Child Abuse

Child abuse can result from physical, verbal, or sexual harm. While child abuse is often considered to take the form of an action, there are also examples of inaction that cause harm, such as neglect. Households in which participants suffer from alcoholism, substance abuse, or anger issues demonstrate higher occurrences of child abuse as compared to households without. Outcomes of 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 is widespread and can occur in any cultural, ethnic, or income group.

Physical abuse involves non-accidental harming of a child by, for example, burning, beating, or breaking bones. Verbal abuse involves harming a child by, for example, belittling them or threatening physical or sexual acts. Emotional trauma can result from several forms of abuse.

Studies show that one in four girls and one in eight boys are sexually abused before the age of 18, and that approximately one in 20 children are physically abused each year. 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.

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.

Religious freedom has become a point of contention in some cases of possible child abuse—some states, for instance, allow for medical neglect due to religious objections. There are also examples of some extreme religious acts that are considered child abuse in certain countries, but which are acceptable in others.

Symptoms

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. Additionally, the person who abused them may be someone they love very much and want to protect. Parents are often unable to recognize symptoms of abuse because they may not want to face this reality.

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.

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

Signs of Sexual Abuse:

  • Fearful behavior (nightmares, depression, unusual fears, attempts to run away)
  • Abdominal pain
  • Bedwetting
  • Urinary tract infection
  • Genital pain or bleeding
  • Sexually transmitted disease
  • Extreme sexual behavior that seems inappropriate for the child's age

Signs of Emotional Abuse:

  • Sudden change in self-confidence
  • Headaches or stomachaches with no medical cause
  • Abnormal fears, increased nightmares, or attempts to run away

Signs of Emotional Neglect:

  • Failure to gain weight (especially in infants)
  • Desperately affectionate behavior
  • Voracious appetite, or stealing food

Causes

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 nonbiological 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

Treatment

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.

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 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 most cases, children who are abused or neglected suffer greater emotional than physical damage. 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 will be. As adults, they may develop marital and sexual difficulties, depression or suicidal behavior. With early intervention and treatment, these outcomes may be avoided. 

References

  • American Psychiatric Association
  • National Library of Medicine
  • Administration for Children and Families
  • American Academy of Pediatrics
  • Department of Health and Human Services  
  • National Institutes of Health

Last reviewed 04/03/2019