Child abuse refers to physical, emotional, or sexual harm inflicted on a child. While child abuse often takes the form of specific actions, such as hitting, it is also possible for inaction to cause harm, as in the case of neglect.
Physical abuse involves non-accidental harming of a child by, for example, beating, burning, or breaking bones. Verbal or emotional abuse involves harming a child by, for example, belittling them or threatening physical or sexual acts. Child sexual abuse is the deliberate exposure of a minor child to sex or sexual activities that the child cannot comprehend or consent to. This behavior includes acts such as inappropriate touching of a child's breasts or genitalia, someone exposing their genitalia to a child, fondling, oral-genital contact, genital and anal intercourse, as well as exhibitionism, voyeurism, and exposure to pornography. Lasting emotional trauma can result from any form of abuse.
Child neglect occurs when someone does not provide the necessities of life to a child, either intentionally or with reckless disregard for the child's well-being. This can include physical neglect, such as withholding food, clothing, shelter, or other necessities. Emotional neglect includes withholding love or comfort or affection. Medical neglect occurs when medical care is withheld. (To learn more about child neglect, see our Diagnosis Dictionary.)
Households in which participants suffer from alcoholism, substance abuse, or anger issues demonstrate higher occurrences of child abuse as compared to households without. Child abuse can result in both short- and long-term injury or even death. Some children may be unaware that they are victims of child abuse. Child abuse can occur in any cultural, ethnic, or income group.
It's not always easy to recognize when a child has been abused. Children who are abused are often afraid to complain because they are fearful that they will be blamed or that no one will believe them; abusers may directly tell them that the abuse is their fault or that it occurred because they were "bad." Additionally, the person who abused them may be someone they love very much and want to protect. Parents who are not themselves abusive may be unable to recognize symptoms of abuse because they trust the abuser or are in denial.
Parents should watch for unexplained changes in a child's body or behavior. A formal examination should be conducted only if a parent has reason to suspect their child has been abused; otherwise, the child may become fearful. Parents should be alert to any of the following changes:
Signs of Physical Abuse:
- Any injury (bruise, burn, fracture, abdominal or head injury) that cannot be explained, or that don’t match up with the explanation given
Signs of Sexual Abuse:
- Fearful behavior (nightmares, depression, unusual fears, attempts to run away)
- Abdominal pain
- Urinary tract infection
- Genital pain or bleeding
- Sexually transmitted disease
- Extreme sexual behavior or knowledge that seems inappropriate for the child's age
Signs of Emotional Abuse:
- Dramatic change in self-confidence
- Social withdrawal
- Headaches or stomachaches with no medical cause
- Abnormal fears, increased nightmares, or attempts to run away; may avoid certain situations or people
- Persistent anxiety or worry about doing something “wrong”
- Poor school performance or a sudden loss of interest in school
- “Regressing” developmentally, either by losing previously acquired developmental skills or by restarting old behaviors
Signs of Neglect:
- Failure to gain weight (especially in infants)
- Poor hygiene
- Desperately affectionate behavior
- Voracious appetite, including stealing or hiding food
- Stealing money or other necessary items
- Lack of adequate clothing or basic necessities
- Failure to attend school regularly
Abuse is typically categorized into one of four types: physical abuse, psychological or emotional abuse, sexual abuse, and neglect. While some children are victims of just one type of abuse, it’s possible for children to experience multiple types, even all four types.
At least one in seven children in the U.S. experiences physical abuse and/or neglect each year, the CDC reports; this number is thought to be an underestimate. While most are victims of neglect, nearly 20 percent are estimated to experience physical abuse. One in four girls and one in 13 boys are sexually abused before the age of 18, according to the CDC.
Whether spanking or other forms of corporal punishment should be considered child abuse is the subject of debate. Historically, briefly striking a child as a punishment for a specific action was widely tolerated and even encouraged in many cultures—and legally, many U.S. states and countries do not consider this practice to be child abuse. However, a growing body of recent evidence suggests that spanking is strongly associated with depression, anxiety, behavioral problems, and aggression in children, and both the American Academy of Pediatrics and the American Psychological Association condemn the practice as harmful and unnecessary.
A small minority of parents decline to provide their children with certain kinds of medical care because they claim doing so would violate their religious beliefs. The type of care declined may be limited to specific practices such as vaccinations or blood transfusions; in more extreme cases, a parent may reject all forms of modern medicine and focus on spiritual "healing" instead—by, for example, attempting to heal the child through prayer. In the U.S., state laws on this subject vary widely. However, many states do still allow religious exemptions to certain kinds of medical care and do not automatically consider such behavior to be child abuse or neglect—even, in some cases, if the child dies due to lack of care. Child deaths as a result of religiously-motivated medical neglect are thought to be rare; however, their true extent is unknown, and many experts and medical providers argue that there should be no religious exemptions in matters of children's health.
A combination of individual, relational, community, and societal factors contribute to the risk of child maltreatment and abuse. Children are never responsible for the harm inflicted upon them, but certain individual characteristics have been found to increase a child's risk of being maltreated. Risk factors are contributing factors—not direct causes.
Examples of risk factors:
- Disabilities or mental retardation in children that may increase caregiver burden
- Social isolation of families
- Parents' lack of understanding of children's needs and child development
- Parents' history of domestic abuse
- Poverty and other socioeconomic disadvantages, such as unemployment
- Family disorganization, dissolution, and violence, including intimate partner violence
- Lack of family cohesion
- Substance abuse in the family
- Young, single, or non-biological parents
- Poor parent-child relationships and negative interactions
- Parental thoughts and emotions supporting maltreatment behaviors
- Parental stress and distress, including depression or other mental health conditions
- Community violence
Evidence suggests that victims of child abuse are more likely to engage in violent or abusive behavior themselves. However, this is far from a foregone conclusion, and research suggests that the majority of people who were abused as children are able to escape this so-called “cycle of violence.” Cultivating self-control, pursuing education, and working in a satisfying job are all linked to a substantially lower risk of engaging in abusive behavior as an adult.
Sadly, children with disabilities or developmental disorders such as ADHD are at heightened risk of being abused. Such children tend to have significant needs and rely more on adults for basic care, which increases the burden on caregivers; children with ADHD or other developmental disorders may also be more likely to “act out,” frustrating parents and potentially leading to abuse. Some abusers may also deliberately take advantage of disabled children, seeing them as “easy targets” of physical or sexual abuse.
Most people struggling to make ends meet do not abuse their children, and individuals from wealthy families mistreat children as well. However, lower socioeconomic status is associated with a heightened risk of child abuse or neglect. In some cases, families living in poverty are also under extreme stress, which can make them more likely to lash out at children when frustrated or to neglect their needs. Poverty also frequently co-occurs with other child abuse risk factors, such as substance abuse, social isolation, or community violence.
Younger parents, particularly teens and very young adults, are likely than older parents to abuse or neglect their children. Some of this heightened risk is thought to be due to parental age itself, as teens and young adults are more likely than older parents to struggle with impulse control and emotional regulation. In addition, young parents tend to be more likely than older parents to live in precarious financial situations and may lack adequate social support, both of which can further increase the risk of abuse or neglect.
If someone suspects a child has been abused, they should contact a pediatrician or a local child protective agency for help. Physicians are legally obligated to report all suspected cases of abuse or neglect to authorities. They can also recommend a therapist and provide the necessary information for investigators. Doctors may also testify in court to obtain legal protection for the child or to help criminally prosecute an individual suspected of engaging in child sexual abuse.
If it's suspected that a child has been sexually abused, the child should be examined as soon as possible by a trained health care professional. It is imperative that any abused child be given immediate access to special support and treatment; a doctor's exam should not be delayed for any reason. Many signs of injury related to sexual abuse are temporary. Ideally, the exam should occur within 72 hours of the event or discovery. A complete physical exam must always be performed so that the examiner can look for any signs of physical or sexual abuse. These two forms of abuse can—and often do—coexist. The longer the abuse continues, the less likely the child will make a full physical or emotional recovery.
Whatever the nature of the abuse, steps should be taken immediately to report the abuse and obtain help. Delaying a report decreases the child's chances for a full recovery.
If he or she has been abused, a child will benefit from the services of a qualified mental health professional. Parents and other members of the family may be advised to seek counseling so that they'll be able to provide the support and comfort the child needs. If someone in the family is responsible for the abuse, a mental health professional may be able to treat that person successfully, as well.
If a child has been abused, a parent may be the only person who can help him or her. Do not delay reporting suspicions of abuse. Denying the problem will only worsen the situation. In any case of child abuse, the safety of the abused youngster is of primary concern. He or she needs to be in a safe environment free from the potential for continuing abuse.
In many cases, children who are abused or neglected struggle with lasting emotional repercussions, even after the abuse is stopped. A child who has been abused or otherwise severely mistreated may become depressed or develop suicidal, withdrawn, or violent behavior. An older child may use drugs or alcohol, try to run away, or abuse others. The younger the child is and the closer the child's relationship to the abuser, the more serious the emotional damage tends to be. As adults, they may develop marital and sexual difficulties, depression, or suicidal behavior. With early intervention and treatment, these outcomes may be avoided.
Parents or other caregivers should first ensure that the child receives appropriate medical care, especially in cases of physical or sexual abuse. In some cases, regular follow-up appointments may be required. To help the child navigate the emotional aftereffects of abuse, psychotherapy is critical. Trauma-focused therapies can be especially useful, as they help children cope with distressing memories and slowly learn to trust adults again. Non-abusing parents may also participate in therapy with the child, with the aim of rebuilding trust and strengthening the parent-child bond. Parents may also wish to seek individual therapy to help navigate feelings of guilt and learn strategies for protecting the child from harm in the future.
Anyone who sincerely suspects a child is being neglected or abused should report their suspicions to authorities; in some states, they have a legal duty to do so, even if they're not what's considered a "mandatory reporter" (teacher, social worker, etc.). According to the U.S. Children's Bureau, if the child is based in the U.S. and appears to be in immediate danger, it's best to call 911. In other cases, concerned individuals are encouraged to reach out to the Childhelp National Child Abuse Hotline (1-800-422-4453) or their state agency (state-specific numbers can be found here). Many other countries have similar resources, most of which can be located through an internet search.
As long as someone has reasonable suspicion that what they observed could be child abuse or neglect, they should feel empowered to report it. Most child abuse happens out of sight of others, and abused children are often terrified to seek help or speak out about what they're enduring; they may even believe that what they have undergone is "normal." Thus, when someone else witnesses possible abuse, reporting it could save an otherwise powerless child from great pain and suffering. It's also important to keep in mind that after a report is made, child protective services will conduct an investigation; in cases where there is no evidence of abuse or neglect, they will determine the report to be unfounded and no further action will be taken (apart from, in some cases, services being offered to the investigated parents). There are no consequences for making a report in good faith, even if the allegations later turn out to be unsubstantiated.