Child abuse, also known as maltreatment, is common. It is important to understand and reduce the risks of abuse for your child and be familiar with the signs of abuse and neglect.
Approximately 4 million cases of child abuse and neglect involving almost 7 million children are reported each year. The highest rate of child abuse is in babies less than one year of age, and 25 percent of victims are younger than age three. The majority of cases reported to Child Protective Services involve neglect, followed by physical and sexual abuse. There is considerable overlap among children who are abused, with many suffering a combination of physical abuse, sexual abuse, and/or neglect.
Types of abuse and neglect
Physical abuse occurs when a child's body is injured as a result of hitting, kicking, shaking, burning, or other show of force. One study suggests that about 1 in 20 children has been physically abused in their lifetime.
Sexual abuse is any sexual activity that a child cannot understand or consent to. It includes acts such as fondling, oral-genital contact, and genital and anal intercourse. It also includes exhibitionism, voyeurism, and exposure to pornography. Studies suggest that up to one in five girls and one in 20 boys will be sexually abused before they are 18 years old. More than 90 percent of child sexual abuse victims know their abuser.
Child neglect can include physical neglect (failing to provide food, clothing, shelter, or other physical necessities), emotional neglect (not providing love, comfort, or affection), and medical or educational neglect (not providing access to needed medical care or education), or supervisory neglect (failure to appropriately supervise). Psychological or emotional abuse results from all of the above, but also can be associated with verbal abuse, which can harm a child's self-worth or emotional well-being.
Risk factors
Most child abuse occurs within the family. Risk factors include parental depression or other mental health issues, a parental history of childhood abuse or neglect, parental substance abuse, and domestic violence.
Child neglect and other forms of maltreatment are also more common in families living in poverty and among parents who are teenagers or who abuse drugs or alcohol.
Signs and symptoms
It is not always easy to recognize when a child has been abused. Children who have been maltreated are often afraid to tell anyone, because they think they will be blamed or that no one will believe them. Sometimes they remain quiet because the person who abused them is someone they love very much, or because of fear, or both.
Parents also tend to overlook signs and symptoms of abuse, because it is hard to believe it could happen or they fear what might happen if people found out. However, a child who has been abused needs special support and treatment as early as possible. The longer children continue to be abused or are left to deal with the situation on their own, the harder it is for them to be able to heal and develop optimally physically and mentally.
Here are some physical signs and behavioral changes in children who may have experienced abuse or neglect:
Physical signs
Non-mobile infant with any injury
Bruises to the torso, ears, or neck in a child less than four years of age
Any injury (bruise, burn, fracture, abdominal or head injury) that is not consistent with the way the injury is said to have happened, that cannot be adequately explained, or that is inconsistent with the child's developmental capabilities
The child discloses abuse or neglect
Failure to gain weight (especially in infants) or sudden dramatic weight gain
Genital pain, bleeding, or discharge
A sexually transmitted disease
Behavioral and mental health changes that raise concern about possible abuse or neglect
It is important to remember that the following changes are seen in many children as a result of many different kinds of stressful situations and are not specific to child abuse and neglect. The reason for the appearance of these behaviors should always be investigated.
Fearful behavior (nightmares, depression, unusual fears)
Unexplained abdominal pain, sudden onset of bed-wetting, or regression in toileting (especially if the child has already been toilet trained)
Attempts to run away
Extreme sexual behavior that seems developmentally inappropriate for the child's age
Sudden change in self-confidence
Headaches or stomachaches with no medical cause
School failure
Extremely passive or aggressive behavior
Desperately affectionate behavior or social withdrawal
Big appetite and stealing food
Long-term consequences
In most cases, children who are abused or neglected suffer greater mental health than physical health damage. Emotional and psychological abuse, physical abuse, and neglect deny the child the tools needed to cope with stress, and to learn new skills to become resilient, strong, and successful. So a child who is maltreated or neglected may have a wide range of reactions and may even become depressed or develop suicidal, withdrawn, or violent behavior. As they get older, they may show learning difficulties, use drugs or alcohol, try to run away, refuse discipline, or abuse others. As an adult, they may develop marital and sexual difficulties, depression, or suicidal behavior.
Not all children who are abused have severe reactions. Usually the younger the child, the longer the abuse continues. The closer the child's relationship with the abuser, the more serious the mental health effects will be. A close relationship with a very supportive adult can increase resiliency, reducing some of the impact.
Getting help
If you suspect your child has been abused, get help immediately through your pediatrician or a local child protective agency. Physicians are legally obligated to report all suspected cases of abuse or neglect to state authorities. Your pediatrician also will detect and treat any medical injuries or conditions, recommend a therapist, and provide necessary information to investigators. The doctor also may testify in court if needed to secure legal protection for the child or criminal prosecution of the person suspected of perpetrating the abuse or neglect.
If your child has been abused, you may be the only person who can help them. There is no good reason to delay reporting your suspicions of abuse. Denying the problem will only make the situation worse. It allows the abuse or neglect to continue unchecked and lowers your child's chance for optimal physical and mental health and well-being.
In any case of abuse or neglect, the child's safety is of primary concern. They need to be in a safe environment, free of the potential for more abuse and neglect.
Preventing abuse and neglect
The major reasons for physical and psychological maltreatment of children within the family often are a parent's feelings of isolation, stress, and frustration. Parents need support and as much information as possible in order to raise their children responsibly. They need to be taught how to cope with their own feelings of frustration and anger without venting them on children. They also need the companionship of other adults who will listen and help during times of crisis.
Support groups through local community organizations often are helpful first steps to ease some of the isolation or frustration parents may be feeling. Parents who were themselves abused as children are in particular need of support. Confronting, addressing, and healing parental mental and emotional health takes a lot of courage and insight. But this is often the best way to lower the odds of past abuse being passed on to the next generation of children
Personal supervision of and involvement in your child's activities are the best ways to prevent physical and sexual abuse outside the home. Pay careful attention to your child's reports about and reactions to his experiences at child care and school. Always investigate if your child tells you he's been maltreated or if he undergoes a sudden unexplained change in behavior.
Although you don't want to frighten your child, you can teach some basic rules of safety in a non-threatening manner. Teach them to keep their distance from strangers, not to wander away from you in unfamiliar territory, to say “no" when someone asks them to do something they don't want to do. Tell them to always to tell you if someone hurts him or makes him feel bad, even if that person is someone they know.
Remember
Open, two-way communication with your child provides the best chance of knowing early when there is a problem. Make sure your child understands they will not get in trouble if they tell you about abuse or other confusing events. Instead of teaching them that they are surrounded by danger, teach them that they are strong, capable, and can count on you to keep them safe.