Child abuse and neglect

To the Editor: In his review of child abuse and neglect (May 25 issue),¹ Wissow defines child maltreatment as “intentional harm or a threat of harm to a child by someone acting in the role of caretaker, for even a short time.” Intent is not generally included in the definition of abuse and should not be considered a necessary prerequisite for characterizing an injury as abusive.²,³ Most abusive injuries are not intentional, nor are they truly accidental in the conventional sense. The parent who shakes an infant, causing brain injury or death, does not intend to cause harm; he.