Introduction

In 1962 pediatricians were instrumental in bringing the “battered child syndrome” (Kempe, Silverman, Steele, Droegemueller, and Silver, 1962) to professional and public attention. Pediatricians are responsible for the health and welfare of children, and must therefore play an important role in addressing the immense problem of child maltreatment. In this chapter, we trace the development of pediatric involvement in the realm of child abuse and neglect, examine the principles and dilemmas of current practice, and explore potential roles.

Course of pediatric involvement and thinking

Radiologists have a maxim: “You see what you look for, and you look for what you know.” For many years physicians have taken care of injured children, but until recently the likelihood that a proportion of those injuries were inflicted appears not to have been considered. Somehow, alternate explanations were found. Today, the major incidence studies of child maltreatment show it to be a phenomenon of epidemic proportions (Straus, Gelles, and Steinmetz, 1980; American Humane Association, 1985; Straus and Gelles, 1986), and pediatricians play a central role in the assessment, diagnosis, and care of maltreated children. A brief historical sketch of how this involvement has developed places current medical practice in perspective.

Before Kempe

Child abuse is not new. Although incidence data have only been assembled in recent years, it is evident that child abuse dates back at least to the beginning of recorded human history (Lynch, 1985; De Mause, 1974). And yet, there is no mention of child abuse in the medical literature until the middle of the twentieth century. How might this be explained?