Suffer the children

Dr. Nico Trocmé and colleagues found that among 60 000 substantiated cases of child abuse identified through the Canadian Incidence Study of Reported Child Abuse and Neglect, 96% did not involve serious physical harm. The authors found that the other 4% involved injuries or health concerns that were severe enough to require medical attention. The authors also found that 13% of cases involved moderate injuries or health conditions.

The authors state that immediate action to protect a child is "adequately justified" in cases of sexual abuse or when clear evidence of risk is present, but in other cases priorities should be shifted from rapid intervention to longer-term service needs. They conclude: "The relatively low injury rates documented by the CIS raise questions about the investigative procedures that dominate the organization of child protective services and, in particular, the emphasis that has been placed on risk assessment."

In a related commentary, Drs. Michelle Ward and Susan Bennett state that since the signs of physical harm are not always obvious and that emotional trauma is also a concern, the findings of Trocmé and colleagues are not enough to temper existing rules concerning mandatory reporting, abuse investigations and risk assessments.

"We would advocate for the availability of a broader range of supports and interventions after the initial risk assessment," state Ward and Bennett. "However, the current evidence does not reassure us about the risk of physical harm, particularly for infants."

p. 911 Nature and severity of physical harm caused by child abuse and neglect: results from the Canadian Incidence Study
-- N. Trocmé et al

p. 919 Studying child abuse in Canada: We are just at the beginning
-- M.G.K. Ward, S. Bennett