Fourth National Incidence Study of Child Abuse and Neglect (NIS–4)

Serious harm. As noted above, NIS defines an injury or impairment asserious when it involves a life-threatening condition, represents a long-term impairmentof physical, mental, or emotional capacities, or requires professional treatment aimed atpreventing such long-term impairment. Examples of serious injuries/impairmentsinclude: loss of consciousness, stopping breathing, broken bones, schooling loss thatrequired special education services, chronic and debilitating drug/alcohol abuse,diagnosed cases of failure to thrive, third-degree burns or extensive second-degree burns,and so forth. 30 Serious harm from Harm Standard maltreatment occurred to 6.6 childrenper 1,000 in 2005–2006, representing 487,900 children, or over one-third (39%) of allchildren who were countable under the Harm Standard.Moderate harm. Moderate injuries or impairments are those that persistedin observable form (including pain or impairment) for at least 48 hours (e.g., bruises,depression or emotional distress not serious enough to require professional treatment).Moderate harm occurred to 9.4 children per 1,000 (or 694,700 children) in 2005–2006,and these accounted for over one-half (55%) of all children countable under the HarmStandard.Inferred harm. Under the NIS definitions, the nature of the maltreatmentitself gave reasonable cause to assume that injury or impairment probably occurred for 1child per 1,000 in the United States in 2005–2006, or 71,500 children countable under theHarm Standard. 31 Following the hierarchy conveyed by the ordering in Table 3–2, theNIS uses the “inferred harm” category only for qualifying children who did not alsosustain fatal, serious, or moderate harm. However, inferred harm should not be30 Details are in the “Evaluative Coding Manual” in the NIS–4 Analysis Report (Sedlak, Mettenburg,Winglee et al., 2010).31 As described in the preceding sections, there are instances where the Harm Standard guidelines permitinferring that a child was harmed, even though observable symptoms were not yet evident. Theseconditions include the more serious forms of sexual abuse, blatant abandonment, blatant refusal ofcustody, illegal transfers of custody, and extremely close confinement (tying or binding). In addition, theHarm Standard guidelines permit circumstantial evidence of harm to support a child’s countability inconnection with “other” sexual abuse (i.e., beyond intrusion and genital molestation), “other” closeconfinement, verbal or emotional assault and threats, terrorizing, administering unprescribed drugs,“other” abuse or exploitation (i.e., beyond the forms readily classifiable as sexual, physical, or verbal),unstable custody arrangements, and “other” custody-related neglect.3–12