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JAMA Patient Page
November 27, 2018

Interventions to Prevent Child Maltreatment

JAMA. 2018;320(20):2160. doi:10.1001/jama.2018.17741

The US Preventive Services Task Force (USPSTF) has recently published recommendations on interventions to prevent child maltreatment.

What Is Child Maltreatment?

Child maltreatment refers to acts of abuse or neglect by a parent or caregiver that result in harm or possible harm to a child. Abuse can be physical, psychological, or sexual. Neglect can be failure to protect a child from harm or failure to provide for basic physical, psychological, or educational needs. Child maltreatment is a serious problem in the United States, affecting hundreds of thousands of children each year. Most cases of child maltreatment are neglect. Many cases are not reported. Signs and symptoms of maltreatment are varied but can include frequent injuries, poor hygiene, lack of medical care, frequent absence from school, being excessively withdrawn or fearful, and displaying knowledge of sexual acts inappropriate for age. Child maltreatment can result in injury and death in children, as well as long-term disability, mental health problems, and substance abuse.

How Can Child Maltreatment Be Identified and Prevented?

Primary care clinicians such as pediatricians have frequent contact with children because of the frequency of routine wellness visits in infancy and early childhood. Because of this, they are in a unique position to identify high-risk families and provide or refer for interventions when appropriate. Children at increased risk of maltreatment include those of younger age (<4 years old); those with special health care needs; those with parents who are young, single, or not biologically related to them; those in households with poor education, low income, or social isolation; and those in communities with high rates of violence, high rates of unemployment, or weak social networks.

Examples of interventions that may prevent child maltreatment include referral to community resources, parent education to increase use of positive discipline strategies, and behavioral therapy for parents to improve coping skills and strengthen the parent-child relationship. Home visitation programs are another commonly used approach. These programs involve a professional visiting a child’s home to assess family needs and provide counseling, educational services, and clinical care as needed with the goal of improving family functioning and parent-child interactions.

What Is the Patient Population Under Consideration for Providing Interventions to Prevent Child Maltreatment?

This USPSTF recommendation applies to children and adolescents aged 18 years or younger who do not have any signs or symptoms of maltreatment.

What Are the Potential Benefits and Harms of Providing Interventions to Prevent Child Maltreatment?

The potential benefit of identifying high-risk families for child maltreatment is to provide interventions to prevent child maltreatment before it begins. However, research in this area is limited. There are currently no accurate tools for predicting a child’s individual risk of maltreatment, and there is significant variation in types of preventive interventions and inconsistent reporting of outcomes. Potential harms of preventive interventions include stigma and other negative effects on family life. There are currently not enough data on the potential magnitude of these harms.

How Strong Is the Recommendation for Providing Interventions to Prevent Child Maltreatment?

The USPSTF concluded that current evidence is insufficient to determine the balance of benefits and harms of providing interventions to prevent child maltreatment in children and adolescents.

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Article Information

Source: US Preventive Services Task Force. Interventions to prevent child maltreatment: US Preventive Services Task Force recommendation statement [published online November 27, 2018]. JAMA. doi:10.1001/jama.2018.17772

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