Specific injuries will have specific consequences. The mortality from abusive head trauma (AHT) is high. Around 20% to 30% of AHT child victims die of their injuries, and around two-thirds survive only to have significant long-term disability, including neurologic, behavioral, and cognitive sequelae.[10]Christian CW, Committee on Child Abuse and Neglect, American Academy of Pediatrics. The evaluation of suspected child physical abuse. Pediatrics. 2015 May;135(5):e1337-54.
https://publications.aap.org/pediatrics/article/135/5/e20150356/33747/The-Evaluation-of-Suspected-Child-Physical-Abuse
http://www.ncbi.nlm.nih.gov/pubmed/25917988?tool=bestpractice.com
[65]Chiesa A, Duhaime AC. Abusive head trauma. Pediatr Clin North Am. 2009 Apr;56(2):317-31.
http://www.ncbi.nlm.nih.gov/pubmed/19358918?tool=bestpractice.com
Children with AHT have a poorer outcome than children with accidental head trauma, with longer hospital stays and higher morbidity.[24]Vinchon M, Defoort-Dhellemmes S, Desurmont M, et al. Accidental and nonaccidental head injuries in infants: a prospective study. J Neurosurg. 2005 May;102(4 Suppl):380-4.
http://www.ncbi.nlm.nih.gov/pubmed/15926388?tool=bestpractice.com
[168]Keenan HT, Runyan DK, Marshall SW, et al. A population-based comparison of clinical and outcome characteristics of young children with serious inflicted and noninflicted traumatic brain injury. Pediatrics. 2004 Sep;114(3):633-9.
http://www.ncbi.nlm.nih.gov/pubmed/15342832?tool=bestpractice.com
Poor outcomes and fatalities from abusive abdominal injury are significantly higher than for accidental abdominal trauma.[169]Lane WG, Lotwin I, Dubowitz H, et al. Outcomes for children hospitalized with abusive versus noninflicted abdominal trauma. Pediatrics. 2011 Jun;127(6):e1400-5.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3103272
http://www.ncbi.nlm.nih.gov/pubmed/21555490?tool=bestpractice.com
Mortality is higher for immersion scalds than for accidental spill burns.[138]Purdue GF, Hunt JL, Prescott PR. Child abuse by burning - an index of suspicion. J Trauma. 1988 Feb;28(2):221-4.
http://www.ncbi.nlm.nih.gov/pubmed/3346922?tool=bestpractice.com
[170]Nakarmi KK, Pathak BD, Shrestha D, et al. Comparison of accidental pediatric scald burns in a tertiary care center: hot cauldron burns versus accidental spill burns. F1000Res. 2021;10:1086.
https://f1000research.com/articles/10-1086/v2
http://www.ncbi.nlm.nih.gov/pubmed/35083037?tool=bestpractice.com
Of all forms of child maltreatment, neglect most commonly causes fatalities in the form of starvation, lack of necessary medical care, or lack of appropriate supervision.
Children who have been abused manifest a variety of negative outcomes as adults, including high-risk behaviors such as binge drinking, drug use, and criminal behavior.[12]Gilbert R, Spatz Widom C, Browne K, et al. Burden and consequences of child maltreatment in high income countries. Lancet. 2009 Jan 3;373(9657):68-81.
http://www.ncbi.nlm.nih.gov/pubmed/19056114?tool=bestpractice.com
[171]Danese A, Moffitt TE, Harrington H, et al. Adverse childhood experiences and adult risk factors for age-related disease: depression, inflammation, and clustering of metabolic risk markers. Arch Pediatr Adolesc Med. 2009 Dec;163(12):1135-43.
https://jamanetwork.com/journals/jamapediatrics/fullarticle/382524
http://www.ncbi.nlm.nih.gov/pubmed/19996051?tool=bestpractice.com
[172]Wegman HL, Stetler C. A meta-analytic review of the effects of childhood abuse on medical outcomes in adulthood. Psychosom Med. 2009 Oct;71(8):805-12.
http://www.ncbi.nlm.nih.gov/pubmed/19779142?tool=bestpractice.com
[173]Rivera B, Widom CS. Childhood victimization and violent offending. Violence Vict. 1990 Spring;5(1):19-35.
http://www.ncbi.nlm.nih.gov/pubmed/2278946?tool=bestpractice.com
Child abuse of any form (emotional, physical, or sexual abuse, neglect) is also associated with increased mental health problems in adulthood.[10]Christian CW, Committee on Child Abuse and Neglect, American Academy of Pediatrics. The evaluation of suspected child physical abuse. Pediatrics. 2015 May;135(5):e1337-54.
https://publications.aap.org/pediatrics/article/135/5/e20150356/33747/The-Evaluation-of-Suspected-Child-Physical-Abuse
http://www.ncbi.nlm.nih.gov/pubmed/25917988?tool=bestpractice.com
This may include depression, post-traumatic stress disorder, substance abuse, or antisocial personality disorder.[12]Gilbert R, Spatz Widom C, Browne K, et al. Burden and consequences of child maltreatment in high income countries. Lancet. 2009 Jan 3;373(9657):68-81.
http://www.ncbi.nlm.nih.gov/pubmed/19056114?tool=bestpractice.com
[174]Luntz BK, Widom CS. Antisocial personality disorder in abused and neglected children grown up. Am J Psychiatry. 1994 May;151(5):670-4.
http://www.ncbi.nlm.nih.gov/pubmed/8166307?tool=bestpractice.com
[175]Afifi TO, Fortier J, Sareen J, et al. Associations of harsh physical punishment and child maltreatment in childhood with antisocial behaviors in adulthood. JAMA Netw Open. 2019 Jan 4;2(1):e187374.
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2722572
http://www.ncbi.nlm.nih.gov/pubmed/30681709?tool=bestpractice.com
Child abuse has also been associated with numerous poor adult physical health outcomes, including obesity, cancer, heart disease, and lung disease. Furthermore, there are ongoing studies evaluating epigenetic mechanisms for these physical health outcomes in adulthood from child abuse and neglect.[176]Yang BZ, Zhang H, Ge W, et al. Child abuse and epigenetic mechanisms of disease risk. Am J Prev Med. 2013 Feb;44(2):101-7.
https://www.ajpmonline.org/article/S0749-3797(12)00797-0/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/23332324?tool=bestpractice.com
[177]Leeb RT, Lewis T, Zolotor AJ. A review of physical and mental health consequences of child abuse and neglect and implications for practice. Am J Lifestyle Med. 2011 Jun 3;5(5):454-8.
Abused children also have a lower educational attainment and are overrepresented among those receiving special educational support.[12]Gilbert R, Spatz Widom C, Browne K, et al. Burden and consequences of child maltreatment in high income countries. Lancet. 2009 Jan 3;373(9657):68-81.
http://www.ncbi.nlm.nih.gov/pubmed/19056114?tool=bestpractice.com
[178]Perez CM, Widom CS. Childhood victimization and long-term intellectual and academic outcomes. Child Abuse Negl. 1994 Aug;18(8):617-33.
http://www.ncbi.nlm.nih.gov/pubmed/7953902?tool=bestpractice.com
The long-term financial outlook for survivors of abuse is also poorer than for nonabused children.[12]Gilbert R, Spatz Widom C, Browne K, et al. Burden and consequences of child maltreatment in high income countries. Lancet. 2009 Jan 3;373(9657):68-81.
http://www.ncbi.nlm.nih.gov/pubmed/19056114?tool=bestpractice.com