abuse 371when a parent or responsible caretaker fails to provide adequate supervision,
food, clothing, shelter, or other basics for a child.^2 All forms of abuse and
neglect may result in serious harm to a child (Figure 15.1).
In the United States, child protective services best estimates indicate
that there are approximately eight hundred thousand annual cases of child
maltreatment. Childhood exposure to abuse, neglect, and parental violence
has been associated with risky behaviors, smoking, using illicit drugs, and
overeating.^1 Depression, suicidal behavior, perpetrating youth and intimate
partner violence, and negative health conditions, such as heart disease and
cancer, have also been associated with child abuse and neglect.^1
15.3 Abuse during PregnancyAlthough child abuse/neglect is one of the most common forms of violence,
injuries can result from behaviors that begin prior to birth (during preg-
nancy). The effects of alcohol, drugs, poor nutrition, and physical trauma are
well documented in the professional and lay literature. Assault of the pregnant
women can result in a wide range of emotional and physical trauma, includ-
ing the potential for injuries that result in death (homicide), perinatal death,
low-birth-weight live births, and preterm delivery.^3 In two separate studies
of nearly two thousand women aged eighteen to sixty-five, it was reported
that approximately 15% of women reported intimate partner violence or
abuse during a pregnancy.3,4 Greater frequency of abuse was associated with
increased health risks to the mother and her developing fetus.^3 Koening et al.^4
reported that women more commonly experienced violence during than
after their pregnancy (61% of those women reporting abuse during or after
pregnancy were abused only during their pregnancy, 21.7% were repeatedly
abused, and 16.7% were abused only after delivery).^4 The American College of
Figure 15.1 example of abuse resulting in fatal injuries to four-year-old child.