Nonaccidental Injuries in Adopted Children: A Systematic Review

Abstract

Nonaccidental injuries (NAI) and child abuse in adopted children are pressing public health issues, shaped by pre-adoption adversities and post-adoption stressors. This systematic review synthesizes evidence on NAI prevalence, risk factors, screening tools, and perpetrator patterns in adopted children under 16. We searched PubMed, Google Scholar, and EMBASE on October 15, 2024, using terms like “nonaccidental injuries,” “child abuse,” and “adoption,” yielding 2,847 studies from 1990–2025. Twelve studies (case series, case reports, prospective/retrospective) met inclusion criteria. Neglect (70%) and physical abuse (45%) were predominant, with fractures (70%, 40% transverse, 35% skull) and bruises (45%) most common, linked to institutional neglect, socioeconomic challenges, and transracial adoption. Parents/caregivers were frequent perpetrators, aligning with broader maltreatment trends. The International Society for the Prevention of Child Abuse and Neglect (ISPCAN) Child Abuse Screening Tool (ICAST), a 10-item questionnaire for detecting physical, sexual, emotional abuse, and neglect, was used in 5/12 studies, highlighting a gap in standardized screening. Study quality, assessed via the Newcastle-Ottawa Scale, was moderate (7/9) due to inconsistent follow-up and comparability. This review underscores adopted children’s vulnerability due to adverse childhood experiences, urging adoption-specific screening tools, trauma-informed interventions, and enhanced post-adoption support. Longitudinal research and policy reforms are essential to address cultural/socioeconomic risks and reduce maltreatment.