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CHILD MALTREATMENT

ESSENTIALS OF DIAGNOSIS ICD-10 Diagnostic Criteria

The legal definitions regarding child maltreatment vary from state to state. In general, neglect is the failure to provide adequate care and protection for children. It may involve failure to feed the child adequately, provide medical care, provide appropriate education, or protect the child from danger. Physical abuse is the infliction of nonaccidental injury by a caretaker. It may take the form of beating, punching, kicking, biting, or other methods. The abuse can result in injuries such as broken bones, internal hemorrhages, bruises, burns, and poisoning. Cultural factors should be considered in assessing whether the discipline of a child is abusive or normative (Giardino & Alexander, 2005; Helfer et al, 1999). Sexual abuse of children refers to sexual behavior between a child and an adult or between two children when one of them is significantly older or more dominant. The sexual behaviors include the following: touching breasts, buttocks, and genitals, whether the victim is dressed or undressed; exhibitionism; fellatio; cunnilingus; penetration of the vagina or anus with sexual organs or with objects; and pornographic photography. Psychological abuse occurs when a caretaker causes serious psychological injury by repeatedly terrorizing or berating a child. When serious, it is often accompanied by neglect, physical abuse, sexual abuse, and exposure to domestic violence (Hamarman & Bernet, 2000). Also, psychological abuse occurs when a person indoctrinates a child to fear or hate a parent without good cause, which is sometimes called parental alienation.

The psychiatric classification of abuse and neglect in the International Classification of Diseases, 10th Revision (ICD-10) appears in Chapter XIX, "Injury, Poisoning and Certain Other Consequences of External Causes," and in the section "Maltreatment Syndromes." The codes from ICD-10 related to child maltreatment are the following:

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T74.0 Neglect or abandonment
T74.1 Physical abuse
T74.2 Sexual abuse
T74.3 Psychological abuse

Adapted with permission from the World Health Organization (WHO): International Statistical Classification of Diseases and Related Health Problems 10th Revision, Fifth edition, 2016. Geneva: World Health Organization.

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Giardino  AP, Alexander  R. Child Maltreatment: A Clinical Guide and Reference & A Comprehensive Photographic Reference Identifying Potential Child Abuse. 3rd ed. St. Louis: GW Medical Publishing; 2005.
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Hamarman  S, Bernet  W. Evaluating and reporting emotional abuse in children: Parent-based, action-based focus aids in clinical decision making. J Am Acad Child Adolesc Psychiatry. 2000;39:928.  [PubMed: 10892236]
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Helfer  ME, Kempe  RS, Krugman  RD, eds. The Battered Child. 5th ed. revised. Chicago: University of Chicago Press; 1999.

GENERAL CONSIDERATIONS

Practitioners in private practice, as well as those employed by courts or other agencies, see children who may have been emotionally, physically, or sexually abused. As a clinician, the practitioner may provide assessments and treatment for abused children and their families in both outpatient and inpatient settings. As a forensic investigator, the practitioner may work ...

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