• U Thyen, F Kirchhofer, and C Wattam.
• Klinik für Pädiatrie, Medizinische Universität zu Lübeck. thyen@paedia-mu.luebeck.de
• Gesundheitswesen. 2000 Jun 1; 62 (6): 311-9.

ObjectivesDescriptive study on health outcomes, co-morbidity, severity and social context in child abuse and neglect.MethodsCross-sectional study of consecutively incoming cases in eleven German Child Protection Centres between January and July 1997 using a standardised survey instrument.ResultsWe report on 263 children from 251 families. The majority of children was less than ten years old, 63% were girls, 37% boys. Of all children, 134 had suffered sexual abuse with physical contact, 20 sexual abuse without contact, 77 physical abuse, 62 emotional abuse and 99 neglect (multiple responses were allowed). The overlap between various types of abuse was considerable: many children had suffered more than one, a quarter more than two types of abuse. The majority of cases was classified as either severe and/or chronic. Most children and youngsters suffered emotional distress or posttraumatic stress, long-term consequences of physical injuries were less common. Intra-familiar relationship problems and emotional distress of the care-giver had greater impact on the risk for abuse or neglect compared to socioeconomic risk factors. In 55% child protection workers documented a disability in social and emotional development, in a quarter of children developmental retardation.ConclusionsThe current, exclusive classification of types of abuse and neglect does not adequately describe the complexity of childrens' experiences of intra-familiar violence. Future research should be oriented towards the physical, emotional and social consequences of child maltreatment and use multifactorial designs to capture the complex aetiology and multiple acts and omissions responsible for the distress and injuries. Prospective studies are important to assess specific effects of child abuse and neglect on child development.

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