The first public case of child abuse in the United States that garnered widespread interest took place in 1866 in New York City. Mary Ellen Wilson was an illegitimate child, 10 years of age, who lived with her foster parents [3]. Neighbors were concerned that she was being mistreated; however, her foster parents refused to change their behaviors and said that they could treat the child as they wished [2]. Because there were no agencies established to protect children specifically, Henry Berge, founder of the Society for the Prevention of Cruelty to Animals, intervened on Mary's behalf [3]. He argued that she was a member of the animal kingdom and deserved protection. The case received much publicity, and as a result, in 1874 the New York Society for the Prevention of Cruelty to Children was formed [3]. Because of this case, every state now has a system in place for reporting child abuse. The Pennsylvania Department of Public Welfare (now known as the Department for Human Services) was established in 1921 and part of its original intent was to care for "dependent, defective, and delinquent children" [7].

The child welfare system in Pennsylvania is supervised by the state but administered by the different local counties [27]. This means that there are a total of 67 county agencies that administer the child welfare and juvenile justice services [27]. Aside from frank abuse, reports of other acts that might affect the well-being of a child are also accepted. The State of Pennsylvania delineates two functions for the local agencies: child protective services (CPS) and general protective services (GPS).

The federal definition of child abuse is evident in CAPTA, published as a product of federal legislation. CAPTA defines a child to be any individual younger than 18 years of age, except in cases of sexual abuse. In cases of sexual abuse, the age specified by the child protection laws varies depending on the state in which the child resides [5]. CAPTA defines child abuse as, "any recent act or failure to act on the part of a parent or caretaker, which results in death, serious physical or emotional harm, sexual abuse, or exploitation, or an act or failure to act that presents an imminent risk of serious harm" [6].

Physical abuse injuries can range from minor bruises and lacerations to severe neurologic trauma and death. Physical abuse is one of the most easily identifiable forms of abuse and the type most commonly seen by healthcare professionals. Physical injuries that may be indicative of abuse include bruises/welts, burns, fractures, abdominal injuries, lacerations/abrasions, and central nervous system trauma [8,34].

Child sexual abuse can be committed by a stranger or an individual known to the child. Sexual abuse may be manifested in many different ways, including [9,10]:

According to the Annual Child Protective Services Report, a yearly statistical report that documents child abuse cases in Pennsylvania, the child abuse hotline registered a total of f 32,919 reports of suspected abuse or neglect in 2020 [27]. Approximately 14% of these cases were substantiated, which translates to 4,593 cases of child abuse in 2020 [27]. This is a decrease of 9,333 reports (22%) compared with 2019, a decline attributed to the COVID-19 pandemic, and the reduced contact between children and mandated reporters during that time [27]. Of the substantiated child abuse cases, there were 73 fatalities, 22 more than in 2019 [27]. More than half (51.4%) of perpetrators of child abuse in 2020 were the parent of the child victim [27].

In Pennsylvania, mandated reports of potential child abuse (CPS or GPS cases) are made either in writing (through the online portal) or orally to ChildLine. The ChildLine is available seven days per week, 24 hours per day at 800-932-0313 or 412-473-2000. In 2020, ChildLine answered 163,215 calls, including suspected child abuse cases, referrals for GPS, and inquiries for general information to services [27]. Electronic submission of suspected child abuse reports may be made in lieu of calling ChildLine.

All mandated reporters who report via telephone shall also make a written report, which may be submitted electronically, within 48 hours [51]. The written reports are made through the Child Welfare Information Solution (CWIS) Portal, available online at https://www.compass.state.pa.us/cwis. The written report will include all of the following information, if known [55]:

All mandated reporters who report via telephone shall also make a written report, which may be submitted electronically, within 48 hours [51]. The written reports are made through the Child Welfare Information Solution (CWIS) Portal, available online at https://www.compass.state.pa.us/cwis. The written report will include all of the following information, if known [55]:

According to Pennsylvania law, a person or official required to report cases of suspected child abuse may take or request photographs of the child who is subject to a report and, if clinically indicated, request a radiologic examination and other medical tests on the child [56]. If completed, medical summaries or reports of the photographs, x-rays, and relevant medical tests should be sent along with the written report or within 48 hours after a report is made electronically.

Reporters are afforded protections after reporting a suspected incidence of child abuse. Any person or institution who, in good faith, makes a report of child abuse, cooperates with a child abuse investigation, or testifies in a child abuse proceeding is considered immune from civil and criminal liability [44]. Mandated reporters who make a report in good faith and then later face discrimination in their workplace can take legal action [44]. For the most part, the reporter's identity is kept confidential. If a case is referred to law enforcement, then the name of the reporter must be given upon request; however, reporters are treated as confidential informants [49].

According to Pennsylvania statutes, a person or official required to report a case of suspected child abuse or to make a referral to the appropriate authorities who willfully fails to do so commits a misdemeanor of the third degree for the first violation and a misdemeanor of the second degree for a second or subsequent violation [44,54]. An offense is a felony of the third degree if all three of the following are true: