Child Maltreatment Begin in the First Months of Life: Prospective Evidence From Two Socioeconomic Distinct Brazilian Populations

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Abstract
Background: Maltreatment is strongly associated with adverse childhood outcomes. Yet, despite infants’ greater developmental vulnerability, prospective data characterizing maltreatment throughout the first years of life remain scarce. We aimed to examine the distribution and trajectories of exposure to maltreatment across infancy and toddlerhood in two socioeconomically distinct Brazilian populations. Methods: We analyzed data on 681 children from two longitudinal studies. Maltreatment was assessed from infancy through toddlerhood using 3-5 repeated measures of the Conflict Tactics Scales: Parent-child Version and operationalized as cumulative exposure. Trajectories were estimated using monotonic integrated P-splines and group differences were assessed using likelihood ratio tests. Findings: Maltreatment was already reported at 3 months. Psychological aggression was the most prevalent subtype, reported in 26% of children by 3 months and in around 90% of both groups by 24 months. Corporal punishment was substantially more frequent in the socioeconomically vulnerable population (LR = 45·94, p < 0·002). At 24 months, more than 95% of all children had been ever exposed to at least one subtype maltreatment behaviour. Co-occurrence was more common than isolated exposure by 12 months (60·3% and 79·7% of exposed infants), a pattern that continued to increase by 24 months (81·3% and 92·8%). Interpretation: Maltreatment rapidly accumulates during the first childhood years across different socioeconomic contexts. While socioeconomic vulnerability was substantially associated with corporal punishment, the results suggest an important role of culture in caregiving practices overall. Preventive efforts should begin during pregnancy and address maltreatment as a continuum of practices.