Despite laws to protect them, the number of abused and neglected children in the United States has increased dramatically—likely due to an increase in maltreated children as well as increase in ascertainment and reporting. An estimated almost 900,000 reports of child maltreatment were substantiated in 2002. Of these, 60% involved child neglect, 20% physical abuse, 10% sexual abuse, and 7% emotional maltreatment (see Table 22.1). An estimated 1,400 children died of maltreatment in 2002. Eighty percent of perpetrators of physical abuse were parents, but less than 3% of all parent perpetrators were associated with sexual abuse. Girls are five times more likely to be the victim of sexual abuse. Infant boys have the highest rate of fatalities.

It is clear from these statistics that child abuse and neglect are of epidemic proportions. Developmental, psychiatric, and physical scars are the result. Chapter 19 reviews the psychiatric disorders associated with trauma. The present chapter will review risk and protective factors for child abuse and neglect, and discuss the role of individual assessment and intervention, as well as societal education and policy advocacy to help improve the care of infants, children, and adolescents in our country.