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Children represent 20% of all burn admissions annually; 20-30% are related to abuse or neglect. Our institution Child Protective Services (CPS) recently decided to stop following and interpreting hair toxicology results for pediatric burn patients. Drug use/exposure is an important risk factor for child abuse/neglect. The goal of this study was to evaluate the value of hair toxicology testing to identify child abuse or neglect. Medical records of pediatric patients ≤14 years admitted between 1/1/2019 and 2/29/2024 were reviewed. Demographics, burn injury information, suspicion of child abuse/neglect on admission, routine urine drug screening tests, hair toxicology results, and reporting to the State Health and Human Services (HHS) were collected. Descriptive statistics were obtained. Univariate analyses were performed to assess the utility of hair toxicology with p < 0.05 considered significant. Two hundred ninety-eight patients were included; child abuse was suspected in 31.5%; hair toxicology performed for 75.2% and positive for 35.7%. Hair toxicology was more likely to be performed when child abuse was suspected on admission (81.9% vs. 72.1%, p = 0.044), and to be positive (40.4% vs. 20.6%, p < 0.001). Suspicion on admission was associated with higher HHS involvement (95.7% vs. 24%, p < 0.001). HHS was more likely to be involved when hair toxicology was performed (54% vs. 24.3%, p < 0.004) and positive (96.3% vs. 28.4%, p < 0.001). Hair toxicology screening for pediatric burn patients is still a valuable tool to help clinicians report suspected abuse/neglect not otherwise detected on admission using other tools.
Despite significant consequences (e.g., greater risk for internalizing and externalizing problems) and high prevalence rates (greater than 15%), neglect is currently the least studied form of child maltreatment. However, prior research suggests that maternal childhood sexual abuse may be a particularly salient risk factor for neglect as it is associated with a number of difficulties that can impair caregiving abilities. The current study explored multiple potential risk factors for the association between maternal childhood sexual abuse and perpetration of neglect. This study relied on secondary data analysis from a clinic that conducts evaluations of families involved in child protective services and with high-risk child maltreatment cases. The sample consisted of 410 mother-child dyads. Multiple risk factors, from the Kempe Family Stress Inventory, were examined as possible mechanisms for an indirect association between maternal childhood sexual abuse and perpetration of neglect. Substance use disorder was examined as a moderator for all effects. Partial indirect effects were found for maternal childhood sexual abuse and perpetration of neglect, through maternal social-emotional functioning and harsh punishment. Substance use moderated the association between harsh punishment and perpetration of neglect, such that harsh punishment was only associated with an increased probability of perpetrating neglect when mothers also had a substance use disorder. Present results extend current literature on intergenerational mechanisms of risk and highlight the importance of supporting mothers' own trauma recovery, the development of a positive social community, and the utilization of positive parenting practices.
Parental burnout refers to exhaustion, emotional distancing from children, and an arc of decline in parenting capacity. Although burnout is known to be elevated among parents of children with externalizing problems, there has been little investigation of the unique role of burnout in parenting practices. To determine if parental burnout - unique from parents' mental health symptoms and children's externalizing behaviors - relates to more negative and less positive self-reported parenting behaviors. The participants were 140 Australian caregivers referred to a parenting support program because of substantiated child abuse or neglect or due to a combination of family stress and a child with significant externalizing behaviors. Caregivers completed a survey to report their burnout, personal mental health symptoms of depression and anxiety, the focal child's externalizing behaviors, and positive (e.g., warmth, involvement) and negative (e.g., coercion and hostility) parenting behaviors. Total burnout was uniquely associated with parental reports of decreased positive and increased negative parenting behaviors in hierarchical regression models controlling for child age, welfare referral, parent mental health symptoms and child externalizing behaviors. Other findings from these models showed that parent mental health was uniquely associated with less positive parenting, whereas child externalizing behavior was uniquely associated with more negative parenting. When the interaction between total burnout and child externalizing behaviors was tested in these models, it was not significantly related to positive or negative parenting behaviors. Additional hierarchical models considered the four burnout subscales. Two subscales were associated with less positive parenting - emotional distancing and self-contrast (a perceived arc of decline in parenting), and two subscales were associated with more negative parenting - exhaustion and self-contrast. Parental burnout has unique associations with decreased parental warmth and support and increased hostility and coercion towards children in at-risk families.
Childhood emotional abuse and neglect (CEAN) are adverse experiences that are often underrecognized for their long-lasting impacts on health. Despite research having demonstrated a link between childhood adversity and diabetes, the association between CEAN and the timing of diabetes diagnosis, along with their sociodemographic patterns, remains poorly understood. This cross-sectional survey collected data on CEAN from 306 Saudi individuals diagnosed with diabetes. Employing a culturally modified version of the self-report Childhood Trauma Questionnaire-Short Form, the severity of CEAN was evaluated using composite scores (none, moderate, or severe) derived from the questionnaire items. Chi-square tests were used to examine associations among abuse severity, sociodemographic variables, and age at diagnosis, with Cramér's V calculated to determine the effect size. Multivariable logistic regression was performed to adjust for potential confounders. Severe emotional abuse was reported by 38.9% of the participants, and severe neglect by 22.2%. Severity levels of both emotional maltreatment and neglect were significantly correlated with sex, age group, marital status, educational attainment, occupation, and age at diagnosis (all P < .05). Greater severity of both emotional abuse and neglect was correlated with an older age at diabetes diagnosis, demonstrating linear trends. CEAN are prevalent among individuals with diabetes and are significantly associated with sociodemographic factors and age at diagnosis. In multivariable logistic regression analysis, adjusting for age and sex, emotional abuse was independently correlated with an earlier age at diabetes diagnosis (adjusted odds ratio = 2.62, 95% confidence interval: 1.25-5.49, P = .011). These findings underscore the enduring impact of early-life emotional adversity on health and highlight the need to incorporate trauma informed and socially responsive strategies in diabetes management and prevention.
Childhood maltreatment is a risk factor for detrimental health outcomes in adulthood. However, less is known about whether the quality of adult romantic relationships may buffer or exacerbate these long-term associations. To examine whether qualitative aspects of current romantic relationships moderate the associations between childhood abuse and neglect and adult somatic/mental complaints. The Quality of Relationship Inventory (QRI), Childhood Trauma Questionnaire (CTQ) and the Von Zerssen complaints list were answered by a large, population-representative sample (N = 1494, 50.8% women). Participants' age ranged from 18 to 89 years (M = 52, SD = 15.27). Analyses were conducted via correlations and multiple linear regression models, including potential confounders (gender, age, relationship duration). Abuse and neglect were associated with more complaints in adulthood. Greater relationship support attenuated these associations. Greater relational depth was associated with a stronger positive association between childhood maltreatment and adult complaints. Relationship conflict did not moderate the associations between childhood maltreatment and adult complaints. Relationship quality is a meaningful context in which the long-term correlates of childhood maltreatment unfold. Supportive versus potentially dysregulating forms of closeness should be distinguished in subsequent longitudinal research, prevention efforts, and clinical approaches/counseling.
Although prior research indicates that environmental instability adversely affects children's well-being, it remains unclear whether abusive or neglectful parenting behaviors constitute a central and proximal outcome of such instability. To address these gaps, the present study sought to examine multiple forms of environmental instability as predictors of child maltreatment, controlling for persistent environmental harshness in corresponding domains. The present study utilized longitudinal, repeated-measures data from a cohort of births across 20 large American cities, oversampled for nonmarital births (N = 3544). Conditions of environmental instability and environmental harshness from birth to age five were examined as predictors of caregivers' engagement in abusive and neglectful behaviors using longitudinal multilevel modeling. Average levels of emotional abuse increased between ages three and five, whereas physical abuse decreased over the same period. Results indicated that instability in both the domains of employment and informal support from age one to five were associated with greater abusive behaviors (i.e., emotional and physical abuse), independent of sustained exposure to environmental harshness over the same period. This study underscores the importance for researchers and practitioners to attend to the specific role of instability in the early childhood environment in shaping child maltreatment risk and children's long-term well-being. Efforts to promote equitable family well-being are therefore likely to be most effective when they address not only families experiencing persistent adversity but also those vulnerable to sudden and unpredictable changes in their circumstances and needs.
A predictive risk model (PRM) was trained to stratify risk among children investigated for alleged maltreatment based on the likelihood of future child protection involvement. In the current brief, we assess the model's ability to differentiate risk of adverse events not used to build the model (i.e., arrest, death) among adolescent populations investigated following reported maltreatment to guide prevention-oriented services. Child welfare and vital statistics records were obtained through a data use agreement. Among adolescents born in 2000 and 2001 and investigated for alleged maltreatment between ages 11 and 17 (n = 72,340), risk scores were calculated using a random forest algorithm based on information available at the time of maltreatment report. The records of these adolescents were then linked to arrest and death records. Among adolescents investigated for maltreatment, 5.8% experienced a juvenile arrest or death before age 21. Of those who experienced an arrest or death, 43.9% fell in the highest risk decile. A PRM trained to predict foster care placement had strong external validity in predicting both future arrests and deaths. The average time from investigation to adverse event indicates a meaningful window for interventions to be delivered focused on supporting and stabilizing adolescents and their families.
Information regarding risk factors among service member families for different child maltreatment types is needed to improve prevention efforts. To identify factors associated with first occurrences of 4 child maltreatment types and examine child age-related changes in risk for each type among active duty service member families. This population-based retrospective cohort study used data from the Child Maltreatment in Military Families Life Course Study on active duty service member families with a first occurrence of child maltreatment in fiscal years 2009 through 2018 and a representative sample of active duty families without child maltreatment incidents. Data were analyzed from August 2023 to February 2026. One or more parents serving as an active duty service member. First documented occurrences of neglect, physical abuse, emotional abuse, and sexual abuse, identified using Family Advocacy Program data. Associations between sociodemographic, family, and military-related characteristics and first occurrences of maltreatment types were examined in univariable and multivariable logistic regressions. The study included 618 101 active duty service member families (28 684 [4.64%] with a first occurrence of child maltreatment and 589 417 [95.36%] without child maltreatment incidents), consisting of 1 070 510 family-months (FM); the total weighted sample was 65 142 809 FM (59 031 293 male service member FM [90.62%]; mean [SD] age, 32.74 [6.97] years). Crude rates of child maltreatment were highest for child neglect (22.16 per 100 000 FM) followed by physical abuse (10.97 per 100 000 FM), emotional abuse (4.23 per 100 000 FM), and sexual abuse (2.66 per 100 000 FM). Factors associated with higher odds of all child maltreatment types in multivariable models were female service member families (eg, sexual abuse: odds ratio [OR], 1.39 [95% CI, 1.18-1.64]; physical abuse: OR, 1.82 [95% CI, 1.70-1.95]), early parenting (age <21 years) (eg, neglect: OR, 1.32 [95% CI, 1.22-1.41]; sexual abuse: OR, 2.12 [95% CI, 1.75-2.56]), larger number of dependent children (≥3) (eg, emotional abuse: OR, 1.63 [95% CI, 1.48-1.79]; sexual abuse: OR, 2.32 [95% CI, 2.06-2.61]), and never-deployed status (eg, sexual abuse: OR, 1.90 [95% CI, 1.55-2.32]; emotional abuse: OR, 3.76 [95% CI, 3.09-4.57]). Risk rates peaked at 3 months of age for neglect (48.61 per 100 000 FM) and physical abuse (25.49 per 100 000 FM). Risk of emotional and sexual abuse peaked in middle childhood (age 5-12 years) and adolescence but was generally lower (<6 per 100 000 FM) than risk of other child maltreatment types across all ages. In this cohort study, families with female service members, never-deployed service members, 3 or more children, and young parents had higher risk of child maltreatment. Dynamic prevention approaches appear to be needed to address evolving risk factors across the family life course.
Violence and abuse against women and children remain prominent issues in Lebanon, resulting in dire psychological consequences. The aims of the current study are to evaluate the moderating role of child abuse in the relationship between (1) domestic violence and suicidal ideation, and (2) domestic violence and self-harm. This cross-sectional study was conducted between January and May 2023. Women between the ages of 18 and 50 were recruited to participate using a snowball sampling technique. 915 women consented to take an online questionnaire that collected information about sociodemographic characteristics. It also included the following scales: Composite Abuse Scale (Revised)-Short Form, Columbia Suicide Severity Rating Scale, Child Abuse Self-Report Scale (CASRS-12), and Self-Harm Inventory (SHI). Older age (aOR = 0.96) was significantly associated with lower odds of having suicidal ideation, whereas higher domestic violence (aOR = 1.09), psychological child abuse (aOR = 1.36) and child neglect (aOR = 1.09) were significantly associated with higher odds of having suicidal ideation. The interaction domestic violence by sexual abuse (aOR = 1.04) was significantly associated with suicidal ideation in the binary model. In an additional ordinal logistic regression analysis of suicidal ideation severity, older age remained protective, while child neglect and physical abuse were associated with greater severity of suicidal ideation. The interaction domestic violence by child neglect was significantly associated with self-harm. At low (Beta= 0.01; p = .013), moderate (Beta= 0.022; p < .001), and high (Beta= 0.035; p < .001) levels of child neglect, higher domestic violence was significantly associated with more self-harm. The current study results have the potential to guide mental health professionals in implementing further interventions for child abuse and domestic violence. It can encourage a multidisciplinary approach starting with Lebanese community-based programs that combine the efforts of researchers and practitioners in order to reduce the burden of child abuse and domestic violence.
While subconjunctival hemorrhages (SCHs) have been suggested by some to be sentinel injuries which should prompt further evaluation for abuse, the risk of abuse in children with isolated SCHs is not currently known. To determine if infants and young children with isolated SCHs have current or subsequent concerns for physical abuse. Children 1 to <48 months old with SCHs diagnosed between 2011 and 2015 within a large, integrated healthcare system were included and followed until their fifth birthdays. Retrospective cohort study. Children with isolated SCHs had no other injuries identified within 7 days before or after the SCHs. Child physical abuse before the child's fifth birthday was identified by diagnosis codes and free-text review of medical notes and radiology reports. We identified 1281 patients with SCHs (mean [SD] age 22.5 [14] months), 603 (47.1%) were female. Only 12 children (0.9%) had physical abuse. Among children with isolated SCHs, 0.4% had physical abuse, compared to 3.0% of those with non-isolated SCHs (p < 0.001). For infants <12 months old, 0.6% with isolated SCHs had physical abuse, compared to 10.0% of those with non-isolated SCHs. Most children with SCHs in our study did not have child physical abuse before their fifth birthday. Children with isolated SCHs had a lower risk of future abuse compared to children with non-isolated SCHs.
This quality improvement project aimed to improve clinician knowledge, comfort, and adherence to standard of care for suspected cases of child abuse and neglect. A multi-pronged child abuse identification QI program was implemented within a large integrated healthcare system in Southern California to educate physicians on the detection and appropriate work-up for suspected child abuse and neglect. This included educational modules, webinars, and updated clinical support tools. A survey was given to clinicians who completed the educational modules regarding their comfort and knowledge with child abuse protocols. Use of skeletal surveys, the standard of care for suspicious injuries, was examined for patients < 12 months old presenting with skeletal fractures, sentinel injuries, and head trauma. For clinicians who completed the educational modules, 97% reported increased confidence in identifying child abuse cases, while 95% reported increased confidence in managing such cases (p<.01). For children < 6 months old with skeletal fractures there was a significant increase in skeletal surveys from 4% to 17% and for children 6-12mos an increase from 6 to 14% (ps<0.01). For children < 6 months old with sentinel injuries, the rate in skeletal surveys increased from 2% to 8% and for those with sentinel injuries or fracture the rate of skeletal surveys increased from 3% to 10% (ps<0.01). For children < = 12months old with head trauma, the rate of skeletal surveys increased from 8%-23%(ps<0.01). Overall, the findings suggest the QI program contributed to substantial improvement in adherence to standard of care for suspected child abuse.
This scoping review investigates the relationship between childhood maltreatment, including physical, emotional, and sexual abuse, as well as neglect, and Attention-Deficit/Hyperactivity Disorder (ADHD) and Related Neurodevelopmental Outcomes. Following the PRISMA-ScR guidelines, a comprehensive literature search was conducted across five databases (PsycNET, Social Services Abstracts, ERIC, PubMed, and EBSCO) using a broad set of search terms related to ADHD, maltreatment, and childhood. The review included peer-reviewed articles published in English over the past 10 years, Studies published between January 2015 and February 2025 were included. The final database search was completed on March 1, 2025. The studies examined maltreatment in children with ADHD. Of the 854 initially identified studies, 12 met the inclusion criteria. Thematic analysis revealed three major findings: (1) various forms of maltreatment are strongly associated with increased risk and severity of ADHD symptoms; (2) mediating factors such as genetic predisposition, family dynamics, and emotional reactivity shape this relationship; and (3) maltreatment contributes to the persistence of ADHD symptoms and comorbid conditions into adulthood. These findings underscore the need for early trauma-informed interventions that address both biological and environmental influences on ADHD development. Attention-Deficit/Hyperactivity Disorder (ADHD) is a common condition in children and young people. It can affect attention, self-control, activity levels, and emotional regulation. At the same time, some children grow up in difficult or harmful environments, including experiences of emotional, physical, or sexual abuse, or different forms of neglect. This review looked at research published in the past ten years to better understand how childhood maltreatment and ADHD are connected. Across many studies, there was a clear and consistent link between experiences of maltreatment and ADHD. Children who experienced abuse or neglect were more likely to show symptoms of ADHD, and their symptoms were often more severe or lasted longer over time. However, the relationship appears to be complex. Some studies suggest that children with ADHD may also be more vulnerable to negative or harsh responses from caregivers because of behaviors such as impulsivity, hyperactivity, or emotional outbursts. This means the relationship between ADHD and maltreatment may go in both directions. Recent research also highlights the role of family stress, emotional difficulties, and biological stress responses in shaping how these experiences affect children over time. These findings suggest that when professionals assess a child for ADHD, it is important to also consider whether the child has experienced trauma or significant stress.
Globally, an estimated 12-13% of children experience sexual abuse, with prevalence rates of approximately 18% among girls and 8% among boys. Clinicians evaluating pediatric patients who present with anogenital complaints or lesions face considerable diagnostic challenges. The purpose of this narrative review is to outline the most frequently encountered conditions that can mimic child sexual abuse (CSA), thereby raising clinical awareness and helping to minimize both false-positive and false-negative diagnoses. We conducted a semi-systematic literature search in PubMed covering the period from 2000 to 2025, using the search terms "child sexual abuse," "differential diagnosis," "mimics," and "mimickers," supplemented by the German interdisciplinary guideline on child abuse and neglect. Notably, the vast majority of children who have been sexually abused present without detectable physical abnormalities. Conversely, an erroneous diagnosis of abuse-or the failure to identify a treatable underlying condition-can carry severe consequences. Many practitioners in primary care lack sufficient training to distinguish the wide range of dermatologic and systemic disorders that may affect the anogenital region. Precise recognition, careful documentation, and scientifically grounded interpretation of physical findings are critical to ensue child protection. Optimal medical care for suspected CSA victims requires that clinicians possess expertise in pediatric and adolescent gynecology and forensic medicine, recognize the constraints inherent to physical examination findings, and consistently employ up-to-date classification frameworks and clinical guidelines. Heightened awareness of CSA mimickers is essential both to prevent unfounded allegations and to ensure timely, appropriate management of genuine abuse.
Child neglect, defined as a parent or guardian's failure to provide basic needs such as food, clothing, shelter, or medical care, is a widespread global public health issue with long-term consequences for child development. To implement an artificial intelligence-based analysis of street-level imagery to detect built and natural environmental characteristics and to associate these indices with neighborhood-level child neglect risk, while controlling for socioeconomic factors. Street-level imagery, the Area Deprivation Index (ADI), and child neglect incidents were aggregated to census block groups (CBGs; n = 141) within neighborhoods in Los Angeles, California, USA. We analyzed Google Street View images randomly sampled within neighborhoods using semantic segmentation, a computer vision (CV) technique, to quantify environmental features. These measures were aggregated into CBGs and combined into indices representing natural surveillance, natural environment, lighting, and land-use mix. Zero-inflated negative binomial models, incorporating the child population as an offset, were estimated to evaluate associations with neighborhood neglect rates while controlling for the ADI. Higher levels of natural surveillance, natural environment, lighting, and land use mix were each associated with reduced neighborhood neglect risk, controlling for area-level deprivation. AI analysis of street imagery benefits child welfare research by translating environmental features into measurable indices that reflect residents' subjective perceptions and objective realities. Research can use these tools to improve evidence-based policy, aiding neighborhood strategies and prevention efforts to reduce child neglect.
Given the prevalence of online trolling among university students, identifying its contributing factors is essential. However, few studies have explored the potential role of past family experience in facilitating this behavior, or the mediating and buffering mechanisms underlying this relationship. This study sought to examine the relationship between childhood neglect and online trolling among university students, as well as the mediating mechanism of depressive symptoms and the moderating mechanism of self-concept clarity in this relationship. A three-wave longitudinal study was performed over six months, with a three-month interval between each pair of assessment time points. A total of 501 Chinese university students completed the scales relevant to this study three times. Time 1 (T1) childhood neglect positively predicted Time 3 (T3) online trolling, and Time 2 (T2) depressive symptoms mediated this relationship. T1 self-concept clarity moderated the indirect effect of T1 childhood neglect on T3 online trolling. Specifically, the mediating effect of the path through which T1 childhood neglect predicted T3 online trolling via T2 depressive symptoms became weaker when self-concept clarity increased. Childhood neglect is associated with university students' online trolling through greater depressive symptoms. For those with childhood neglect experiences, self-concept clarity appears to be associated with lower levels of online trolling over time through lower depressive symptoms.
Child abuse continues to be a big concern for the country of India, with its huge population and massive population of children, and varied socio-cultural and religious activities. After some concerted efforts from the government and other NGOs, and with some change in literacy and awareness, this continues to be a major cause for concern. This paper would focus on the socio-cultural context, legal provisions, reporting mechanisms, and rehabilitation efforts related to child abuse in India. Using a bibliometric analysis of the literature published between 2018 and June 2025, along with a qualitative content review of literature where key patterns and gaps were identified. Global and regional trends were highlighted using the Visualisation of Similarities (VoS) viewer, while thematic coding and critical analysis provided insights into the Indian context. Five major themes were discussed: socio-cultural factors in child abuse, gender-specific victimisation, incidents happening within the thought safety of the child space, long-term post-traumatic effects, and escalation requirements that require integrated efforts. These findings highlight the complexities and weaknesses of the current system of the child abuse scenario in India; there is an urgent call for more inclusive research and policies. It is important that there be a coordinated effort from policymakers, healthcare professionals, educators, and the public to better address and mitigate this issue. Improved preventive measures, strong interventions, and an integrated strategy will help safeguard children and create a society that ensures their welfare and safety.
A growing body of research underscores the detrimental impact of child maltreatment on a child's development. Encompassing a wide range of actions by caregivers that significantly impede optimal development and violate societal norms, child maltreatment can manifest in various forms, including neglect of physical, cognitive, emotional, and social needs. Accordingly, this study aimed to describe the self-reported psychological, social, and physical sequelae reported by Egyptian university students with histories of childhood maltreatment. Employing a cross-sectional design, researchers conducted the study over a six-month period. Participants completed self-report questionnaires in the presence of research team members. The questionnaires were designed to assess the type of child abuse experienced, along with its long-term physical, social, and psycho-behavioral effects. The findings describe a high prevalence of self-reported psycho-behavioral and physical health difficulties among university students with histories of childhood maltreatment. Specifically, participants reported experiencing symptoms of generalized anxiety, low self-esteem, feelings of inadequacy, and post-traumatic stress symptoms. Notably, gastrointestinal problems emerged as the primary physical health concern reported among participants with histories of childhood maltreatment. This study describes a substantial burden of self-reported psychological and physical difficulties among university students with histories of childhood maltreatment. Because the study was descriptive, cross-sectional, and based on a non-validated self-report questionnaire, further research using validated measures and more rigorous designs is needed. The study was retrospectively registered with ClinicalTrials.gov under the identifier NCT06366126 on April 10, 2024.
High psychological stress has been widely reported among patients with head and neck cancer (HNC); however, its association with early life predictors remains underexplored. This study aimed to evaluate the prevalence of childhood trauma and its association with perceived psychological stress in patients diagnosed with HNC. A total of 150 patients were assessed after cancer diagnosis and before treatment initiation. Demographic and clinicopathological data were obtained from medical records. Perceived psychological stress was measured by the reduced 10-item perceived stress scale (PSS-10). Overall occurrence of childhood trauma and its subtypes were assessed using the Childhood Trauma Questionnaire (CTQ). Most participants were male (78.7%), middle-aged (56.0%), married (58.7%), and had an elementary level of education (47.3%). Overall, 133 patients (88.7%) reported the occurrence of at least one type of childhood trauma, Physical abuse was the most reported childhood trauma subtype by the HNSCC patients (76.7%), followed by emotional neglect (56%), physical neglect (41.3%), emotional abuse (24.7%) and sexual abuse (3.3%). When perceived psychological stress levels were categorized into quartiles and adjusted for clinicopathological and biobehavioral variables, childhood physical neglect was significantly associated with higher psychological stress levels (OR = 1.18; 95% CI: 1.012-1.39; p = 0.034). The occurrence of childhood emotional abuse was associated with lower perceived stress levels (OR = 0.82; 95% CI: 0.692-0.99; p = 0.043). These findings demonstrate, for the first time, that diferente types of childhood maltreatment can modulate psychological stress levels in patients with head neck cancer. Screening and clinical management strategies aimed at reducing psychological stress in this population should consider the potential impact of adverse childhood experiences.
Child protection systems are critical in responding to and resolving child maltreatment concerns. Mapping trends in system activity and expenditure can highlight opportunities to better support vulnerable children and families. To describe national and state/territory trends in child protection system activity and government expenditure in Australia. All children aged <18 years who had contact with Australian state/territory child protection systems between 2014-15 and 2023-24. We conducted a descriptive analysis of publicly reported population-level data from the Australian Institute of Health and Welfare and the Productivity Commission. Child protection system activity indicators included investigations of alleged maltreatment notifications, substantiated investigations, care and protection orders, and out-of-home care (OOHC) placements. Expenditure included the total and per child costs of child protection system activity to the government. National child protection activity remained largely stable from 2014-15 to 2023-24, despite notable variation across states/territories. Over 50% of children were repeat clients (i.e., had previously been the subject of an investigation). Substantiated notifications for emotional abuse rose from 43.1% to 57.0% over the period, and government spending on child protection services nearly doubled from AUD 5.4 billion in 2014-15, to AUD 10.2 billion in 2023-24. Despite increased national investment in child protection, overall system activity has remained stable, with notable variation across states/territories. High proportions of repeat clients suggest persistent unmet needs among children and families. These results highlight the value of earlier, preventive support to create more sustainable pathways and reduce reliance on statutory response systems.
Intrafamilial violence against children is a significant public health issue with long-lasting medical, psychological, and legal consequences. Forensic physicians play a critical role in documenting such abuse, yet their contributions are often overlooked. Describe the characteristics of forensic medical evaluations performed on child victims of suspected intrafamilial abuse and assess the scope of the forensic physician's role. This retrospective observational study was conducted at the Forensic Medical Unit (UMJ) of La Timone Hospital in Marseille. All medico-legal reports for minors (under 18 years old) who were referred for suspected intrafamilial violence between January 2020 and May 2022 were reviewed. Cases involving accidental or extrafamilial violence were excluded. Among the 15,569 individuals examined at the Forensic Unit, 1008 forensic certificates involved minors in cases of intrafamilial abuse: 423 boys and 585 girls aged from 6 days to 17 years. Physical abuse was reported by 78% of children: 61% had at least one injury upon physical examination (mainly bruising), and more than a quarter of these injuries were identified as non-accidental. Psychological abuse was reported by 16% of children and was associated with physical abuse in 94% of cases. Significant psychological distress was observed in 16%, primarily among those over 12 years old. Neglect, mainly physical neglect, was reported in 19% of minors. The study underscores the recurrent and complex nature of intrafamilial abuse and highlights the unique yet constrained role of forensic physicians. Enhancing multidisciplinary collaboration, such as through specialized pediatric forensic units (UAPED), is crucial for improving the assessment and documentation of all dimensions of child abuse.