Nonaccidental Injury in Children

NAI in children (physical abuse or battering) includes injuries that result from deliberate actions against the child or failure to prevent injury occurring to the child. The spectrum of injury includes the following:

• Skeletal injury.

• Internal injuries (brain, abdomen, or eye).

• Fabricated or induced illness (Munchausen syndrome by proxy, factitious illness).

The range of NAI extends from minor (e.g., bruising) to fatal, and younger infants are at risk of more serious injuries.

Different types of abuse overlap. Physical abuse will often coexist with emotional abuse. Injury may occur in the context of neglect, such as leaving a child unsupervised and exposed to dangerous situations. Physically abused children are at increased risk of sexual abuse. Hobbs and Wynne (12) found that 1 in 6 of 769 physically abused children and 1 in 7 of 949 sexually abused children had suffered both forms of abuse.

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