Definitional ambiguity has been a major stumbling block in child abuse and neglect research and practice. There has been considerable difficulty in formulating valid and reliable definitions of child maltreatment. Definitions are critical because they influence case identification and thereby knowledge about child maltreatment. Identification of child maltreatment relies on a complex interaction of (1) harm to the child; (2) caretaker behaviors that produced or contributed to that harm; and (3) societal or cultural assignment of responsibility or culpability.

Child maltreatment was initially defined in the medical and social welfare literature in the United States and Europe during the 1960s and 1970s. Definitions centered on physical harm resulting from acts of omission or commission by parents and other caretakers. Two diagnostic criteria were particularly important. First, child abuse was identified when children had injuries that did not match with their caretaker's explanations of how the injuries occurred. Second, because child abuse is rarely a one-time occurrence, an important diagnostic sign was the identification of multiple injuries in various stages of healing. The early work on child abuse and neglect focused on children who had been seriously harmed, either by being physically assaulted with resulting injuries or by being neglected with tangible evidence, such as severe malnutrition.

Over the next 40 years, definitions expanded in both the national and international literatures to encompass a broad range of harms to children. The four basic categories of child maltreatment are: physical abuse, physical neglect, emotional maltreatment, and child sexual abuse. Neglect may also include medical neglect or educational neglect if a parent or caretaker does not meet the child's basic needs in these two areas. Neglect may also include non-organic failure to thrive, which involves sustained subnormal growth in an infant that can be attributed to parental deprivation of the infant's nutritional and emotional needs. A type of child maltreatment that was identified primarily in medical settings, Munchausen's Syndrome by Proxy, is a facetious illness fabricated by a parent, usually a mother with previous medical knowledge and experience. The induced symptoms may be damaging, or even fatal, to the child. Fatal maltreatment, in which a child dies from a repetitive pattern of abuse and/or neglect, is often a separate category in the professional literature.

International child abuse efforts have resulted in additional definitional categories. Even though these problems exist in Euro-American nations, the international literature brought them more to the forefront. First, child labor is a matter of some controversy in that the anthropological literature has documented the positive effects of children socialized while working alongside their families in agricultural, gathering and hunting, or other subsistence activities. When children's labor becomes exploitive, however, most often with children laboring away from their families in factories or industries making exports, international advocacy groups may include this as a category of child maltreatment. Second, child prostitution has been included under the definitional category of child sexual abuse. And, third, selective neglect, or underinvestment, has been identified in international demographic data through patterns of differential mortality in which some categories of children are less likely to thrive or survive due to medical, nutritional, and other forms of inattention and neglect. One example would be female children in societies with high son preference (Scrimshaw, 1983).

Establishing cross-cultural definitions of child maltreatment has been complex. Just as there is no absolute standard for optimal child-rearing that would be considered valid cross-culturally, there has been difficulty in establishing a universal definition of abusive or neglectful child-rearing. Standards for child abuse and neglect originated in European and North American societies. A long history of anthropological research on cross-cultural child-rearing patterns has shown that European and American cultures are often at odds with child-care practices and patterns in a broader sample of the world's cultures. Defining child maltreatment cross-culturally involves issues of human universals, cultural relativity, and human rights.

Three definitional levels have been suggested for culturally informed definitions of child maltreatment. First, cultural practices vary and what one group considers abusive, another group may consider well within the normative range of behavior. Differences in definitions of child maltreatment that can be ascribed to differences in normative cultural beliefs and practices are not, strictly speaking, abuse since they are not proscribed, at least by the group in question. This does not preclude discussions and evaluations of the relative harm and benefit of different practices, but acknowledges that there is not currently a universally accepted standard for optimal or for deficient child-rearing. Second, idiosyncratic departure from cultural standards and norms affords an intra-cultural view that highlights those individuals who violate the continuum of acceptable behavior. And third, societal-level maltreatment of children is sometimes confused with culturally acceptable behaviors. Societal neglect refers to the level of harm or deprivation that a larger political body (e.g., nation) is willing to tolerate for its children (Korbin, 1981, 1997). Because child maltreatment has not always been labeled as such in other cultures, some anthropological works have examined physical punishment (Levinson, 1989) or emotional climate as accepting or rejecting (Rohner, 1986).

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