “fall” shaped like a hand). A delay in seeking medical attention for the child may also signal maltreatment. Victims of chronic abuse may be malnourished, have poor hygiene, and display a general failure to thrive as a result of ongoing neglect by their parents or caretakers. Allegations of BCS generally elicit adamant denial of any wrongdoing by the perpetrator or others aware of the abuse. Thus, health care workers should pay particular attention to any inconsistencies in the medical history and document any evidence of potential abuse. If no new injuries appear while the child is hospitalized, the diagnosis of BCS may be strengthened. While doctors and other professionals can be instrumental in identifying and preventing BCS, they may also inadvertently act as barriers to intervention through a reluctance to believe that the parent or caretaker would deliberately hurt the child; such denial may prevent them from making the correct diagnosis and effectively intervening. Although traditionally defined in terms of physical symptoms, BCS has also been associated with emotional and behavioral problems in victimized children that may last long after the physical abuse has ended.
Research suggests that people with high impulsivity and poor anger regulation often perpetrate the violent acts that cause BCS during episodes of rage or frustration. The perpetrators tend to be emotionally unstable and often were victims of childhood abuse. Parents who hurt their children are more likely to be substance abusers, have low intelligence, and possess antisocial or psychopathic traits, relative to nonabusive parents. Children resulting from unwanted pregnancies are at a greater risk of being mistreated than children resulting from planned pregnancies. Research also suggests that BCS may be more common in families of lower socioeconomic status, possibly because of additional parental stress due to a lack of support and resources. It is important to note, however, that BCS impacts families from all socioeconomic backgrounds.
Once BCS is identified, securing the child’s safety is of paramount importance. This generally means placing the child in protective care while both the parents and children obtain appropriate psychological and medical treatment. Frequently, criminal charges will be filed against the abuser. Intervention should include addressing any psychological, social, and behavioral factors contributing to the abuse. Success in preventing future abuse largely depends on the abusers’ willingness to attend and comply with treatment. Children should be returned to the home only if and when the environment is determined to be safe; extreme caution is warranted given the potentially catastrophic consequences for the child. Providing interventions to people at risk for perpetrating violence, such as those with personal histories of abuse, unstable living situations, and/or substance abuse problems, and those who demonstrate a lack of care for their child, may be helpful in preventing BCS.
- Kempe, C. H., Denver, F. N., Cincinnati, B. S., Droegemueller, W., & Silver, H. K. (1962). The batteredchild syndrome. Journal of the American Medical Association, 181, 17–24.
- Leventhal, J. M. (2003). Test of time: “The battered-child syndrome” 40 years later. Clinical Child Psychology and Psychiatry, 8(4), 543–545.
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