New child abuse spectrum in an era of increased awareness

Three hundred eight-two children were evaluated for abuse or neglect during a 30-month period in a pediatric clinic in a county hospital. Fifty-one percent presented for sexual abuse, 34% for physical abuse, and 15% for neglect. Thirteen children were hospitalized. Children examined for sexual abuse had a mean age of 5.8 years and a median age of 5 years; 71% had normal findings on examination, including 48% of those with a history of penetration. Fourteen children were brought for evaluation on the basis of caretakers' misinterpretation, overconcern, or malice. The current spectrum of patients seen for child abuse or neglect reflects increased public and professional awareness of the problem. Earlier recognition of abuse, especially greater readiness to consider sexual abuse, brings younger, less physically injured children to the clinic.