Child Abuse

  • Medical Author:
    Roxanne Dryden-Edwards, MD

    Dr. Roxanne Dryden-Edwards is an adult, child, and adolescent psychiatrist. She is a former Chair of the Committee on Developmental Disabilities for the American Psychiatric Association, Assistant Professor of Psychiatry at Johns Hopkins Hospital in Baltimore, Maryland, and Medical Director of the National Center for Children and Families in Bethesda, Maryland.

  • Medical Editor: David Perlstein, MD, MBA, FAAP
    David Perlstein, MD, MBA, FAAP

    David Perlstein, MD, MBA, FAAP

    Dr. Perlstein received his Medical Degree from the University of Cincinnati and then completed his internship and residency in pediatrics at The New York Hospital, Cornell medical Center in New York City. After serving an additional year as Chief Pediatric Resident, he worked as a private practitioner and then was appointed Director of Ambulatory Pediatrics at St. Barnabas Hospital in the Bronx.

Child abuse facts

  • Child abuse is when a caregiver either fails to provide appropriate care (neglect), purposefully inflicts harm, or harms a child while disciplining him or her.
  • Survivors of child maltreatment are at greater risk for physical, emotional, work, and relationship problems throughout childhood and into adulthood.
  • Common forms of child abuse include neglect, physical assault, emotional abuse, and sexual assault.
  • Child abuse risk factors include issues that involve the victim, family, perpetrator, and community.
  • Victims of child abuse often experience stress in reaction to the abuse as well as symptoms related to the kind of abuse they endured.
  • Child abuse symptoms and signs vary according to the child's developmental stage and age.
  • The treatment for child abuse involves first securing the safety of the child from further abuse and addressing any physical injuries from which the child may be suffering. The emotional needs of the child are then assessed and addressed.
  • There are many ways to prevent child abuse, and every state in the U.S. has child-abuse-reporting hotlines.

What is child abuse?

Child abuse is any injury that is intentionally inflicted on a child by a caregiver or during discipline. While the caregiver is usually an adult, most often the mother of the child, it can also include teenagers who are in the caregiving role, like a babysitter or a camp counselor. It is important to understand that child abuse must involve injury, whether physical or emotional, visible or not immediately visible. So while most child-care professionals (for example, psychiatrists, psychologists, pediatricians, and teachers) do not recommend the use of corporal punishment due to the risk of emotional damage and accidental physical injury, spanking a child does not automatically constitute child abuse unless the child sustains some kind of injury.

Many children worldwide suffer abuse every year, affecting all educational and socioeconomic levels, ethnicities, cultures, and religions. The most common form of child abuse in the United States is being left at home alone without adult supervision, also called supervision neglect. All forms of neglect account for about 75% of the child-abuse reports made to child welfare authorities. Other common forms of child abuse include physical assault, physical neglect, emotional abuse, and sexual assault that involves physical contact.

Child abuse has far-reaching negative effects on its victims and on society. Survivors of child maltreatment are at greater risk for physical, emotional, work, and relationship problems throughout childhood and into adulthood.

What are the different types of child abuse?

The most common types of child maltreatment are neglect, physical, emotional, and sexual abuse:

  • Neglect is the failure of the child's caretaker to provide adequate care for the child. Examples of this form of child maltreatment include a lack of supplying adequate food, shelter, season-appropriate clothing, supervision, medical or mental health care, or a lack of providing appropriate emotional comfort. Supervision neglect is the most common form of child neglect.
  • Physical abuse is defined as a caretaker inflicting physical injury on a child through assault. That includes corporal punishment that results in physical injuries, like bruises, scratches, welts, or broken bones.
  • Emotional abuse involves statements by a caretaker that can injure a child's sense of self-esteem. Examples of emotional abuse include calling the child negative names, cursing at, or otherwise insulting the child.
  • Sexual abuse is defined as exposing the child to inappropriate sexual content, behavior, or contact. That can include allowing the child to see pornography or sexual acts between adults or a caretaker having sexual contact with the child.

Neglect, physical, and sexual abuse are the types of child abuse that usually result in reporting to and intervention by the authorities.

What are risk factors for child abuse?

The risk factors for child abuse include issues that pertain to the victim, perpetrator, family, and community situations. Children under 4 years of age and those with special physical, developmental, or mental-health needs are at higher risk for being victims of maltreatment. Younger caregivers who have had child-abuse, mental-health, or drug problems in their family of origin are more at risk for abusing children. Also, adults who have trouble understanding the needs of children and appropriate parenting skills, as well as those who are single parents, of low socioeconomic status, or have transient other adult caregivers (like the parent's friend, boyfriend, or girlfriend) in the home are also more at risk of becoming child abusers.

Family risk factors for child maltreatment include social isolation, fragmentation, or parents who are stressed, engaging in domestic violence, or the presence of poor parent-child relationships. Community issues that increase the likelihood that child abuse occurs include low community socioeconomic status, high unemployment rates, high availability of alcohol or other drugs (for example, alcohol through liquor stores or bars), and poor community social connections.

What are symptoms and signs of child abuse?

Children who are victims of abuse often experience symptoms of stress in reaction to the abuse, in addition to symptoms that are specific to the kind of abuse they have suffered. The signs and symptoms of abuse often vary according to the age and developmental stage of the child. It is also important to understand that victims of child abuse are often abused in more than one way, so the child may demonstrate symptoms consistent with more than one kind of maltreatment. Examples of less specific signs and symptoms of child abuse include

  • a tendency to either avoid, overly please, or ingratiate themselves to the abuser;
  • poor school performance;
  • irritability/quickness to anger;
  • crying more often and/or easily;
  • anxiety or panic;
  • frequent complaints of physical symptoms, like headaches and stomachaches;
  • young kids may act younger than their age or than they had previously (regress);
  • spending more time alone, away from friends and family;
  • becoming more "clingy" and more dependent on certain relationships;
  • expressing thoughts about hurting him or herself or others;
  • more risk-taking behaviors and/or showing less concern for their own safety.

Examples of risk-taking behaviors in children include unsafe play, like climbing excessively high or running in the street. More potentially specific signs and symptoms of abuse may include the following:

  • Neglect: The child may lose weight or fail to gain weight appropriately for their age. Their energy level and ability to learn will likely decrease. They may become withdrawn and show physical signs of malnutrition, like dry skin or hair or develop thinning hair.
  • Physical abuse: A child who is the victim of physical abuse may have repeated physical injuries and emergency room or other doctor's visits with or without adequate explanation. They may claim to be accident prone or provide other stories about how they sustained injuries and may tend to wear excessive clothing to cover injuries or otherwise engage in secrecy in an attempt to protect the abuser from intervention by child welfare authorities and law enforcement.
  • Emotional abuse: Emotionally abused children may make negative statements about themselves or others that mimic the abuser, like calling his or herself names or otherwise exhibiting pessimism or low self-esteem.
  • Sexual abuse: The child who has been sexually abused may exhibit sexual knowledge or behaviors that are much older than is appropriate for their age. They may also exhibit inappropriately sexual behavior, resulting in their engaging in masturbating excessively or in front of others, as well as participating in inappropriate sexual play with children. Medically, children who are sexually abused may develop genital injuries or sexually transmitted diseases.

How do physicians diagnose child abuse?

Many health-care professionals may help make the diagnosis of child abuse, including licensed mental-health therapists, pediatricians, other primary-care providers, specialists whom you see for a medical condition, emergency physicians, psychiatrists, psychologists, psychiatric nurses, and social workers. One of these professionals will likely perform or refer for an extensive medical interview and physical examination as part of establishing the diagnosis. Child abuse may be associated with a number of other medical conditions, so routine laboratory tests are often performed during the initial evaluation to rule out other causes of symptoms. Occasionally, an X-ray, scan, or other imaging study may be needed, particularly if physical abuse is suspected. As part of this examination, the sufferer may be asked a series of questions from a standardized questionnaire or self-test to help assess the occurrence of child abuse. Thorough exploration for any history or presence of mental-health symptoms will be conducted such that child maltreatment can be distinguished from other sources of emotional problems.

What is the treatment for child abuse?

The treatment for child abuse involves first securing the safety of the child from further abuse and addressing any physical injuries from which the child may be suffering. As these interventions are occurring, child-welfare services work with law enforcement in assessing the safety of the child in the home, whether or not the child should be removed from that home and the potential need for further legal involvement as a result of the abuse allegations. When it is determined that sexual abuse has occurred, the perpetrator of the abuse is usually required to have their name included on a sexual offenders' registry, which will prevent them from working in settings that involve children and may impose legal penalties if the offender has any contact with people under 18 years of age.

Medical interventions may involve addressing a variety of issues, like treating broken bones, concussion, or other head injury associated with physical abuse, genital injuries, or sexually transmitted disease that may result from sexual abuse.

Addressing the emotional impact of child abuse on the victim is an important part of treatment of child maltreatment. The mental health of the child is usually assessed, either through screening questions or tests by the pediatrician or through a full mental-health assessment by a mental-health professional. If it is determined that the child is suffering from a mental-health condition, it will be treated through individual or group therapy, as well as medication treatment when appropriate.

Family oriented interventions for child abuse may involve providing the caretaker with classes on anger management to help them develop healthy ways to manage their anger, parenting classes as a means of improving their knowledge and implementation of parenting approaches that are appropriate for the child's age, developmental level, medical, mental, and emotional needs. Family interventions may also involve the use of a parent mentor to provide the caretaker with a role model from whom they can learn appropriate parenting skills. Family therapy involves family members meeting with a therapist and may be used to process and resolve family issues.

What are the complications and prognosis of child abuse?

Children who are subjected to maltreatment are at risk for a variety of physical and emotional problems, often depending on their age. Physically, children can suffer from brain injury, including mental retardation, concussions, seizures, and death. Behaviorally and emotionally, children may develop a myriad of problems, including depression, anxiety, trouble bonding with others, and issues with controlling their anger.

Adults who were the victims of child abuse are at higher risk for a variety of emotional and physical problems, as well as for economic problems. The most common physical problems are neurological and musculoskeletal problems, followed by respiratory, heart, and gastrointestinal ailments. Compared to adults with no history of child-abuse victimization, those who were abused as children are at risk for achieving lower levels of education, employment, income, and assets. Those risks are apparently even greater for women compared to men. Adult survivors of abuse are also at higher risk of incarceration and for family violence occurring in their own homes.

Is it possible to prevent child abuse?

There are primary, secondary, and tertiary ways of preventing child abuse. Primary intervention involves awareness training for professionals who work with children, policy makers for children's issues, and for the general public. Secondary prevention programs work to alleviate the risk factors that make vulnerable children at risk for abuse. Tertiary prevention programs work with families in which abuse has already occurred in an attempt to decrease the effects of the abuse and to prevent it from occurring again.

Attempts at secondary and tertiary prevention of child abuse tend to address the risk factors and strengthen protective factors. Such programs often use approaches that strengthen parenting skills and supports, as well as enhance the ability for the caretaker to provide for the needs of the child. The inverse of most risk factors, protective factors for child abuse include having the involvement of supportive family, strengthening family and peer relationships, developing healthy coping skills, and improving individual emotional regulation.

What should people do if they suspect that a child is being abused?

If it is suspected that a child is being abused, laws in most of the United States require that a professional that is in the role of caring for the child (for example, a teacher, doctor, or daycare provider) make a formal report of the abuse to child-welfare authorities in the state in which it is suspected to have occurred. Those professionals are often called mandated reporters. Both for those professionals and for people who are not mandated reporters, child-abuse reporting hotlines are available in every state in the United States.

Where can people find more information about child abuse?

American Professional Society on the Abuse of Children
350 Poplar Avenue
Elmhurst, IL 60126
877-402 7722
http://www.apsac.org

Child Abuse Prevention Association
503 E. 23rd Street
Independence, M0 64055
Phone: 816-252-8388
Fax: 816-252-1337
http://www.childabuseprevention.org

Childhelp
Phone: 800-4-A-CHILD (800-422-4453)
People they help: child-abuse victims, parents, concerned individuals

Child Welfare Information Gateway
Children's Bureau/ACYF
1250 Maryland Avenue, SW, Eighth Floor
Washington, DC 20024
800-394-3366
http://www.childwelfare.gov

Darkness to Light
Phone: 866-FOR-LIGHT (866-367-5444)
People they help: children and adults needing local information or resources about sexual abuse

Rape, Abuse, and Incest National Network
2000 L St., NW, Suite 406
Washington, DC 20036
800-656-HOPE
http://www.rainn.org

Medically reviewed by Margaret Walsh, MD; American Board of Pediatrics

REFERENCES:

Al Odhayani, A., W.J. Watson, and L. Watson. "Behavioural consequences of child abuse." Canadian Family Physician 59.8 Aug. 2013: 831-836.

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Washington, D.C.: American Psychiatric Association, 2013.

American Psychiatric Association's Children, Youth and Families Office. "Understanding and preventing child abuse and neglect." (2013) <http://www.apa.org/pi/cyf>.

Currie, J., and C.S. Widom. "Long-term consequences of child abuse and neglect on adult economic well-being." Child Maltreatment 15.2 May 2010: 111-120.

Fang, X., D.S. Brown, C. Florence, and J. Mercy. "The economic burden of child maltreatment in the United States and implications for prevention." Child Abuse and Neglect Jan. 2012.

Healy, M. "Child neglect accounts for 75% of reported abuse cases." USA Today Sept. 2013.

Hussey, J.M., J.J. Chang, and J.B. Kotch. "Child maltreatment in the United States: Prevalence, risk factors and adolescent health consequences." Pediatrics 118.3 Sept. 2006: 933-942.

Urosevich, K. "It takes a Hui to raise a child: a case for peer-to-peer support for child abuse prevention." Hawaii Journal of Medicine and Public Health 72.10 Oct. 2013: 365-368.

Wegman, H.L., and C. Stetler. "A meta-analytic review of the effects of childhood abuse on medical outcomes in adulthood." Psychosomatic Medicine 71.8 Oct. 2009: 805-812.

Last Editorial Review: 3/21/2016

Reviewed on 3/21/2016
References
Medically reviewed by Margaret Walsh, MD; American Board of Pediatrics

REFERENCES:

Al Odhayani, A., W.J. Watson, and L. Watson. "Behavioural consequences of child abuse." Canadian Family Physician 59.8 Aug. 2013: 831-836.

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Washington, D.C.: American Psychiatric Association, 2013.

American Psychiatric Association's Children, Youth and Families Office. "Understanding and preventing child abuse and neglect." (2013) <http://www.apa.org/pi/cyf>.

Currie, J., and C.S. Widom. "Long-term consequences of child abuse and neglect on adult economic well-being." Child Maltreatment 15.2 May 2010: 111-120.

Fang, X., D.S. Brown, C. Florence, and J. Mercy. "The economic burden of child maltreatment in the United States and implications for prevention." Child Abuse and Neglect Jan. 2012.

Healy, M. "Child neglect accounts for 75% of reported abuse cases." USA Today Sept. 2013.

Hussey, J.M., J.J. Chang, and J.B. Kotch. "Child maltreatment in the United States: Prevalence, risk factors and adolescent health consequences." Pediatrics 118.3 Sept. 2006: 933-942.

Urosevich, K. "It takes a Hui to raise a child: a case for peer-to-peer support for child abuse prevention." Hawaii Journal of Medicine and Public Health 72.10 Oct. 2013: 365-368.

Wegman, H.L., and C. Stetler. "A meta-analytic review of the effects of childhood abuse on medical outcomes in adulthood." Psychosomatic Medicine 71.8 Oct. 2009: 805-812.

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