The Battered-Child Syndrome: 50 Years Later

It was only after this medical "discovery" in 1962 that child abuse was recognized as a regular and recurring aspect of family life, not a sensational exception but a common syndrome.
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The year 2012 has provided the occasion for looking back 50 years to some of the historical and cultural landmarks of 1962, from Vatican II and the Cuban Missile Crisis to the environmental warning of Rachel Carson's Silent Spring and the cinematic thrills of the first James Bond film, Dr. No. Among the subdued and academic but still revolutionary events of 1962 was the publication in the Journal of the American Medical Association of the article "The Battered-Child Syndrome," which completely transformed the way we think about children in our society.

"The Battered-Child Syndrome is a term used by us," wrote the authors, "to characterize a clinical condition in young children who have received serious physical abuse, generally from a parent or foster parent." It was only after this medical "discovery" in 1962 that child abuse was recognized as a regular and recurring aspect of family life, not a sensational exception but a common syndrome.

Historians suppose that child abuse, both physical abuse (battering) and sexual abuse, were at least as common in past centuries as they are today, but instances were rarely documented, because neither medical nor legal frameworks existed for identifying or discussing them. In fact, child abuse is not abuse unless defined as such, so there is always an element of anachronism in applying the term to the maltreatment of children before 1962, while even today the standard for what constitutes abuse varies widely from culture to culture. I have just written a book about a case that occurred in Venice in the 18th century, when a 60-year-old man was accused of having sex with an 8-year-old girl; he was charged merely with "causing a scandal," as there was no other plausible criminal charge on the books, and made to pay a fine to the girl's family. In a notable case in 19th-century New York, the battering of a child could only be prosecuted with reference to the advocacy of the ASPCA and its mandate against cruelty to animals. The publication of the "The Battered-Child Syndrome," however, offered clinical evidence that child abuse was happening all around us all the time, and began to make us all aware of the huge dimensions of this hitherto-submerged syndrome of shocking but quotidian and recurrent human tragedies.

The first author of "The Battered Child Syndrome," C. Henry Kempe, was a pediatrician from a German Jewish family that emigrated from Nazi Germany in the 1930s. He was working at the University of Colorado Medical School in 1962 and trying to understand a seemingly-inexplicable pattern of injuries in young children, such as mysterious fractures and convulsions, without any known history of trauma. The second author, Frederic Silverman, was a radiologist, for the discovery of child abuse was a matter of X-ray technology. Working in the new postwar field of pediatric radiology, Silverman published an article in 1953 on "The Roentgen Manifestations of Unrecognized Skeletal Trauma in Infants," and in 1962 "The Battered-Child Syndrome" was chillingly illustrated with the X-ray images of children's multiple fractures: "The bones tell a story the child is too young or too frightened too tell."

"Beating of children," the article noted, "is not confined to people with a psychopathic personality or of borderline socioeconomic status. It also occurs among people with good education and stable financial and social background." In fact, the authors feared that other doctors would "have great reluctance in believing that parents were guilty of abuse." The pursuant identification of child sexual abuse, also studied by Kempe, seemed no more easily believable than battering abuse.

I was a child in 1962, and I think every child I knew, or at least every boy child, was sometimes spanked by his parents. And all children knew very well that there were some kids who were beaten much more severely than others. Talk of parents beating with belts was very common, and while it was considered bad luck to have such a parent, certainly it never occurred to us as children that there was any possible recourse. Twenty-five years later, when I took a child of my own to a hospital emergency room for an accidental cigarette burn from a stranger waving a cigarette in a public place (remember cigarettes in public places?) I myself was questioned rigorously to ascertain that I, the parent, was not responsible for the wound, now well-established as a common mark of abuse: "You don't smoke?" "Are you sure you don't smoke?" "You don't ever smoke?" The passage of a quarter century from my own childhood to my own parenthood was precisely the period in which "The Battered-Child Syndrome" had become an integral part of pediatric thinking, with doctors now trained to consider as a matter of routine that even parents with good education and stable background could be abusers.

In New York state today, there is a long list of professionals required to report on suspected child abuse, from doctors and nurses, to teachers and day care workers, to police officers and district attorneys. Furthermore, as people came to understand the ways that parental physical discipline could become, or be construed as, battering abuse, there was a shifting in world opinion about the routine spankings of my childhood. In 1979, Sweden actually made the corporal punishment of children illegal, and 33 other countries have followed, though not the United States. In 1987, in New York City, the case of Lisa Steinberg, age 6, was discovered and prosecuted only after she had been battered to death. The recent Penn State sexual abuse case illustrates how difficult it was for people to accept and confront instances of abuse that occurred relatively openly on a university campus but were overlooked or covered up for more than a decade.

The publication of "The Battered-Child Syndrome" in 1962, transforming the way we see our society, has inevitably made us all more suspicious of the world around us. Every medical student, every police officer, every teacher, is fully aware of the dark side of family life, and the possibility that children are victims and parents are perpetrators. The discovery of child abuse in 1962 has made it possible to look for and identify abuse systematically -- in the emergency room, in the classroom, in the apartment next door -- though, tragically, it has not enabled us to prevent it from recurring with persistent and terrible regularity.

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