in the number of maltreated children. In 1974 the
number of reports for suspected maltreatment was
merely 60,000; in 1980, the number increased to
greater than one million. Several factors contribute to
this dramatic increase, including changes in child
abuse reporting laws and an increased recognition of
abuse and neglect as real societal problems. Early laws
governing reporting of suspected child maltreatment
required only professionals to report to the state child
protective service agencies. By the late twentieth cen-
tury, most states required anyone with a suspicion of
maltreatment to make a report. There is also evi-
dence that the level of violence in society has in-
creased such that it has been declared a public health
epidemic. Violence toward children and violence in-
volving children (as witnesses) are both on the rise.
The numbers of maltreated children are impres-
sive, but it is commonly accepted that these numbers
are inaccurate. The cases reported to social services
represent only the ‘‘tip of the iceberg’’ of all maltreat-
ed children. There are several ways researchers know
this to be true. One indication that some children are
missed comes from studies of child fatalities. Many
children are killed as a result of abuse or neglect, but
not all are identified as victims of abuse or neglect at
the time of their death. Second, parent surveys and
other periodic national surveys obtain higher rates of
abuse and neglect than that counted by social ser-
vices. In some cases the difference in rates is not trivi-
al. For example, a nationwide telephone survey of
parents found a nearly tenfold increase in rates of
physical maltreatment compared to rates reported by
social services.
Obtaining accurate numbers of maltreated chil-
dren is difficult for other reasons. A fundamental rea-
son is that simply defining what constitutes child
maltreatment, as previously mentioned, is problemat-
ic. Maltreatment definitions also vary from state to
state. The potential for missing abuse clearly exists
when only two-thirds of reported cases are investigat-
ed, in part because of an overburdened social services
system.
Consider also the process by which children are
identified as being maltreated—someone has to make
a report. This process relies on individuals recogniz-
ing abuse and taking action. Several studies have
identified resilient kids—where abuse or neglect is oc-
curring at home but the children find ways to cope.
These children are less likely to be identified, as are
very young children who cannot relate what has hap-
pened to them. Then there are biases (based on race,
gender, and socioeconomic status) that make individ-
uals more likely to suspect and report maltreatment.
Poor families are notoriously suspect because of pre-
sumably higher financial stress and the frequently as-
sociated lack of education and resources. The
opposite also happens: there are biases that prevent
suspicion of abuse, leading to many maltreated chil-
dren being missed. Girls are traditionally viewed as
the only victims of sexual abuse, and young boys who
act out are labeled as hyperactive but the question of
sexual abuse is never entertained. Even if abuse is rec-
ognized and suspected, someone must take action,
which is a well-known barrier to intervention. People
are reluctant to become involved in family matters
even if it means helping a child.Developmental Perspectives of Child
Maltreatment
It is very important to have an understanding of
the relationship between child development and
child maltreatment. Childhood is typically a time of
rapid change and growth. Each stage of development
brings new challenges and changes in the physical,
cognitive, and behavioral makeup of a child. These
changes are reflected in the epidemiology of mal-
treatment, which is the pattern of abuse and neglect
that is commonly seen. Child development affects all
of the following: the precipitating factors that lead to
maltreatment; the susceptibility of a child to different
types of maltreatment at different ages; the physical
findings of abuse or neglect; the treatment options
following maltreatment; and the likelihood of long-
term sequelae (secondary effects) from abuse or ne-
glect.
Infants are at the greatest risk for all types of mal-
treatment, including fatal maltreatment. This is rela-
tively easy to understand from a developmental
standpoint. Child neglect occurs commonly as infants
are the most dependent on their caregivers to provide
the basic necessities of life in a stable, secure environ-
ment. Parents who are overwhelmed by life stressors
and have personal limitations, or have certain cogni-
tive or medical conditions (such as mental retardation
or depression) may become caregivers who cannot
pick up on infant cues. In these situations there is a
risk of poor attachment and emotional neglect. Par-
ents can also be easily frustrated by an infant whose
crying or temperament makes them difficult to han-
dle, leading to the potential for physical abuse. This
risk is dangerously high given that infants are already
at higher risk for physical abuse because of their phys-
ical attributes, such as softer bones, small size, and the
inability to resist physical harm or verbalize what hap-
pens to them. The ‘‘shaken baby syndrome’’ illus-
trates this principle. An infant has limited muscle
tone, particularly in the neck, and an infant’s head
size is proportionately larger than other parts of its
body. An infant that is forcibly shaken can get a form
of whiplash, which creates forces that shear the deli-78 CHILD ABUSE