More than vigilance: Protecting children from harm

摘要

Physicians have played a prominent role historically in elucidating the scope and significance of abuse of children. The modern era of child protection efforts is often dated to the seminal 1946 paper by John Caffey,2 an expert in the evolving field of radiology, in which he described the association of multiple fractures and subdural hemorrhages in young children. This was followed by a series of careful, thoughtful reports of injured children from clinicians like Henry Kempe and Frederic Silverman.3 This spotlight of medical data helped overcome the natural reactions of denial and secrecy in society, and 1974 federal legislation called Child Abuse Treatment and Protection Act (Public Law 93-247) mandated that each state would have a state agency charged with the protection of children. At this time, almost 40 years later, child abuse is universally accepted as a recognized medical entity. For ease of categorization, types of abuse are often simplistically separated into the 4 basic types of abuse: physical abuse, sexual abuse, emotional abuse, and neglect. In 2009, the field of Child Abuse Pediatrics became the 14th recognized subspe-ciality by the American Board of Pediatrics.