Child abuse

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 purposely physically injured or put at risk of harm by another person.
• Sexual abuse. Child sexual abuse is any sexual activity with a child. This can involve sexual contact, such as intentional sexual touching, oral-genital contact or intercourse. This can also involve noncontact sexual abuse of a child, such as exposing a child to sexual activity or pornography; observing or filming a child in a sexual manner; sexual harassment of a child; or prostitution of a child, including sex trafficking.
• 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.
• Medical abuse. Medical child abuse occurs when someone gives false information about illness in a child that requires medical attention, putting the child at risk of injury and unnecessary medical care.
• Neglect. Child neglect is failure to provide adequate food, clothing, shelter, clean living conditions, affection, supervision, education, or dental or medical care.

In many cases, child abuse is done 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. The child may be afraid to tell anyone about the abuse, especially if the abuser is a parent, other relative or family friend. 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 unusual fears, or a sudden loss of self-confidence
• Sleep problems and nightmares
• An apparent lack of supervision
• Frequent absences from school
• Rebellious or defiant behavior
• Self-harm or attempts at suicide

Specific signs and symptoms depend on the type of abuse and can vary. 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, broken bones (fractures) or burns
• Injuries that don't match the given explanation
• Injuries that aren't compatible with the child's developmental ability

Sexual abuse signs and symptoms

• Sexual behavior or knowledge that's inappropriate for the child's age
• Pregnancy or a sexually transmitted infection
• Genital or anal pain, bleeding, or injury
• Statements by the child that he or she was sexually abused
• Inappropriate sexual behavior with other children

Emotional abuse signs and symptoms

• Delayed or inappropriate emotional development
• Loss of self-confidence or self-esteem
• Social withdrawal or a loss of interest or enthusiasm
• Depression
• Avoidance of certain situations, such as refusing to go to school or ride the bus
• Appears to desperately seek affection
• A decrease in school performance or loss of interest in school
• Loss of previously acquired developmental skills

Neglect signs and symptoms

• Poor growth
• Excessive weight with medical complications that are not being adequately addressed
• Poor personal cleanliness
• Lack of clothing or supplies to meet physical needs
• Hoarding or stealing food
• Poor record of school attendance
• Lack of appropriate attention for medical, dental or psychological problems or lack of necessary follow-up care

Parental behavior

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
• Blames the child for the problems
• Consistently belittles or berates the child, and describes the child with negative terms, such as "worthless" or "evil"
• Expects the child to provide attention and care to the parent and seems jealous of other family members getting attention from the child
• Uses harsh physical discipline
• 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
• Repeatedly brings the child for medical evaluations or requests medical tests, such as X-rays and lab tests, for concerns not seen during the health care provider's examination

Physical punishment

Child health experts condemn the use of violence in any form, but some people still use physical punishment, such as spanking, to discipline their children. While parents and caregivers often use physical punishment with the intention of helping their children or making their behavior better, research shows that spanking is linked with worse, not better, behavior. It's also linked to mental health problems, difficult relationships with parents, lower self-esteem and lower academic performance.

Any physical punishment may leave emotional scars. Parental behaviors that cause pain, physical injury or emotional trauma — even when done in the name of discipline — could be child abuse.

If you're concerned that your child or another child has been abused, seek help immediately. Depending on the situation, contact the child's health care provider, a local child welfare agency, the police department or a 24-hour hotline for advice. In the United States, you can get information and assistance by calling or texting the Childhelp National Child Abuse Hotline at 1-800-422-4453.

If the child needs immediate medical attention, call 911 or your local emergency number.

In the United States, keep in mind that health care professionals and many other people, such as teachers and social workers, are legally required to report all suspected cases of child abuse to the appropriate local child welfare agency.

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, or single parenting
• A child in the family who is developmentally or physically disabled
• Financial stress, unemployment or poverty
• Social or extended family isolation
• Poor understanding of child development and parenting skills
• Alcohol, drugs or other substance abuse

Some children overcome the physical and psychological effects of child abuse, particularly those with strong social support and resiliency skills who can adapt and cope with bad experiences. For many others, however, child abuse may result in physical, behavioral, emotional or mental health issues — even years later.

Here are some examples.

Physical issues

• Premature death
• Physical disabilities
• Learning disabilities
• Substance abuse
• Health problems, such as heart disease, diabetes, chronic lung disease and cancer

Behavioral issues

• Illegal or violent behavior
• Abuse of others
• Withdrawal
• Suicide attempts or self-injury
• High-risk sexual behaviors or teen pregnancy
• Problems in school or not finishing high school
• Limited social and relationship skills
• Problems with work or staying employed

Emotional issues

• Low self-esteem
• Difficulty establishing or maintaining relationships
• Challenges with intimacy and trust
• An unhealthy view of parenthood
• Inability to cope with stress and frustrations
• An acceptance that violence is a normal part of relationships

Mental health disorders

• Eating disorders
• Personality disorders
• Behavior disorders
• Depression
• Anxiety disorders
• Post-traumatic stress disorder (PTSD)
• Trouble sleeping (insomnia) and nightmares
• Attachment disorders

You can take important steps to protect your child from exploitation and child abuse, as well as prevent child abuse in your neighborhood or community. The goal is to provide safe, stable, nurturing relationships for children.

Here's how you can help keep children safe:

• Offer your child love and attention. Nurture and listen to your child and be involved in your child's life to develop trust and good communication. Encourage your child to tell you if there's a problem. A supportive family environment and social networks can help improve your child's feelings of self-esteem and self-worth.
• 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 health care provider or a therapist about ways you can learn to cope with stress and better interact with your child.
• Think supervision. Don't leave a young child home alone. In public, keep a close eye on your child. Volunteer at school and for activities to get to know the adults who spend time with your child. When old enough to go out without supervision, encourage your child to stay away from strangers and to hang out with friends rather than be alone. Make it a rule that your child tells you where he or she is at all times. Find out who's supervising your child — for example, at a sleepover.
• Know your child's caregivers. Check references for babysitters and other caregivers. Make irregular, but frequent, unannounced visits to observe what's happening. Don't allow substitutes for your usual child care provider if you don't know the substitute.
• Emphasize when to say 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 happens, encourage your child to talk to you or another trusted adult about what happened. 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. Put the computer in a common area of your home, not the child's bedroom. Use the parental controls to restrict the types of websites your child can visit. Check your child's privacy settings on social networking sites. Consider it a red flag if your child is secretive about online activities.

  Cover online ground rules, such as not sharing personal information; not responding to inappropriate, hurtful or frightening messages; 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 local authorities, if necessary.

• Reach out. Meet the families in your neighborhood, including parents and children. Develop a network of supportive family and friends. If a friend or neighbor seems to be struggling, offer to babysit or help in another way. Consider joining a parent support group so that you have an appropriate place to vent your frustrations.

If you worry that you might abuse your child

If you're concerned that you might abuse your child, seek help immediately. In the United States, you can get information and assistance by calling or texting the Childhelp National Child Abuse Hotline: 1-800-4-A-CHILD (1-800-422-4453).

Or you can start by talking with your family health care provider. Your provider 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 misusing alcohol or drugs, ask your health care provider about treatment options.

If you were abused as a child, get counseling to ensure you don't continue the abuse cycle or teach those destructive behaviors to your child.

Remember, child abuse is preventable — and often a symptom of a problem that may be treatable. Ask for help today.

Identifying abuse or neglect can be difficult. It requires careful evaluation of the situation, including checking for physical and behavioral signs.

Factors that may be considered in determining child abuse include:

• Physical exam, including evaluating injuries or signs and symptoms of suspected abuse or neglect
• Lab tests, X-rays or other tests
• Information about the child's medical and developmental history
• Description or observation of the child's behavior
• Observing interactions between parents or caregivers and the child
• Discussions with parents or caregivers
• Talking, when possible, with the child

If child abuse or neglect is suspected, a report needs to be made to an appropriate local child welfare agency to further investigate the case. Early identification of child abuse can keep children safe by stopping abuse and preventing future abuse from occurring.

Treatment can help both children and parents in abuse situations. The first priority is ensuring the safety and protection for children who have been abused. Ongoing treatment focuses on preventing future abuse and reducing the long-term psychological and physical consequences of abuse.

Medical care

If necessary, help the child seek appropriate medical care. Seek immediate medical attention if a child has signs of an injury or a change in consciousness. Follow-up care with a health care provider may be required.

Psychotherapy

Talking with a mental health professional can:

• Help a child who has been abused learn to trust again
• Teach a child about healthy behavior and relationships
• Teach a child conflict management and boost self-esteem

Several different types of therapy may be effective, such as:

• Trauma-focused cognitive behavioral therapy (CBT). Trauma-focused helps a child who has been abused to better manage distressing feelings and to deal with trauma-related memories. Eventually, the supportive parent who has not abused the child and the child are seen together so the child can tell the parent 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 also can help parents:

• Discover the roots of abuse
• Learn effective ways to cope with life's unavoidable frustrations
• 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 into foster care may need mental health services.

Where 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, take action immediately.

You can start by contacting your health care provider, a local child welfare agency, the police department or a child abuse hotline for advice. In the United States, you can get information and assistance by calling or texting the Childhelp National Child Abuse Hotline: 1-800-4-A-CHILD (1-800-422-4453).

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. Focus on listening, not investigating. Consider that children may use alternate terms for body parts. Don't ask leading questions — allow the child to explain what happened and 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, "Thank you for letting me know," "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 welfare agency or the police department. Authorities will investigate the report and, if necessary, take steps to ensure the child's safety.
• Help the child remain safe. Ensure the child's safety by separating the abuser and the child, and by providing supervision if the child is in the presence of the abuser. Help the child get medical attention 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 and report it to the local or state child welfare agency.