Children who have suffered from abuse or neglect may have physical or behavioral health problems even after the mistreatment stops, new guidelines for pediatricians emphasize.

The guidelines from the American Academy of Pediatrics build on previous advice for doctors to be on the lookout for signs of past maltreatment. Since the last guidelines came out in 2008, new evidence has documented the connection between mistreatment early in childhood and subsequent health problems, and studies have provided fresh insight into the lasting effects of chronic stress.

“Child maltreatment is seriously under-reported,” said lead author of the guidelines, Dr. Robert Sege of Tufts University and Health Resources in Action in Boston.

“As a result, pediatricians who are treating a child for complex behavioral problems, especially when these problems seem difficult to treat, might do well to consider that the symptoms may have arisen due to prior abuse or neglect,” Sege said by email.

Although some children recover from adversity, traumatic experiences can result in significant disruption of normal development, researchers note in Pediatrics.

“Parents need to be vigilant about the safety of their children and educate their children about appropriate and inappropriate behavior,” Nemeroff added. “Perpetrators often seek positions with access to children including coaching, gardening, repairmen, clergy, and often perpetrators are family members.”

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