Child Abuse and Neglect:

Child abuse facts

Most of us can’t imagine what would make an adult use violence against a child, and the worse the behavior is, the more unimaginable it seems. But the incidence of parents and other caregivers consciously, even willfully, committing acts that harm the very children they’re supposed to be nurturing is a sad fact of human society that cuts across all lines of ethnicity and class. Whether the abuse is rooted in the perpetrator’s mental illness, substance abuse, or inability to cope, the psychological result for each abused child is often the same: deep emotional scars and a feeling of worthlessness.

In the United States, the federal legislation that sets minimum standards for how states handle child abuse defines child abuse and neglect as “any recent act or failure to act on the part of a parent or caretaker, which results in death, serious physical or emotional harm, sexual abuse, or exploitation, or an act or failure to act which presents an imminent risk of serious harm.” In 2005, the most recent year for which the U.S. government has figures, 12.1 of every 1,000 American children, almost 900,000 in all, suffered abuse by adults, with parents of victims accounting for almost 80 percent of the abusers. Every day, about four children die in the U.S. because of abuse or neglect, most of them babies or toddlers. And those are just the cases authorities know about: for every incidence of child abuse or neglect that gets reported, it’s estimated that two others go unreported.

There are four primary types of child abuse:

1. physical abuse
2. sexual abuse
3. emotional abuse
4. neglect

While the first two categories get the most attention, perhaps because they involve physical violence, neglect is far and away the most common form of child abuse, accounting for more than 60 percent of all cases of child maltreatment.

Child neglect: types and warning signs

Neglect is a pattern of failing to provide for a child's basic needs, to the extent that the child’s physical and/or psychological well-being are damaged or endangered. In child neglect, the parents or caregivers are simply choosing not to do their job. There are three basic types of neglect.

Physical Neglect	Failure to provide adequate food, clothing, or hygiene Reckless disregard for the child’s safety, such as inattention to hazards in the home, drunk driving with kids in the car, leaving a baby unattended Refusal to provide or delay in providing necessary health care for the child Abandoning children without providing for their care or expelling children from the home without arranging for their care
Educational Neglect	Failure to enroll a child in school Permitting or causing a child to miss too many days of school Refusal to follow up on obtaining services for a child’s special educational needs
Emotional Neglect	Inadequate nurturing or affection Exposure of the child to spousal abuse Permitting a child to drink alcohol or use recreational drugs Failure to intervene when the child demonstrates antisocial behavior Refusal of or delay in providing necessary psychological care

Some signs of child neglect:

• Clothes that are dirty, ill-fitting, ragged, and/or not suitable for the weather
• Unwashed appearance; offensive body odor
• Indicators of hunger: asking for or stealing food, going through trash for food, eating too fast or too much when food is provided for a group
• Apparent lack of supervision: wandering alone, home alone, left in a car
• Colds, fevers, or rashes left untreated; infected cuts; chronic tiredness
• In schoolchildren, frequent absence or lateness; troublesome, disruptive behavior or its opposite, withdrawal
• In babies, failure to thrive; failure to relate to other people or to surroundings

A single occurrence of one of these indicators isn’t necessarily a sign of child neglect, but a pattern of behaviors may demonstrate a lack of care that constitutes abuse.

Physical child abuse: types and warning signs

Physical child abuse is an adult’s physical act of aggression directed at a child that causes injury, even if the adult didn’t intend to injure the child. Such acts of aggression include striking a child with the hand, fist, or foot or with an object; burning the child with a hot object; shaking, pushing, or throwing a child; pinching or biting the child; pulling a child by the hair; cutting off a child’s air. Such acts of physical aggression account for between 15 and 20 percent of documented child abuse cases each year.

Many physically abusive parents and caregivers insist that their actions are simply forms of discipline, ways to make children learn to behave. But there’s a big difference between giving an unmanageable child a swat on the backside and twisting the child’s arm until it breaks. Physically abusive parents have issues of anger, excessive need for control, or immaturity that make them unable or unwilling to see their level of aggression as inappropriate.

Sometimes the very youngest children, even babies not yet born, suffer physical abuse. Because many chemicals pass easily from a pregnant woman’s system to that of a fetus, a mother’s use of drugs or alcohol during pregnancy can cause serious neurological and physiological damage to the unborn child, such as the effects of fetal alcohol syndrome; mothers can also pass on drugs or alcohol in breast milk. A woman who drinks or uses drugs when she knows she’s pregnant can be charged with child abuse in many jurisdictions if her baby is born with problems because of the substance use.

Another form of child abuse involving babies is shaken baby syndrome, in which a frustrated caregiver shakes a baby roughly to make the baby stop crying. The baby’s neck muscles can’t support the baby’s head yet, and the brain bounces around inside its skull, suffering damage that often leads to severe neurological problems and even death. While the person shaking the baby may not mean to hurt him, shaking a baby in a way that can cause injury is a form of child abuse.

An odd form of physical child abuse is Munchausen’s syndrome by proxy, in which a parent causes a child to become ill and rushes the chlld to the hospital or convinces doctors that the child is sick. It’s a way for the parent to gain attention and sympathy, and its dangers to the child constitute child abuse.

Sexual abuse in children: types and warning signs

Sexual abuse, which accounts for about 10 percent of child abuse, is any sexual act between an adult and a child. Such acts include:

• Behavior involving penetration – vaginal or anal intercourse and oral sex
• Fondling – Touching or kissing a child's genitals, making a child fondle an adult's genitals.
• Violations of privacy – Forcing a child to undress, spying on a child in the bathroom or bedroom.
• Exposing children to adult sexuality – Performing sexual acts in front of a child, exposing genitals, telling "dirty" stories, showing pornography to a child.
• Exploitation – Selling a child’s services as a prostitute or a performer in pornography.

The adult who sexually abuses a child or adolescent is usually someone the child knows and is supposed to trust: a relative, childcare provider, family friend, neighbor, teacher, coach, or clergy member. More than 80 percent of sex offenders are people the child or adolescent victims know. It’s important to understand that no matter what the adult says in defense of his or her actions, the child did not invite the sexual activity and the adult’s behavior is wrong. Sexual abuse is never the child's fault.

Children are psychologically unable to handle sexual stimulation. Even toddlers, who haven’t formulated the idea that the sexual abuse is wrong, will develop problems resulting from the overstimulation. Older children who know and care for their abusers know that the sexual behavior is wrong, but they may feel trapped by feelings of loyalty and affection. Abusers warn their victims not to tell, threatening children with violence or ostracism, and the shame associated with the sexual activity makes the child especially reluctant to tell. When sexual abuse occurs within the family, children may worry that other family members won’t believe them and will be angry with them if they tell — as is often the case. The layer of shame that accompanies sexual abuse makes the behavior doubly traumatizing.

Some signs of sexual child abuse

Often children who have suffered sexual abuse show no physical signs, and the abuse goes undetected unless a physician spots evidence of forced sexual activity. However, there are behavioral clues to sexual abuse, including:

• Inappropriate interest in or knowledge of sexual acts
• Seductive behavior
• Reluctance or refusal to undress in front of others
• Extra aggression or, at the other end of the spectrum, extra compliance
• Fear of a particular person or family member

Children who use the Internet are also vulnerable to come-ons by adults online. Among the warning signs of online sexual child abuse are these:

• Your child spends large amounts of time online, especially at night.
• You find pornography on your child's computer.
• Your child receives phone calls from people you don't know, or makes calls, sometimes long distance, to numbers you don't recognize.
• Your child receives mail, gifts, or packages from someone you don't know.
• Your child turns the computer monitor off or quickly changes the screen on the monitor when you come into the room.
• Your child becomes withdrawn from the family.
• Your child is using an online account belonging to someone else.

Emotional child abuse: types and warning signs

Emotional child abuse involves behavior that interferes with a child’s mental health or social development: one website calls it “the systematic tearing down of another human being.” Such abuse can range from verbal insults to acts of terror, and it’s almost always a factor in the other three categories of abuse. While emotional abuse by itself doesn’t involve the infliction of physical pain or inappropriate physical contact, it can have more long-lasting negative psychological effects than either physical abuse or sexual abuse.

Examples of emotional child abuse include:

Verbal abuse	Belittling or shaming the child: name-calling, making negative comparisons to others, telling the child he or she is “no good," "worthless," "a mistake." Habitual blaming: telling the child that everything is his or her fault.
Withholding affection	Ignoring or disregarding the child Lack of affection and warmth: Failure to hug, praise, express love for the child
Extreme punishment	These are actions that are meant to isolate and terrorize a child, such as tying the child to a fixture or piece of furniture or locking a child in a closet or dark room.
Corruption	This involves causing a child to witness or participate in inappropriate behavior, such as criminal activities, drug or alcohol abuse, or acts of violence.

Emotional abuse can come not only from adults but from other children: siblings, neighborhood or schoolyard bullies, peers in schools that permit a culture of social ostracism (the “mean girl” syndrome). The signs of emotional child abuse include apathy, depression, and hostility. If it happens at school, the child may be reluctant to go to school and develop or fake a physical complaint.

Causes of child abuse

Why would someone abuse a defenseless child? What kind of person abuses a child? Not all child abuse is deliberate or intended. Several factors in a person's life may combine to cause them to abuse a child:

• Stress, including the stress of caring for children, or the stress of caring for a child with a disability, special needs, or difficult behaviors
• Lack of nurturing qualities necessary for child care
• Immaturity: a disproportionate number of parents who abuse their children are teenagers
• Difficulty controlling anger
• Personal history of being abused
• Isolation from the family or community
• Physical or mental health problems, such as depression and anxiety
• Alcohol or drug abuse
• Personal problems such as marital conflict, unemployment, or financial difficulties.

No one has been able to predict which of these factors will cause someone to abuse a child. A significant factor is that abuse tends to be intergenerational – those who were abused as children are more likely to repeat the act when they become parents or caretakers.

In addition, many forms of child abuse arise from ignorance. Sometimes a cultural tradition leads to abuse. Such beliefs include:

• Children are property.
• Parents (especially fathers) have the right to control their children in any way they wish.
• Children need to be toughened up to face the hardships of life.
• Girls need to be genitally mutilated to assure virginity and later marriage.

Effects of child abuse

Child abuse can produce dire consequences during the victim’s childhood and adulthood. Some effects of child abuse are obvious: a child is malnourished or has a cast on her arm; a nine-year-old develops a sexually transmitted disease. But some physiological effects of child abuse, such as cognitive difficulties or lingering health problems, may not show up for some time or be clearly attributable to abuse. Other effects of child abuse are invisible or go off like time bombs later in life.

Emotional Effects of Child Abuse

Just as all types of child abuse have an emotional component, all affect the emotions of the victims. These effects include

Low self-esteem Depression and anxiety Aggressive behavior/anger issues Relationship difficulties

Alienation and withdrawal Personality disorders Clinginess, neediness Flashbacks and nightmares

Many adults who were abused as children find it difficult to trust other people, endure physical closeness, and establish intimate relationships.

Behavioral Effects of Child Abuse

Child abuse can play itself out not only in how its victims feel but in what they do years later. Children who suffer abuse have much greater chances of being arrested later as juveniles and as adults. Significant percentages of inmates in U.S. prisons were abused as children. One of every three abused or neglected children will grow up to become an abusive parent.

Other behavioral effects include

Problems in school and work Prostitution Teen pregnancy Suicide attempts

Criminal or antisocial behavior Alcohol and drug abuse Eating disorders Spousal abuse

Getting help for an abused child

Although many people are reluctant to get involved in other families’ lives, when it comes to child abuse, you don’t have the option of keeping mum. If you know of a child being abused or even suspect abuse, you have the responsibility to report it. In the United States, Canada, and Australia, the concept of mandatory reporting of suspected child abuse is well established and is beginning to catch on in other countries around the world. Laws on mandatory reporters designate classes of professionals — typically school personnel, social workers, health care workers, mental health professionals, childcare providers, and law enforcement personnel, but in some states also clergy, film processors, and drug abuse counselors — who must report suspected child abuse. Eighteen states and Puerto Rico require all citizens to report suspected abuse or neglect.

By reporting, you can make a tremendous difference in the life of a child and the child’s family, especially if you help stop the abuse early. Early identification and treatment can help mitigate the long-term effects of abuse. If the abuse is stopped and the child receives competent treatment, the abused child can begin to regain a sense of self-confidence and trust. Parents may also benefit from support, parent training and anger management.

Staffers at the hotline can help:

• Victims: children and teens who have been abused
• Survivors of child abuse
• Abusers: people who have abused a child or who are afraid that they may abuse a child
• Witnesses to child abuse

Childhelp cannot make a report of child abuse for you, but it can set up a three-way call with your local enforcement agency. You can also call your local enforcement agency directly to report child abuse. Childhelp has a list of local phone numbers you can call for your county or state in the U.S.

Reporting is anonymous. In most states, you do not have to give your name when you report child abuse. The child abuser cannot find out who made the report of child abuse.

Other places to call include:

Help That You Need	Phone Numbers
Emergency intervention	911
Agencies to call to report suspected child abuse. Organized by state within the U.S.	Child Abuse Reporting Numbers
Telephone hotlines, particularly for sexual child abuse, for missing or abducted children, for rape and incest, and for runaway and homeless children and their families	Toll-Free Crisis Hotline Numbers
Helpline for teens who are having problems at home	Youth and Teens or 1-800-RUNAWAY
Identification of paroled sex offenders	National Sex Offender Public Registry and Federal Bureau of Investigation’s Investigative Programs: Crimes Against Children (individual state databases)

Remember, too, that if your own child tells you that he or she has been abused, no matter how horrifying or incredible the report sounds, you must listen to your child and be a source of comfort — and action.

Preventing or stopping child abuse

Reducing the incidence of child abuse is a matter of education and intervention — and you can help with both.

Education

In terms of education, you can support organizations and programs that work with the public to encourage and teach good parenting skills and provide help for parents at risk of abusing their children. Such programs include

• hotlines
• parent education programs
• emergency shelters
• in-home services
• family resource centers
• parent support groups
• mental health services

You can also teach your children how to deal with bullies and how to identify, fend off, and report attempts at sexual abuse. And you can learn how to monitor your children’s Internet use for signs of potential sexual abuse.

Intervention

In addition to reporting suspected child abuse when you learn about it, you can intervene effectively if you encounter a parent or caregiver abusing or about to abuse a child by striking the child or screaming at the child: it’s a matter of offering on-the-spot help rather than scolding or threatening to call authorities. If you yourself are overwhelmed by childcare responsibilities, frustrated by a baby who won’t stop crying, or in danger of harming your children, you can reach out for help. Pick up the phone and call someone who can help, even if it’s someone — like the voice at the end of a hotline — you don’t know.

All the topics mentioned in this section are addressed in websites listed below. Use the links to find out more about child abuse and how you can help prevent it from happening.

Related links for child abuse

Comprehensive sites

Child Abuse Learning Center – The nonprofit that runs the National Abuse Hotline® has a multipage site offering statistics and succinct lists and descriptions of different types of child abuse and their signs and effects, as well as strategies for prevention. (Childhelp)

Child Abuse and Neglect – This site, from a bureau of the U.S. Department of Health and Human Services, provides links to basic information about child abuse and neglect and to many other sites and publications that provide more detailed information and help. (Child Welfare Information Gateway)

Research [on child abuse and neglect] – The sections on “Child Abuse & Neglect” and “Preventing Child Abuse & Neglect” presented by this advocacy organization offer many detailed articles in PDF form. Some require registration, which is free. (Prevent Child Abuse America)

Physical abuse

Shaken Baby Syndrome – Crystal-clear, comprehensive description of what SBS is, how it causes brain damage and death, its signs and symptoms, and strategies for soothing a baby before the caregiver’s frustration mounts. (KidsHealth)

Munchausen by Proxy Syndrome – Excellent article on this stubborn, insidious mental illness that causes parents to abuse their children by causing illnesses or medical symptoms. (KidsHealth)

Drugs and Pregnancy – Good rundown of the ways various illegal and legal drugs, including prescription drugs, can damage a fetus and cause a baby to be born with brain damage, birth defects, and other physiological problems. (American Council for Drug Education)

Sexual abuse

Prevent Child Sexual Abuse: Facts About Those Who Might Commit It – Issued by a nonprofit that was founded by a survivor of childhood sexual abuse, this PDF pamphlet provides a concise but comprehensive primer on the warning signs of sexual abuse in children and in adults who sexually abuse them, along with tips on how to prevent child sexual abuse and how to stop it when you realize it’s happening. (Stop It Now!)

Understanding Child Sexual Abuse – A clear, objective explanation of the effects of child sexual abuse, the chances of recovery, and strategies for prevention. (American Psychological Association)

Sexual Abuse – Good brief description of what constitutes child sexual abuse, how to spot it, and what to do if your child tells you about it. (American Academy of Pediatrics)

Responding to Child Sexual Abuse – Clear, concise instructions for what to say and what to do if a child reports or hints of being abused. (American Academy of Child and Adolescent Psychiatry)

Mother-daughter Sexual Abuse: Breaking the Silence – From an organization that presents itself as the only one in the world specializing in mother-daughter sexual abuse, a fact sheet about what it terms a “grossly underreported crime.” (Making Daughters Safe Again)

Emotional child abuse

Parental Child Abduction is Child Abuse – Comprehensive paper on how abduction by a parent harms a child’s psyche and constitutes child abuse, with lists of causes and detailed descriptions of effects. (PANdora’s Box)

Fact Sheet: Emotional Child Abuse – Good overview of what emotional child abuse is, who abuses this way and why, how it affects children, and what can be done about it. (Prevent Child Abuse America)

Emotional abuse – See the “Answers to common questions” on this British site for good advice about recognizing and responding to emotional child abuse. (National Society for the Prevention of Cruelty to Children)

Child neglect

Child Neglect: A Guide for Prevention, Assessment and Intervention – Detailed and complete guide to what constitutes child neglect, how it affects children, what causes it, and how the community can intervene. (Child Welfare Information Gateway)

Neglect – Succinct lists of physical and behavioral indicators suggesting that a child is being neglected. (Coalition for Children)

Warning signs of child abuse

Recognizing Child Abuse: What Parents Should Know (PDF) – Lists signs and symptoms of child abuse in children and in their parents. Covering physical abuse, emotional maltreatment, neglect, and sexual abuse, this outline is useful for teachers, family friends, and relatives. (Prevent Child Abuse America)

Physical and Behavioral Indicators of Abuse – Clearly laid out in chart form, detailed lists of child abuse and neglect symptoms in several different areas. (The National Children’s Advocacy Center)

Child Abuse - Signs and symptoms – Detailed lists from a British nonprofit, plus insight on listening to children who may be abused and helplines for reporting abuse. Also available in a handy PDF brochure. (Kidscape)

Possible signs of abuse – Part of an Australian government site, this page lists risk factors for child abuse and signs of the different types of abuse. The complete site, with several pages under the heading Protecting children, offers a helpline number and much information about reporting abuse. (Department of Community Services, New South Wales Government)

Child Abuse Symptoms – This page opens with a list of common traits among families that tolerate child abuse, which may help in recognizing abused children. (Surrealist.org)

Effects of child abuse

Long-term Consequences of Child Abuse and Neglect – This government-sponsored site offers details on the physical, psychological, behavioral, and societal effects of child abuse. (Child Welfare Information Gateway)

Child Maltreatment: Effects on Development and Learning – Thorough discussion of how child abuse affects the psyche and the brain itself. (University of Illinois at Urbana-Champaign)

Witnessing, preventing and stopping child abuse

Prevention Tips for Parents – This page carries links to PDF articles and fact sheets that together provide a good overview of how to protect children from abuse. (Prevent Child Abuse America)

Personal Safety for Children – Part of a long series of pages about child safety, this article focuses on what you as an adult can do to protect kids who are vulnerable to abuse at a given moment. (KidPower TeenPower FullPower International)

Reporting Child Abuse – Guidance on how to find out what your responsibilities are and where to get more information. (Darkness to Light)

How to Stop Child Abuse in a Public Place – Tips for how to respond when you see someone mistreating a child. (Child Abuse Network)

Self-Defense – Teen-oriented article about how to avoid, defuse, or prevent an attack. (TeensHealth)

Dealing with Bullies – Written for children, this article presents positive ways to head off and stand up to physical and psychological attacks from bullies and explains the reasons bullies behave the way they do. See also Bullying and Your Child for similar information from the parent’s point of view. (KidsHealth)

Protection from child abuse on the Internet

A Parent's Guide to Internet Safety – Scroll down to the subhead “What Are Signs That Your Child Might Be At Risk On-line?” for ways to recognize possible child abuse, particularly sexual abuse, on the Internet and what to do to prevent and resolve it. (Federal Bureau of Investigation)

Kids’ Rules for Online Safety – A list of specific agreements, written from the child’s perspective, for children to make with their parents regarding their Internet use. (SafeKids.com)

Tips by Teens for Teens – Common-sense guidelines for safety on the Internet that don’t insult the reader’s intelligence. The site also includes suggestions on Internet use for parents of children of different ages. (GetNetWise)

Safety – Scroll down to “Safety Tips” for especially complete listings of ways to protect your child from Internet predators and to check on who’s been contacting your child and what your child is downloading. (Child Abuse Unit)

Discipline without physical punishment

Twelve Alternatives to Lashing Out at Your Child (PDF) – A one-page list of ways to keep from harming a child by yelling or hitting. (Prevent Child Abuse America) See also Teaching Children Discipline (PDF), a concise article on what works, what doesn’t, and why when it’s necessary to shape children’s behavior. (Prevent Child Abuse America)

Parenting Tools: What About Spanking? – Why parents spank, and why spanking doesn’t work. (University of Minnesota Extension)

A Workable Time-Out – Scroll down the page to this subhead for a description of Thomas Phelan's “1–2–3 Magic” child discipline technique, which promises a simple way to warn of and enforce time-outs. (University of Nebraska-Lincoln Cooperative Extension)

Ellen Jaffe-Gill MA , Jaelline Jaffe, Ph.D .,and Jeanne Segal, Ph.D., contributed to this article. Last modified on: 10/10/07.