A single copy of this article may be reprinted for personal, noncommercial use only.
Child abuseBy Mayo Clinic staff
Original Article: http://www.mayoclinic.com/health/child-abuse/DS01099
Any intentional harm or mistreatment to a child under 18 years old is considered child abuse. Child abuse takes many forms, which often occur at the same time.
- Physical abuse. Physical child abuse occurs when a child is purposefully physically injured.
- Sexual abuse. Sexual child abuse is any sexual activity with a child, such as fondling, oral-genital contact, intercourse or exposure to child pornography.
- Emotional abuse. Emotional child abuse means injuring a child's self-esteem or emotional well-being. It includes verbal and emotional assault — such as continually belittling or berating a child — as well as isolating, ignoring or rejecting a child.
- Neglect. Child neglect is failure to provide adequate food, shelter, affection, supervision, education or medical care.
Most child abuse is inflicted by someone the child knows and trusts, often a parent or other relative. If you suspect child abuse, report the abuse to the proper authorities.
A child who's being abused may feel guilty, ashamed or confused. He or she may be afraid to tell anyone about the abuse, especially if the abuser is a parent, other relative or family friend. In fact, the child may have an apparent fear of parents, adult caregivers or family friends. That's why it's vital to watch for red flags, such as:
- Withdrawal from friends or usual activities
- Changes in behavior — such as aggression, anger, hostility or hyperactivity — or changes in school performance
- Depression, anxiety or a sudden loss of self-confidence
- An apparent lack of supervision
- Frequent absences from school or reluctance to ride the school bus
- Reluctance to leave school activities, as if he or she doesn't want to go home
- Attempts at running away
- Rebellious or defiant behavior
- Attempts at suicide
Specific signs and symptoms depend on the type of abuse. Keep in mind that warning signs are just that — warning signs. The presence of warning signs doesn't necessarily mean that a child is being abused.
Physical abuse signs and symptoms
- Unexplained injuries, such as bruises, fractures or burns
- Injuries that don't match the given explanation
- Untreated medical or dental problems
Sexual abuse signs and symptoms
- Sexual behavior or knowledge that's inappropriate for the child's age
- Pregnancy or a sexually transmitted infection
- Blood in the child's underwear
- Statements that he or she was sexually abused
- Trouble walking or sitting
- Abuse of other children sexually
Emotional abuse signs and symptoms
- Delayed or inappropriate emotional development
- Loss of self-confidence or self-esteem
- Social withdrawal
- Headaches or stomachaches with no medical cause
- Avoidance of certain situations, such as refusing to go to school or ride the bus
- Desperately seeks affection
Neglect signs and symptoms
- Poor growth or weight gain
- Poor hygiene
- Lack of clothing or supplies to meet physical needs
- Taking food or money without permission
- Eating a lot in one sitting or hiding food for later
- Poor record of school attendance
- Lack of appropriate attention for medical, dental or psychological problems, even though the parents have been notified
- Emotional swings that are inappropriate or out of context to the situation
Sometimes a parent's demeanor or behavior sends red flags about child abuse. Warning signs include a parent who:
- Shows little concern for the child
- Appears unable to recognize physical or emotional distress in the child
- Denies that any problems exist at home or school, or blames the child for the problems
- Consistently blames, belittles or berates the child and describes the child with negative terms, such as "worthless" or "evil"
- Expects the child to provide him or her with attention and care and seems jealous of other family members getting attention from the child
- Uses harsh physical discipline or asks teachers to do so
- Demands an inappropriate level of physical or academic performance
- Severely limits the child's contact with others
- Offers conflicting or unconvincing explanations for a child's injuries or no explanation at all
Although most child health experts condemn the use of violence in any form, some people still use corporal punishment (such as spanking) as a way to discipline their children. Corporal punishment has limited effectiveness in deterring behavior and is associated with aggressive behavior in the child. Any corporal punishment may leave emotional scars.
Parental behaviors that cause pain or physical injury — even when done in the name of discipline — could be child abuse.
When to see a doctor
If you're concerned that your child or another child has been abused, seek help immediately. The sooner you get help and support for the child, the better the child's chance of recovery.
If the child needs immediate medical attention, call 911 or your local emergency number. Depending on the situation, contact the child's doctor, a local child protective agency, the police department, or a hotline such as Childhelp National Child Abuse Hotline (800-422-4453).
Keep in mind that health care professionals are legally required to report all suspected cases of child abuse to the appropriate county or state authorities.
Child abuse occurs across all social and economic levels and ethnic groups. Factors that may increase a person's risk of becoming abusive include:
- A history of being abused or neglected as a child
- Physical or mental illness, such as depression or post-traumatic stress disorder (PTSD)
- Family crisis or stress, including domestic violence and other marital conflicts, single parenting, or young children in the family, especially several children under age 5
- A child in the family who is developmentally or physically disabled
- Financial stress or unemployment
- Social or extended family isolation
- Poor understanding of child development and parenting skills
- Alcoholism or other forms of substance abuse
Some children overcome the physical and psychological effects of child abuse, particularly those with strong social support who can adapt and cope with bad experiences. For many others, however, child abuse has lifelong consequences. For example, child abuse may result in physical, behavioral, emotional and mental issues. Examples include:
- Physical disabilities and health problems
- Learning disabilities
- Attention-deficit/hyperactivity disorder (ADHD)
- Substance abuse
- Delinquent or violent behavior
- Abuse of others
- Suicide attempts
- Frequent, casual sex with many different partners (sexual promiscuity) or teen pregnancy
- Low self-esteem
- Difficulty establishing or maintaining relationships
- Challenges with intimacy and trust
- An unhealthy view of parenthood that may perpetuate the cycle of abuse
- Inability to cope with stress and frustrations
- Eating disorders
- Personality disorders
- Post-traumatic stress disorder (PTSD)
Treatments and drugs
Talk therapy, also called psychotherapy, can help a child who has been abused learn to trust again, as well as teach the child about normal behavior and relationships. Therapy can also teach children conflict management and boost self-esteem. Several different types of therapy may be effective, such as:
- Trauma-focused cognitive behavioral therapy. This type of therapy helps an abused child to better manage distressing feelings and to deal with trauma-related memories. Eventually, the nonabusing parent and the child are seen together so the child can let the nonabusing parent know exactly what happened.
- Child-parent psychotherapy. This treatment focuses on improving the parent-child relationship and on building a stronger attachment between the two.
Psychotherapy can help parents discover the roots of abuse, learn effective ways to cope with life's inevitable frustrations and learn healthy parenting strategies. If the child is still in the home, social services may schedule home visits and make sure essential needs, such as food, are available.
Children who are placed in foster care because their home situation is too dangerous will also need mental health services and therapies.
Places to turn for help
If you need help because you're at risk of abusing a child or you think someone else has abused or neglected a child, there are organizations that can provide you with information and referrals, such as:
- Childhelp National Child Abuse Hotline: 800-4-A-CHILD (800-422-4453)
- Prevent Child Abuse America: 800-CHILDREN (800-244-5373)
Coping and support
If a child tells you he or she is being abused, take the situation seriously. The child's safety is most important. Here's what you can do:
- Encourage the child to tell you what happened. Remain calm as you assure the child that it's OK to talk about the experience, even if someone has threatened him or her to keep silent. But don't ask leading questions (questions that suggest specific answers) — leave detailed questioning to the professionals.
- Remind the child that he or she isn't responsible for the abuse. The responsibility for child abuse belongs to the abuser. Say "It's not your fault" over and over again.
- Offer comfort. You might say, "I'm so sorry you were hurt," "I'm glad that you told me," and "I'll do everything I can to help you." Let the child know you're available to talk or simply listen at any time.
- Report the abuse. Contact a local child protective agency or the police department. Authorities will investigate the report and, if necessary, take steps to ensure the child's safety.
- Seek medical attention. If necessary, help the child seek appropriate medical care.
- Help the child remain safe. Don't let the child be alone with the abuser. If that's not possible, do what you can to eliminate the abuser's access to the child. Make sure the child knows how to call for emergency help if needed.
- Consider additional support. You might help the child seek counseling or other mental health treatment. Age-appropriate support groups also can be helpful.
If the abuse has occurred at school, make sure the principal of the school is aware of the situation, in addition to reporting it to the local or state child protection agency.
You can take simple steps to protect your child from exploitation and child abuse, as well as prevent child abuse in your neighborhood or community. For example:
- Offer your child love and attention. Nurturing your child, listening and being involved in his or her life can develop trust and good communication. This encourages your child to tell you if there's a problem.
- Don't respond in anger. If you feel overwhelmed or out of control, take a break. Don't take out your anger on your child. Talk with your doctor or therapist about ways you can learn to cope with stress and better interact with your child.
- Think supervision. Don't leave young children home alone. In public, keep a close eye on your child. Volunteer at school and for activities so that you get to know the adults who spend time with your child. Don't allow your child to go anywhere or accept anything without your permission. When your child is old enough to leave home without parental supervision, encourage your child to stay away from strangers and to hang out with friends rather than alone — and to tell you where he or she is at all times. Make sure you know who is supervising your child when he or she is out of your care, such as at a sleepover.
- Know your child's caregivers. Check references for baby sitters and other caregivers. Make irregular, but frequent, unannounced visits to observe what's happening. Don't ever allow substitutes for your usual child care provider if you don't know the substitute.
- Emphasize the importance of saying no. Make sure your child understands that he or she doesn't have to do anything that seems scary or uncomfortable. Encourage your child to leave a threatening or frightening situation immediately and seek help from a trusted adult. If something does happen, encourage your child to talk to you or another trusted adult about the episode. Assure your child that it's OK to talk and that he or she won't get in trouble.
- Teach your child how to stay safe online. Place the computer in a common area of your home. Use the parental controls to restrict the types of websites your child can visit, and check your child's privacy settings on social networking sites. Consider it a red flag if your child is secretive about online activities. Cover ground rules, such as not sharing personal information, not responding to inappropriate, hurtful or frightening messages, not sharing photos or videos online, and not arranging to meet an online contact in person without your permission. Tell your child to let you know if an unknown person makes contact through a social networking site. Report online harassment or inappropriate senders to your service provider and to local authorities, if necessary.
- Reach out. Meet the families in your neighborhood, including both parents and children. Consider joining a parent support group so you have an appropriate place to vent your frustrations. If a friend or neighbor seems to be struggling, offer to baby-sit or help in another way.
If you worry that you might abuse your child
If you're concerned that you might abuse your child, seek help immediately, especially if you were abused as a child. If you were a victim of any type of child abuse, get counseling to assure you don't continue the abuse cycle or teach those destructive behaviors to your child. These organizations can provide information and referrals:
- Childhelp National Child Abuse Hotline: 800-4-A-CHILD (800-422-4453)
- Prevent Child Abuse America: 800-CHILDREN (800-244-5373)
Or you can start by talking with your family doctor. He or she may offer a referral to a parent education class, counseling or a support group for parents to help you learn appropriate ways to deal with your anger. If you're abusing alcohol or drugs, ask your doctor about treatment options. Remember, child abuse is preventable — and often a symptom of a problem that may be treatable. Ask for help today.
- Set rules for Internet use. American Academy of Pediatrics. http://www.healthychildren.org/English/family-life/Media/Pages/Set-the-Rules-for-Internet-Use.aspx. Accessed Aug. 29, 2012.
- Position statement regarding physical punishment. American Psychological Association. http://apsa.org/About_APsaA/Position_Statements/Physical_Punishment.aspx. Accessed Aug. 29, 2012.
- What to know about child abuse. American Academy of Pediatrics. http://www.healthychildren.org/English/safety-prevention/at-home/Pages/What-to-Know-about-Child-Abuse.aspx. Accessed Aug. 29, 2012.
- Kolko DJ, et al. Evaluation of the sustainability and clinical outcome of alternatives for families: A cognitive-behavioral therapy (AF-CBT) in a child protection center. Child Abuse & Neglect. 2011;35:105.
- Recognizing child abuse and neglect: Signs and symptoms. Child Welfare Information Gateway. http://www.childwelfare.gov/pubs/factsheets/signs.cfm. Accessed Aug. 29, 2012.
- Understanding child maltreatment: Fact sheet 2010. http://www.cdc.gov/violenceprevention/pdf/CM-factsheet-a.pdf. Accessed Aug. 29, 2012.
- Nanni V, et al. Meta-analysis of childhood maltreatment and outcome in depression. American Journal of Psychiatry. 2012;169:141.
- King DC, et al. Childhood maltreatment and psychiatric disorders among detained youths. Psychiatric Services. 2011;62:1430.
- Schechter DS. The developmental neuroscience of emotional neglect: Its consequences, and the psychosocial interventions that can reverse them. American Journal of Psychiatry. 2012;169:452.
- Thompson R, et al. Predictors of engagement with mental health services among mothers of children at risk of maltreatment. In press. Accessed Aug. 29, 2012.
- Putnam FW. Beyond sticks and stones. Psychiatry. 2010;167:1422.
- Strengthening families and communities: 2011 Resource guide. U.S. Department of Health and Human Services. http://www.childwelfare.gov/pubs/guide2011/guide.pdf. Accessed Aug. 29, 2012
- National child abuse statistics. Childhelp. http://www.childhelp.org/pages/statistics#abuse-conseq. Accessed Aug. 29, 2012.
- Hoecker JL (expert opinion). Mayo Clinic, Rochester, Minn. Sept. 22, 2012.
- Billings ML (expert opinion). Mayo Clinic, Rochester, Minn. Oct. 18, 2102.
- Frequently asked questions. Childhelp. http://www.childhelp.org/pages/faq. Accessed Oct. 19, 2012
- Contact us. Prevent Child Abuse America. http://www.preventchildabuse.org/contact_us.shtml. Accessed Oct. 19, 2012