Physical Abuse Series:
Torture and Starvation

Torture and intentional starvation of children are difficult concepts to comprehend and acknowledge.  Many of these children are isolated or hidden so detection and intervention are typically delayed.  Only recently has the concept of torture in children living in high-resource countries been described and defined.  Intentional starvation is often associated with other elements of torture; in all cases, there is extreme psychological and spiritual injury from which many do not fully recover.  However, in this module, we will share a “thriver's” story of resilience, faith, and hope to inspire and encourage healthcare providers to recognize and respond to children impacted by torture and starvation.

Like torture, intentional starvation involves not only egregious physical harm but also egregious psychological harm.  Knowing there is food available to others within the same household amplifies the physical and emotional pain of starvation.  Recovery from starvation is sometimes slow, and children may not understand why they cannot eat without limit (due to life-threatening refeeding syndrome) when they are first rescued.

Torture and starvation represent the darkest side of child maltreatment.  The case presentations and images are disturbing and may elicit trauma symptoms – sometimes unbidden – in any individual viewing this module.  The learner is encouraged to assess their own potential responses, have a strong commitment to self-care, and know who to turn to and what to do if symptoms arise.


The Physical Abuse Series is comprised of this Core Framework and a set of "plug-ins" that are being developed over time. Each additional plug-in module provides in-depth information based on the injury type (e.g., Fractures, Abusive Head Trauma, Cutaneous).

Clinical vignettes are presented throughout the Physical Abuse Series to reinforce clinical relevance and applicability of the learning concepts.

Developed in partnership with:
  • Nancy Kellogg, MD, Senior Medical Editor
  • Shalon Nienow, MD


Authors, Contributors, and Reviewers