The stakes are enormous. Child abuse is recognized as a global health issue, and in the United States it occurs at what researchers describe as epidemic proportions. Federal data show 546,159 victims of child abuse and neglect in 2023 alone, and the vast majority of these cases, roughly 89 percent, are committed by one or both parents. Children from minority groups are often the most affected, with Black or African American children among the most likely to experience abuse, second only to American Indian or Alaska Native children. Yet the definitions of what constitutes abuse vary dramatically across countries and cultures, creating a legal and ethical minefield for immigrant families who may not realize that practices considered normal at home are illegal in their new country.

The problem is particularly acute for Hispanic families, who make up 19 percent of the American population and represent the largest share of recent immigrants. Hispanic culture is far from monolithic, encompassing communities from South and Central America and the Caribbean with distinct traditions, but certain common threads run through the research. The concept of familismo, a cultural orientation and sense of obligation to family, has been linked to greater parental warmth in some studies. At the same time, physical violence as a disciplinary method remains common in many Hispanic cultures, and the chances that such behaviors are carried over by families immigrating to the United States are high. The result is a potential collision between generations of cultural practice and a legal system, anchored by the Child Abuse Prevention and Treatment Act of 1974, that defines abuse in terms of serious physical or emotional harm.

What makes the new study distinctive is its grounding in intersectionality theory, a framework rooted in feminist scholarship that examines how multiple categories of identity, such as race, ethnicity, gender, and nativity, interact to shape experience. Rather than treating demographic characteristics as independent variables, the researchers designed their analyses to test whether these dimensions jointly predict how individuals classify discipline practices as culturally acceptable or abusive. The framework has practical urgency: racial and ethnic disparities exist in both the reporting and substantiation of child maltreatment, and current child protection policies can disproportionately affect women of color who use social services and face heightened surveillance and risk of reports to child protective services.

The scale itself emerged from a careful two-stage piloting process. First, four experienced mental health clinicians specializing in child abuse, with 10 to 20 years of experience each, reviewed a draft pool of 54 items describing parenting behaviors and case vignettes. Then ten first-generation Hispanic immigrants from a range of nationalities, including Puerto Rican, Cuban, Colombian, Mexican, Dominican, and Nicaraguan participants, examined the refined items and identified which behaviors they would associate with parents in their own cultures and whether they would label those behaviors abusive or acceptable. Consensus required agreement from at least 70 percent of the pilot group. Eighteen items survived, ten identified as culturally acceptable behaviors such as yelling, using the chancla, the slipper famously wielded in many Latino households, or letting a child sleep with parents, and eight identified as abusive behaviors such as spanking, leaving a child alone in a car, or forcing a child to bathe with an adult.

The main study recruited 1,477 undergraduates at a large Hispanic-Serving Institution in Miami, ultimately yielding an analytic sample of 1,089 participants after exclusions for failed attention checks, missing data, and groups too small for meaningful analysis. The final sample was 72.2 percent Hispanic, 16.3 percent non-Hispanic Black, and 11.6 percent non-Hispanic White, nearly 70 percent U.S.-born, and predominantly female at 88.8 percent. Participants rated each of the 18 behaviors on a three-point scale: not abusive, inappropriate but not abusive, or abusive. The choice of a college population was deliberate, since emerging adults are on the cusp of parenthood, attitudes at this life stage predict later parenting intentions, and parenting practices tend to be transmitted intergenerationally.

Psychometrically, the study unfolded in two parts. Study 1 established the scale’s initial properties using exploratory factor analysis with principal axis factoring and oblique rotation on a polychoric correlation matrix, an approach suited to the ordinal, non-normally distributed responses. The analysis supported a two-factor structure: Factor 1 captured discipline and psychological aggression, including spanking, yelling, the chancla, cursing, ignoring, comparing, fighting, and religion, while Factor 2 reflected neglect and physical endangerment, such as using drugs in front of a child, refusing treatment for illness, and allowing smoking. The two factors accounted for 29.5 percent of the variance and were moderately correlated. Internal consistency for the full 18-item measure was acceptable at a Cronbach’s alpha of 0.71, though the abusive subscale showed weaker reliability, a limitation the authors acknowledge candidly.

Study 2 then deployed regression models to test how demographic identities shaped perceptions, and the results were revealing. Gender and parental status emerged as the strongest and most consistent predictors: women and parents were significantly more likely to classify culturally acceptable practices as abusive. Among Hispanic participants, those not born in the United States were more likely than U.S.-born Hispanics to view behaviors like spanking as abusive, a finding that ran counter to the researchers’ hypothesis and suggests that acculturation may shift parenting beliefs toward American child protection norms. Across racial and ethnic groups, Hispanic participants were more likely than Black participants to classify culturally acceptable practices as abusive. Notably, for the more overtly harmful behaviors in Factor 2, parental status was the only significant predictor, suggesting broad agreement that neglecting a sick child or encouraging substance use transcends cultural and gendered expectations.

The effect sizes were small, with the models explaining roughly 1 to 6 percent of the variance, a reminder that unmeasured cultural and contextual factors account for most of the variation in how people judge discipline. Still, the patterns carry real implications for prevention. The authors suggest that father-focused education programs may be valuable, since men were less likely to identify physical discipline as harmful and may therefore be at greater risk of normalizing such practices. Culturally adapted interventions have already shown promise, from brief summer parent training programs benefiting Hispanic children to the multinational Triple P Positive Parenting Program, and the PPDS could help practitioners identify which disciplinary practices are perceived as acceptable within specific communities, allowing messaging to be tailored rather than uniform.

The researchers are careful to frame their findings as preliminary. The sample was heavily female and drawn from a single Miami institution in a minority-majority city, socioeconomic status was not assessed, and social desirability bias may have influenced responses to questions about parenting. The abusive subscale needs refinement, and future work should apply confirmatory factor analysis and measurement invariance testing across cultural groups. Yet the core contribution stands: a novel measure that captures culturally situated discipline practices invisible to existing tools like the Alabama Parenting Questionnaire or the Child Abuse Potential Inventory. As parenting practices pass from generation to generation and families cross borders into legal systems with different rules, understanding exactly how culture shapes perceptions of abuse may be the first step toward protecting children without criminalizing the traditions their parents brought with them.

Subject of Research: Development and validation of a scale measuring cultural perceptions of parenting and discipline practices

Article Title: Development and Validation of the Parenting Practices and Discipline Scale in an Ethnically Diverse Sample

Article References: Ortiz Diaz, K., Kenny, M. C., & Baez, H. (2026). Development and Validation of the Parenting Practices and Discipline Scale in an Ethnically Diverse Sample. Journal of Child and Family Studies. https://doi.org/10.1007/s10826-026-03370-6

Image Credits: AI Generated

DOI: 10.1007/s10826-026-03370-6

Keywords: child abuse, parenting practices, discipline, Hispanic families, intersectionality, psychometrics, scale development, cultural perceptions, child welfare, corporal punishment, acculturation, exploratory factor analysis

The research team conducted a narrative review with systematic elements, searching PubMed in November and December 2025 with combinations of pediatric terms such as child, infant, neonate, newborn, and adolescent and maltreatment terms such as abuse, neglect, non-accidental, and battered child, crossed with cold-related terms including hypothermia, cold injury, low body temperature, and frostbite. A supplementary non-systematic search of German-language publications in Google Scholar was added to catch literature not indexed in PubMed. Two reviewers independently screened abstracts against inclusion and exclusion criteria, excluding studies focused exclusively on adults, on clinical or therapeutic hypothermia, and on accidental cold exposure such as winter sports accidents. Out of 192 search results plus four additional German-language publications, only 22 papers ultimately made the cut, a strikingly small body of evidence for a phenomenon the authors describe as a significant threat to affected children.

To understand why cold is so dangerous to young children, the review lays out the underlying physiology in detail. Hypothermia is generally defined as a core body temperature falling below 35 degrees Celsius, although the World Health Organization uses a threshold of 36.5 degrees for newborns. Crucially, hypothermia does not require extreme environments: it can develop at ordinary room temperature if a victim is unable to take self-rescue measures and no help arrives. In water, the danger multiplies, because heat conducts 20 to 25 times faster through water than through air. The body fights back with stress hormone release, shivering, peripheral vasoconstriction, glycogen mobilization, and, in infants, heat production from brown fat tissue. Yet children lose heat faster than adults because of their larger surface-to-volume ratio, narrower range of thermoregulatory responses, and faster metabolic exhaustion. A literature review cited in the paper documented neonatal cooling rates ranging from 1.2 to a staggering 28.5 degrees Celsius per hour.

Local cold injuries follow a different but equally grim pathophysiology. Frostbite results from rapid exposure to extreme cold, producing ice crystals both inside and outside cells, and typically strikes the extremities, nose, and ears. Severity is usually graded clinically into four levels. Non-freezing cold injury develops more slowly and involves no ice crystal formation, but both forms trigger vasoconstriction, ischemia, inflammatory cellular damage, electrolyte shifts that initiate cell death, and thrombosis. The body does mount a defense known as the hunting response, in which blood vessels dilate for five to ten minutes to protect chilled tissue, but if cold exposure continues, circulation to the affected body part is shut down to preserve the core, leading to further ischemia and necrosis. The consequences can range from lasting sensory deficits to amputation and death, and both injury types demand intensive, multidisciplinary treatment.

Against this physiological backdrop, the case reports assembled by the Düsseldorf team paint a disturbing picture of how cold exposure is weaponized or allowed to harm children. Gustavson and Levitt described four cases of abuse-related pediatric hypothermia in 1996, noting that hypothermia without a consistent history should always raise suspicion of abuse. In three of their four cases, the children had been forced into cold water or held under a cold shower, leading the authors to propose inflicted cold-water immersion or near drowning as a recognized mechanism. Other reports lean toward neglect: Bernstein and colleagues described a newborn found in a dumpster, still attached to her placenta, with an initial core temperature of just 20 degrees Celsius. Knight and colleagues, reviewing pediatric neglect deaths, reported a three-year-old boy with patterned contusions found dead at home, in whom autopsy revealed hypothermia as the cause of death.

One of the review’s clearest findings is demographic. Every case of abuse- or neglect-related hypothermia identified in the literature involved infants and children aged six or younger, and only one reported case involved a child older than four, a six-year-old boy tied to a bed with an electrical cord in a cold room, deliberately prevented from escaping. This age pattern almost certainly reflects vulnerability: very young children cannot remove themselves from cold environments, cannot communicate what happened, and depend entirely on caregivers for warmth and shelter. The authors also observed that most of the affected children showed concomitant injuries indicative of physical abuse or pronounced signs of other forms of neglect, suggesting that cold exposure tends to appear in particularly severe cases of maltreatment, where caregivers who inflict one hazard are likely violating the child’s wellbeing in multiple ways at once.

The rarity of published cases, however, may be more apparent than real. The review highlights substantial underreporting: mild hypothermia resulting from abuse or neglect likely goes unrecognized in clinical settings or is deemed too insignificant to publish, and hypothermia is notoriously difficult to detect post mortem, which may allow it to escape forensic notice entirely. Publication bias further skews the record toward the most severe cases. The true extent of unreported cases is therefore likely considerable, the authors conclude, and clear generalizations from 22 publications remain difficult. Outcomes in the documented cases nonetheless span the full spectrum, from children who recovered without lasting physical effects to those requiring amputation of extremities and those who died.

Local cold injuries tell an even sparser story. The review found only isolated reports, including a 2024 case of medical child abuse in which a mother caused what the authors called cold burn injuries by repeatedly spraying her 17-month-old child’s skin with deodorant spray. Neglect-related frostbite is similarly rare in the literature, with the closest cases being newborns left outside in the cold, though the authors note that distinguishing neglect from active abuse is often legally and clinically impossible in such scenarios. A retrospective study of 46 pediatric frostbite cases by Boles and colleagues found that lack of supervision was a major risk factor and the most common cause, with the child unsupervised in 9 of 14 cases involving children up to 12 years old. The review also flags alcohol intoxication as a risk factor for hypothermia in older children and adolescents, raising questions about supervisory neglect depending on age and circumstances.

A particularly subtle finding concerns hypothermia as a secondary phenomenon rather than a direct result of cold exposure. Hypothermia is a well-known sign in severe trauma and can indicate brain injury with impaired central thermoregulation, and it appears regularly in abusive head trauma. Kennedy and colleagues, studying 520 children with traumatic brain injury, of whom 50 had abusive head trauma, found a twofold increase in unfavorable outcomes among children with secondary hypothermia. Lee and colleagues, in a retrospective study of 156 physically abused children admitted to intensive care, found that trauma-induced hypothermia was associated with poor neurological outcomes and was the second strongest risk factor for mortality, with abusive head trauma accounting for 87.1 percent of ICU admissions. This creates a diagnostic trap: secondary hypothermia from abusive head trauma could be mistaken for additional cold-related abuse, and healthcare professionals must be aware of the phenomenon to prevent false allegations.

The review closes with a warning about differential diagnosis and interpretation pitfalls. Cold-induced skin injuries can resemble thermal burns and must be distinguished from them, while cold aerosol burns, sometimes called frosties, are frequently self- or peer-inflicted among adolescents. Accidental hypothermia in newborns, whose limited thermoregulatory reserves put them at risk of pneumonia and sepsis, must also be considered, and the authors note that external factors such as homelessness, forced displacement, or war may prevent parents from protecting their children through no fault of their own. Even bruising demands careful reading, because hypothermia impairs coagulation and can produce more pronounced hematomas, while standard laboratory coagulation tests run at 37 degrees Celsius fail to capture the full extent of the dysregulation. The authors acknowledge that their findings, drawn largely from high-income countries, may not generalize elsewhere, and they call for studies with larger case numbers. Their central message stands: hypothermia and cold injuries, though rare on paper, are severe, potentially fatal manifestations of child maltreatment, and recognizing them could save the youngest and most vulnerable patients.

Subject of Research: Hypothermia and local cold injuries as rare but severe manifestations of child abuse and neglect

Article Title: Hypothermia and cold injuries – rare but severe manifestations of child abuse and neglect

Article References: Küppers, L., Ritz, S., & König, L. M. (2026). Hypothermia and cold injuries – rare but severe manifestations of child abuse and neglect. International Journal of Legal Medicine. https://doi.org/10.1007/s00414-026-03977-w

Image Credits: AI Generated

DOI: 10.1007/s00414-026-03977-w

Keywords: child abuse, child neglect, hypothermia, frostbite, cold injury, cold exposure, forensic medicine, pediatrics, abusive head trauma, thermoregulation, child protection, legal medicine

The clinical stakes of this research are considerable. Distal humeral physeal separation occurs almost exclusively in immature elbows, typically the result of birth trauma, accidental injury, or—critically—non-accidental trauma. Because the ligaments and joint capsule of a young child’s elbow are stronger than the growth plate cartilage itself, twisting or pulling forces tend to fail through the physis rather than dislocating the joint. True elbow dislocation is exceedingly rare in infants, which means that when a radiograph shows the forearm displaced relative to the humerus, a physeal separation should be the leading consideration. The injury also carries a strong association with child abuse, and its radiographic recognition may be the first clue of unsuspected abuse when the history provided is absent or inconsistent. A missed or delayed diagnosis can lead to permanent growth disturbance and lasting elbow deformity.

The challenge for clinicians is that the diagnostic toolkit is limited at the point of first contact. Ultrasound and magnetic resonance imaging can directly visualize the unossified chondroepiphyses, but these modalities are usually deployed only after the injury is already suspected. Ultrasound is portable and well tolerated by neonates without sedation but is highly operator-dependent, while MRI is constrained by availability and the need for immobilization. Plain radiographs remain the first-line imaging modality for evaluating elbow symptoms in children, yet the abundance of cartilage in the immature elbow makes confident interpretation notoriously difficult. Prior literature on this injury consisted largely of case reports and small retrospective series describing posterior or medial displacement of the radius and ulna relative to the distal humerus, without a controlled comparison against normal elbows.

To fill that gap, the research team searched their institution’s electronic imaging archive for all elbow and forearm radiographs performed in children three years of age or younger over a 16-year period, from January 2008 to December 2024. The initial search yielded 311 examinations, reduced to 259 unique studies after excluding incomplete or unavailable imaging. Reports containing terms such as physeal fracture, physeal separation, or transphyseal fracture of the distal humerus were flagged, and the complete medical records were then reviewed for clinical, imaging, or surgical confirmation of the injury. After rigorous exclusion of normal studies, forearm fractures, supracondylar and metaphyseal fractures, congenital abnormalities, dislocations, condylar fractures, and infections, 19 children with confirmed distal humeral physeal separation formed the study group. A comparison group of 32 age- and sex-matched children without elbow fracture was drawn from the same source population, whose imaging indications ranged from evaluation of congenital or syndromic abnormalities to accidental household trauma and birth-related trauma.

Two board-certified radiologists, one with more than 20 years of experience in pediatric radiology and the other with 11 years spanning pediatric and musculoskeletal imaging, independently reviewed all examinations. They were blinded to group assignment, clinical history, and prior reports, and disagreements were resolved by consensus. For each study, they recorded the presence or absence of soft-tissue swelling on both anteroposterior and lateral views, elbow joint effusion assessed by elevation of the anterior fat pad—the so-called sail sign—or visibility of the posterior fat pad, abnormal ossific fragmentation, and abnormal medial or posterior alignment of the forearm relative to the distal humerus. In children who had developed a capitellar ossification center, the radiocapitellar alignment and the anterior humeral line were also assessed. Inter-rater agreement was substantial to near perfect for most findings, with kappa values ranging from 0.68 to 0.95, although elbow effusion showed only slight agreement at 0.24.

The final cohort comprised 51 children—32 boys and 19 girls—with a median age of just 17 days and a range spanning from birth to 1,186 days. Among the 19 children with physeal separation, birth-related injury was the most common mechanism, accounting for 10 cases, followed by accidental injury in 6 and non-accidental trauma in 3. The median age at diagnosis varied strikingly by mechanism: 3.5 days for birth trauma, 101 days for accidental trauma, and 329 days for non-accidental injury. Most children were treated with closed reduction and percutaneous pinning, while the remainder were managed with immobilization, in one case augmented by external traction. Follow-up data, available for 18 children with a median of 94 days, revealed a sobering reality: more than half had residual limitations in elbow motion, and a minority developed cubitus varus, an inward angulation deformity of the arm.

The imaging results were dramatic. Soft-tissue swelling was present in 94.7 percent of injured elbows on anteroposterior views versus 34.4 percent of controls, and in 78.9 percent versus 12.5 percent on lateral views, differences that were highly statistically significant. Abnormal ossific fragmentation appeared in 78.9 percent of the separation group compared with just 3.1 percent of controls. Most striking of all, abnormal medial forearm alignment was seen in 89.5 percent of children with physeal separation and in exactly zero controls, while abnormal posterior alignment was present in 78.6 percent of the injured group and, again, in no control child. In univariable analysis, medial alignment carried an odds ratio of 455, posterior alignment 213.5, and ossific fragmentation 72.3. But when the researchers applied Firth penalized logistic regression—a method chosen to reduce the small-sample bias that plagues standard logistic regression with sparse data—only abnormal medial forearm alignment remained independently associated with the injury, with an odds ratio of 104.2.

The study also illuminated several technical pitfalls that complicate diagnosis in this population. Elbow effusion, a classic sign of intra-articular injury in older children, proved unreliable here: it was uncommon even among injured children and showed the poorest agreement between readers. The authors explain that in very young children the anterior coronoid and posterior olecranon fossae are underdeveloped, making it difficult to distinguish physiologically prominent fat pads from the pathologic displacement that signals an effusion. Positioning posed another obstacle. Among the 16 children with capitellar ossification, three had suboptimally positioned lateral views that precluded assessment of the radiocapitellar line and anterior humeral line, and the injured group was particularly prone to poor positioning—possibly because additional rotation across the injured physis makes standard views harder to obtain. Among children with adequate lateral views, an abnormal anterior humeral line was present in all children with separation and none of the controls, though the small evaluable subgroup prevented its inclusion in the regression models.

The pattern of ossific fragmentation added further nuance. Fragments in the injured group were distributed relatively evenly across the medial, posteromedial, and posterior distal humerus, mirroring the predominance of medial and posterior displacement. The authors note that some of these appearances likely represented early accessory ossification of the capitellum—the first secondary ossification center to mineralize in the elbow, typically between one and two years of age—that was overcalled as pathology in the presence of an effusion. Only a minority of children had capitellar ossification at all, underscoring the extreme skeletal immaturity of this cohort. Even when the capitellum is present, its small and often irregular early ossification makes confident assessment of the radiocapitellar line and anterior humeral line challenging, since the line drawn along the radial shaft can miss the capitellum in a substantial fraction of normal young elbows, and the anterior humeral line may transect only the anterior third of the immature ossification center in up to 40 percent of children under four.

The authors are candid about their limitations. The retrospective design restricted the clinical information available and precluded repeat imaging, and despite being the largest single-institution cohort reported to date, the sample of 19 cases remains small—a consequence of the injury’s rarity. That small size likely inflated the apparent discriminative power of medial alignment, and the final model’s area under the curve of 1.00, with 100 percent sensitivity and specificity, almost certainly reflects overfitting rather than true performance, the researchers caution. The comparison group, drawn from children imaged for syndromic workups or injury exclusion, may not be entirely normal, though the authors argue this better reflects routine clinical practice. Even so, the central message stands with unusual clarity: in an infant or toddler whose elbow radiograph shows the forearm displaced medially relative to the distal humerus, distal humeral physeal separation should be presumed until proven otherwise, prompting urgent further imaging with ultrasound or MRI, orthopedic referral, and—in cases where the history does not fit—careful consideration of non-accidental trauma. Future prospective studies incorporating comparison views of the asymptomatic side could refine these criteria and help prevent the treatment delays and growth disturbances that have shadowed this elusive injury for decades.

Subject of Research: Radiographic diagnosis of distal humeral physeal separation in infants and toddlers

Article Title: Distal humeral physeal separation: radiographic findings in infants and toddlers

Article References: Yaya-Quezada, C., Nguyen, J. C., Forero-Millan, J., Hailu, S. S., Lerebo, W. T., & Taragin, B. H. (2026). Distal humeral physeal separation: radiographic findings in infants and toddlers. Pediatric Radiology. https://doi.org/10.1007/s00247-026-06790-0

Image Credits: AI Generated

DOI: 10.1007/s00247-026-06790-0

Keywords: distal humeral physeal separation, pediatric radiology, elbow fracture, growth plate injury, infants, toddlers, radiography, child abuse, birth trauma, forearm alignment, elbow effusion, ossific fragmentation