Update on child physical abuse, sexual abuse, and prevention.

PURPOSE OF REVIEW: The most recent literature regarding assessment and management of child maltreatment will be considered. The current status of abuse prevention activity will also be reviewed.

RECENT FINDINGS: Clinical practice continues to be burdened by the general lack of training and knowledge of the presenting signs and symptoms of child maltreatment by general practitioners. The need for better training is emphasized. Physician engagement in child protection is further inhibited by imprecise reporting obligations and an inadequate child protective services response by the state. Several randomized, controlled trials of home-visiting programs by professionals have demonstrated modest effects in the primary prevention of child abuse and neglect; however, the prevention of recurrent maltreatment of children who remain in the home has proved elusive.

SUMMARY: Current clinician training in child maltreatment is inadequate. Research into effective education of clinicians and program effectiveness is plainly needed, and should be supported by increased funding.