Prevalence of physical abuse by caregivers toward infants aged 0-24 months: a systematic review and meta-analysis.

Abstract

Background: Although the prevalence of physical abuse in childhood is well studied, the extent among infants-a period of high vulnerability-remains poorly characterized. We aimed to estimate the prevalence of physical abuse of infants (<24 months) by caregivers, using data from anonymous self-report studies.

Methods: A systematic review and meta-analysis were conducted following the Cochrane Handbook. We searched MEDLINE, Embase, PsycINFO, CINAHL, and Web of Science (inception to Sep 3rd, 2025) for studies anonymously reporting the prevalence of physical abuse toward infants (0-24 months) by primary caregivers. Two reviewers independently screened studies and assessed risk of bias using the Joanna Briggs Critical Appraisal tool for prevalence studies. Prevalence estimates were aggregated using Bayesian multilevel logistic regression and heterogeneity quantified with 95% prediction intervals. The protocol was registered with PROSPERO (ID: CRD42023459469).

Findings: We identified 20 relevant studies (>220,000 caregivers) with prevalence estimates spread across 16 types of abuse, spanning North America, Europe, and East Asia. The pooled prevalence of reporting at least one form of abuse in a typical sample was 4·8%, 95% CI [2·6%, 7·5%] or 3·9%, 95% CI [1·9%, 6·4%] excluding "lesser" forms of abuse (e.g., spanking)-but with notable heterogeneity, 95% prediction interval [0·6%, 11·9%]. Aggregate estimates ranged from <3% for severe forms of abuse (e.g., shaking, hitting) to 9·5% for spanking or 20·5%-21·0% for slapping on the wrist (which might be culturally sanctioned in some areas).

Interpretation: Approximately one in twenty infants in a typical sample worldwide experience physical abuse by caregivers, though estimates vary and are likely underreported. Even in the first two years of life, many children face violent caregiving practices, pointing to an urgent need for prevention. The large gap between self-reports and official statistics highlights that most infant abuse remains hidden.

Funding: No funding was received for this research.