In the United States, interviews with parents reveal that as many as two thirds of documented instances of physical abuse begin as acts of corporal punishment meant to correct a childs behavior, while a large-scale Canadian study found that three quarters of substantiated cases of physical abuse of children have occurred within the context of physical punishment. Other studies have shown that children and infants who are spanked by parents are several times more likely to be severely assaulted by their parents or suffer an injury requiring medical attention. Studies indicate that such abusive treatment often involves parents attributing conflict to their childs willfulness or rejection, as well as "coercive family dynamics and conditioned emotional responses". Factors involved in the escalation of ordinary physical punishment by parents into confirmed child abuse may be the punishing parents inability to control their anger or judge their own strength, and the parent being unaware of the childs physical vulnerabilities.Children resulting from unintended pregnancies are more likely to be abused or neglected. In addition, unintended pregnancies are more likely than intended pregnancies to be associated with abusive relationships, and there is an increased risk of physical violence during pregnancy. They also result in poorer maternal mental health, and lower mother-child relationship quality.There is some limited evidence that children with moderate or severe disabilities are more likely to be victims of abuse than non-disabled children.
Diagnosis
Differential diagnoses
The differential diagnosis includes elastofibroma, fibrolipoma, desmoid-type fibromatoses, and nuchal fibrocartilaginous pseudotumor. Management
Simple excision is curative. However, in patients with Gardner syndrome, up to 45% will develop desmoid-type fibromatosis at other sites, and so this should be searched for and excluded. Patients can develop a recurrence, so follow-up is required. Epidemiology
This is a rare tumor, presenting over a wide age range, but usually in the 3rd to 5th decades of life. There is a slight male predilection, although this is not seen in syndrome associated patients. The most common site is the posterior neck, but may also be seen in other sites (extremities, lumbosacral area, buttocks, face). See also
Fibrous Lesions

References
Further reading
Lester D. R. Thompson; Bruce M. Wenig (2011). Diagnostic Pathology: Head and Neck: Published by Amirsys. Hagerstown, MD: Lippincott Williams & Wilkins. pp. 8:44–45. ISBN 978-1-931884-61-7.