Neglected.

C hild abuse, be it physical, sexual, or emotional, is one of the saddest, needless, and longest running stories in the history of public health. Even more outrageous has been our collectively poor track record in adequately recognizing, solving, or, at least, preventing this problem. Using data collected in 2008, the US Centers for Disease Control and Prevention (CDC) estimated that the total lifetime costs associated with confirmed child abuse and neglect cases for that year (1,740 deaths and 579,000 nonfatal cases) was about $124 billion, although other methods of measurement applied suggest that the cost may be as large as $585 billion. The CDC estimated that the average lifetime cost per victim of nonfatal abuse was $210,012 (broken down, that’s $32,648 in childhood health costs, $10,530 in adult health costs, $144,360 in productivity costs, $7,728 in child welfare costs, $6,747 in criminal justice costs, and $7,999 in special education costs). These lifetime sums put child abuse in the same economic ballpark as strokes ($159,846) or type 2 diabetes (between $181,000 and $253,000). The average lifetime costs associated with fatal child maltreatment are even higher: $1,272,900 (approximately $14,100 in medical costs and $1,258,800 in productivity losses).1 The bleak and tragic stories of abused children are all too familiar to those of us who work as pediatricians, nurses, social workers, teachers, and children’s health or well-being professionals. What appears below is one of the most poignant examples I have read: