Review Article
Volume 10 Issue 7 - 2021
SCAN: A Succinct and Practical Guide for Recognizing and Reporting Suspected Child Abuse and Neglect
Nicholas A Kerna1,2*, Hilary M Holets3,4, Abdullah Hafid5, Kevin D Pruitt6, ND Victor Carsrud7, Uzoamaka Nwokorie8, John V Flores3,4, Raymond Nomel9 and Shain Waugh10
1SMC–Medical Research, Thailand
2First InterHealth Group, Thailand
3Beverly Hills Wellness Surgical Institute, USA
4Orange Partners Surgicenter, USA
5Academy of Integrative Health & Medicine (AIHM),
6Kemet Medical Consultants, USA
7Lakeline Wellness Center, USA
8University of Washington, USA
9All Saints University, College of Medicine, St. Vincent and the Grenadines
10Fettle Path, USA
*Corresponding Author: Nicholas A Kerna, (mailing address) POB47 Phatphong, Suriwongse Road, Bangkok, Thailand 10500.
Received: May 28, 2021; Published: June 30, 2021


Child abuse and neglect are significant public health issues with adverse consequences that can carry over into adulthood, affecting the child's physical, psychological, and emotional development. Approximately 25% of all children confront some form of abuse or neglect during their life. Any violation of a child (a minor–under 18 years of age) by an adult resulting in harm or injury is deemed child abuse.

Abuse recognizes no boundaries. It occurs in every country, at every socioeconomic level, in all races and ethnicities, and spans all education levels. The signs of child abuse and neglect include impulsive and aggressive behavior, depression, anxiety, frequent absence from school, hesitation to return home, and a withdrawal from friends and activities. Physical abuse is suspected due to unexplained bruises, burns, and fractures. Sexual abuse is more difficult to detect without a medical examination. The signs of neglect are poor hygiene, inadequate clothing, stealing, obsessive craving for food, and being overweight or underweight.

Repeated facial trauma is a characteristic of physical abuse. Physicians, dentists, and especially pediatric dentists are uniquely positioned to identify such injuries. Abusive head trauma, known as a shaken baby syndrome, results in brain injury in infants and young children. Nevertheless, it is difficult to detect due to the lack of external signs. While anogenital examinations of victims of sexual abuse are frequently negative, sexual abuse causes prepubertal genital bleeding, mandating routine prepubertal genital examinations in females.

The circumstances for reporting child abuse and neglect have changed drastically in recent years. Many countries have systems in place to respond to reports of child abuse. However, the socioeconomic and cross-cultural differences between developed and developing countries significantly impact the identification, prevention, and management of child abuse. In actuality, child abuse and neglect are frequently overlooked or not reported due to the complex legal procedure inherent to its reporting. Among health care professionals, physicians play a crucial role in detecting, identifying, and reporting suspected child abuse and neglect (SCAN). However, their abilities to do so are considerably influenced by the lack of formal training in this area, starting from their task as medical students, residents, and recent physicians.

Physical abuse is described as a non–accidental bodily injury inflicted on a child by hitting, slapping, pushing, pulling, biting, burning, violent shaking, or any other physical means to control the child. Sexual abuse is any sexual contact or exploitation of the child that includes performing and forcing sex acts upon the child. Sex acts include rape, fondling, indecent exposure, and the exploitation of the child in any sexually explicit manner. Emotional abuse is more prevalent than psychological abuse, acting as a means of control. Similar to physical abuse, it can take the form of threatening to leave the child, being severely critical, shouting, or name-calling. Although psychological abuse encompasses psychological abuse, the latter aims to convince the child that they are incompetent, stupid, or crazed.

While abuse is extreme, neglect—whether physical or emotional—also impacts the child. Physical neglect involves refusing to provide food, clothing, medical care, adequate shelter or supervision, and abandonment. Emotional neglect includes refusing to spend time or displaying affection towards the child. More often, child abuse and neglect are recurrent patterns of behavior involving regular attacks that harm the child with damage directly related to the length of the abusive behavior.

Importantly, this review further covers specifically SCAN for medical students, SCAN for medical residents, SCAN for physicians, and the mandatory reporting of SCAN. Also addressed are 1) the comparative life of the abused or neglected child before and after recognizing and reporting SCAN and 2) legislation to defend children against abuse.

Keywords: Child, Emotional Abuse; Neglect; Physical Abuse; Psychological Abuse; Reporting


  1. Brown CL., et al. “Child Physical Abuse And Neglect (2020).
  2. Gonzalez D., et al. “Child Abuse and Neglect (2020).
  3. 42 US Code § 5101 - Office on Child Abuse and Neglect. LII / Legal Information Institute (2021).
  4. Hornor G. “Child neglect: assessment and intervention”. Journal of Pediatric Health Care2 (2014): 186-192.
  5. Child maltreatment (2021).
  6. Al Odhayani A., et al. “Behavioural consequences of child abuse”. Canadian Family Physician8 (2013): 831-836.
  7. Kempe CH., et al. “The battered-child syndrome”. The Journal of the American Medical Association 181 (1962): 17-24.
  8. D'Antonio IJ., et al. “Child maltreatment: international perspectives”. The American Journal of Maternal/Child Nursing2 (1993): 39-52.
  9. Mathews B and Kenny MC. “Mandatory reporting legislation in the United States, Canada, and Australia: a cross-jurisdictional review of key features, differences, and issues”. Child Maltreatment1 (2008): 50-63.
  10. Mathur S and Chopra R. “Combating child abuse: the role of a dentist”. Oral Health and Preventive Dentistry3 (2013): 243-250.
  11. Paglia L. “Child abuse: Awareness is the first step to action”. European Journal of Paediatric Dentistry2 (2018): 89.
  12. Nagarajan SK. “Craniofacial and oral manifestation of child abuse: A dental surgeon's guide”. Journal of Forensic Dental Sciences1 (2018): 5-7.
  13. Joyce T and Huecker MR. “Pediatric Abusive Head Trauma (2020).
  14. Piteau SJ., et al. “Clinical and radiographic characteristics associated with abusive and nonabusive head trauma: a systematic review”. Pediatrics2 (2012): 315-323.
  15. Hadley J., et al. “Sexual Abuse as a Cause of Prepubertal Genital Bleeding: Understanding the Role of Routine Physical Examination”. Journal of Pediatric and Adolescent Gynecology (2021).
  16. Bailhache M., et al. “Is early detection of abused children possible?: a systematic review of the diagnostic accuracy of the identification of abused children”. BMC Pediatrics 13 (2013): 202.
  17. Diaz A., et al. “Comparison of Modes of Administration of Screens to Identify a History of Childhood Physical Abuse in an Adolescent and Young Adult Population”. Annals of Global Health5-6 (2017): 726-734.
  18. Teeuw AH., et al. “Parents' Opinion About a Routine Head-to-Toe Examination of Children as a Screening Instrument for Child Abuse and Neglect in Children Visiting the Emergency Department”. Journal of Emergency Nursing2 (2016): 128-138.
  19. Teeuw AH., et al. “Screening for child abuse using a checklist and physical examinations in the emergency department led to the detection of more cases”. Acta Paediatrica2 (2019): 300-313.
  20. Giroux ME., et al. “Differences in child sexual abuse cases involving child versus adolescent complainants”. Child Abuse and Neglect 79 (2018): 224-233.
  21. Rizvi MB., et al. “Pennsylvania Child Abuse Recognition and Reporting (2020).
  22. Rizvi MB., et al. “New York State Child Abuse, Maltreatment, and Neglect (2020).
  23. Regis A.
  24. Christian CW. “Professional education in child abuse and neglect”. Pediatrics1 (2008): S13-17.
  25. Alpert EJ., et al. “Interpersonal violence and the education of physicians”. Academic Medicine 1 (1997): S41-50.
  26. Narayan AP., et al. “Pediatric residency training in child abuse and neglect in the United States”. Pediatrics6 (2006): 2215-22221.
  27. Jenny C., et al. “Analysis of missed cases of abusive head trauma”. The Journal of the American Medical Association 7 (1999): 621-626.
  28. Dubowitz H. “Child sexual abuse and exploitation-A global glimpse”. Child Abuse and Neglect 66 (2017): 2-8.
  29. Starling SP., et al. “Child abuse training and knowledge: a national survey of emergency medicine, family medicine, and pediatric residents and program directors”. Pediatrics4 (2009): e595-602.
  30. Pelletier HL and Knox M. “Incorporating Child Maltreatment Training into Medical School Curricula”. Journal of Child and Adolescent Trauma3 (2017): 267-274.
  31. Donohue B., et al. “A standardized method of diplomatically and effectively reporting child abuse to state authorities. A controlled evaluation”. Behavior Modification5 (2002): 684-699.
  32. Warner-Rogers JE., et al. “The influence of case and professional variables on identification and reporting of physical abuse: a study with medical students”. Child Abuse and Neglect9 (1996): 851-866.
  33. Jonson-Reid M., et al. “Child and adult outcomes of chronic child maltreatment”. Pediatrics5 (2012): 839-845.
  34. Deblinger E and Runyon MK. “Understanding and treating feelings of shame in children who have experienced maltreatment”. Child Maltreatment4 (2005): 364-376.
  35. Burgic Radmanovic M. “Mental Disorders in Sexually Abused Children”. Psychiatria Danubina3 (2020): 349-352.
  36. Teicher MH and Samson JA. “Annual Research Review: Enduring neurobiological effects of childhood abuse and neglect”. Journal of Child Psychology and Psychiatry3 (2016): 241-266.
  37. Teicher MH., et al. “The effects of childhood maltreatment on brain structure, function and connectivity”. Nature Reviews Neuroscience10 (2016): 652-666.
  38. Flaherty EG., et al. “From suspicion of physical child abuse to reporting: primary care clinician decision-making”. Pediatrics3 (2008): 611-619.
  39. Flaherty EG., et al. “Pediatrician characteristics associated with child abuse identification and reporting: results from a national survey of pediatricians”. Child Maltreatment4 (2006): 361-369.
  40. Gunn VL., et al. “Factors affecting pediatricians' reporting of suspected child maltreatment”. Ambulatory Pediatrics2 (2005): 96-101.
  41. Al Hajeri H., et al. “Assessment of the knowledge of United Arab Emirates dentists of Child Maltreatment, protection and safeguarding”. European Journal of Paediatric Dentistry2 (2018): 105-118.
  42. European Status Report On Preventing Child Maltreatment.
Citation: Kerna NA, Holets HM, Hafid A, Pruitt KD, Carsrud NDV, Nwokorie U, Flores JV, Nomel R, Waugh S. “SCAN: A Succinct and Practical Guide for Recognizing and Reporting Suspected Child Abuse and Neglect”. EC Paediatrics 10.7 (2021): 63-74.

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