Child Abuse

What is child abuse?

Child abuse is hurting a child. It occurs when a child experiences harm or neglect. Often, the abuser is someone the child knows. It may be a parent, family member, caregiver or family friend.

Most U.S. child abuse laws agree on this definition of child abuse: Any intentional harm or mistreatment of a child under age 18 is abuse and a criminal offense.

Another term for child abuse and neglect is adverse childhood experiences (ACEs). If untreated, these experiences can impact a child’s lifelong health and well-being.

What are the types of child abuse?

Child abuse can come in many forms:

• Physical: Slapping, pushing, punching, kicking, shaking or burning a child or not allowing a child to eat, drink or use the bathroom.
• Emotional: Frequently verbal, involving insults, constant criticism, harsh demands, threats and yelling.
• Sexual: Rape, incest, fondling, indecent exposure, using a child in pornography or exposing a child to pornographic material.
• Medical: Intentionally trying to make a child sick or not treating a medical condition.

Is child neglect a form of child abuse?

Yes. Child neglect is a form of abuse. Neglect is failing to provide a child with food, shelter, education, medical care and emotional support.

What is incest?

Incest is a sexual act between family members who are too closely related to be legally married. The sex act can be anything from fondling to intercourse. Any sexual act with a child is abuse.

How does sexual abuse affect a child?

Researchers have noted certain characteristics in children who have experienced abuse. Some behaviors may be more noticeable, such as:

• Acting out sexually in inappropriate ways.
• Chronic belly pain, headaches or other physical complaints.
• Return to childish behaviors such as thumb-sucking and bedwetting.
• Running away.
• Self-destructive behavior, such as cutting and self-harm.
• Severe behavioral changes.

Other characteristics may be harder to identify, such as:

• Anxiety and depression.
• Difficulty learning and concentrating.
• Evidence of post-traumatic stress disorder (PTSD).
• Lack of emotional development.
• Poor self-esteem.
• Recurring nightmares.
• Suicidal thoughts and/or attempts.

How common is child abuse?

Child neglect and child abuse are common. At least 1 in 7 children has experienced neglect in the past year. The actual figure is likely higher. In the United States in 2018, nearly 1,770 children died of abuse and neglect.

Who is more at risk of child abuse and neglect?

Some children are at higher risk of experiencing abuse and neglect. Risk factors include children who:

• Live in poverty. Rates of child abuse are five times higher for children in families with low socioeconomic status.
• Are younger than 4 years of age.
• Have special needs, which increase the burden on caregivers.

What are signs of child abuse?

Signs of child abuse may not be obvious. You may first notice a shift in the child’s behavior. Or they may react differently to situations. Any change in a child’s behavior or temperament without an obvious trigger can be a sign of abuse.

Other signs of child abuse include:

Physical signs:

• Looking unclean or neglected.
• Unexplained bruises, welts, sores or skin problems that don’t seem to heal.
• Untreated medical or dental problems.
• Pain in the genital area.
• Vaginal bleeding other than a menstrual cycle (period).
• Unusual discharge or pain.

Emotional signs:

• Fear of one or both parents or caregivers (including babysitters, day care workers, teachers and coaches).
• Fear of an activity or place.
• Crying often or in situations that seem inappropriate.
• Regression (returning to behaviors typical of a younger child).

Behavioral signs:

• Acting different from other children, especially if it’s a sudden change.
• Frequent absences from school.
• Being withdrawn.
• Bullying peers or younger children or being bullied themselves.
• Trouble learning and paying attention.
• Avoiding physical contact with adults, peers or older youth.
• Overachievement or being overly eager to please.
• Unusual sexualized behaviors or comments, especially ones that seem more mature or pornographic.

Who can be an abuser?

Frequently, the abuser is someone the child knows and is close to, including;

• Parent or other family member.
• Family friend.
• Caregiver.
• Anyone close to the child (teacher, coach, religious leader).
• Peers or older children who have experienced abuse themselves and are re-enacting what happened to them.

Why do people abuse children?

Several situations can result in a person abusing a child:

History of abuse: Parents or other adults who hurt children may have experienced abuse themselves. Experiencing abuse can also lead an adult to look the other way if their child is in an abusive situation. However, not all people who experienced abuse will abuse others. Most survivors of child abuse do not harm children.

Difficulty with caring for children: Some adults hurt children because they don’t know how to discipline them. Or they have unrealistic expectations for the child’s behavior.

Feelings of anger: Some people who abuse have overwhelming feelings of anger when faced with a problem. They may have problems with family, money, work or relationships. Their frustration and anger can result in abusive actions. In some cases, the person sees the child as the source of the problems, causing them to act out against the child.

Untreated mental health conditions: People who have depression, substance use disorder or personality disorders are at higher risk for abusing children.

If you have abused or neglected a child or witnessed signs of child abuse, seek help from a local mental health agency. Getting help can prevent or reduce the child’s long-term trauma.

How does a healthcare provider detect child abuse?

The healthcare provider will carefully evaluate the child, looking for physical and behavioral signs of abuse. County or state authorities may also take part in the investigation.

• The diagnosis may involve:
• Physical exam.
• Lab tests.
• X-rays or other tests.

The diagnostic team will also:

• Ask about the child’s medical and developmental history.
• Observe the child’s behavior and interactions with parents or caregivers.
• Talk to parents or caregivers.
• Talk to the child, if possible.

What are the treatments for a child who has been abused?

Children may need immediate medical treatment if they have physical injuries, seem dazed or lose consciousness. Follow your healthcare provider’s recommendations for follow-up visits or visits to specialists as needed.

Children who experience abuse most likely need ongoing behavioral health care. Counseling and therapy can help prevent future abuse and reduce long-term damage. During psychotherapy sessions, a mental health professional helps the child learn to trust and boost their self-esteem. They also teach children about healthy relationships and conflict management strategies.

Therapy is beneficial for parents, too. It can help cope with the situation, uncover the roots of abuse and learn healthy parenting strategies.

How can I stop child abuse?

Take action if you notice signs of child abuse or if abuse is happening in your house.

Talk to the child: Talk to the child if you notice a change in their behavior or if they start reacting in worrisome new ways. Having open, friendly conversations (within healthy boundaries) allows the child to trust you and feel comfortable telling you if they don’t feel safe. Let children know it’s OK to tell you something even if it might upset someone.

Seek help: Don’t let fear or embarrassment prevent you from seeking help. When you contact authorities to report abuse, your name is not released to the family or person involved. If you suspect that a child is experiencing abuse, call or contact:

• 911 if the child is in immediate danger.
• Your local child protective agency, police or hospital.
• The Child Help National Child Abuse hotline (1-800-422-4453), open 24/7.
• Pediatrician, who can also help direct you in cases of child abuse.
• Religious or spiritual advisor, who can provide counseling and support.

You should also:

• Keep the child away from the abuser until authorities are notified.
• Supervise any future contact with the person.
• Never threaten the suspected abuser or take the law into your own hands.

If you think you have abused a child or are at risk for committing abuse:

• Reach out to a friend, family member and health professional.
• Make sure the child is safe and away from you during this time.
• Seek a counselor who can help you understand and work through your feelings.

What is the outlook for children who have been abused?

Children who experience abuse may have:

• Immediate injuries, including cuts, bruises and broken bones.
• Frequent injuries.
• Learning problems.
• Emotional, psychological and behavioral problems, including depression.
• Anxiety and difficulty with social skills.
• Fear of certain adults or places.

Child abuse can leave a lasting impact on children if left untreated. Adult survivors of child abuse are more likely to have social and emotional problems. They may:

• Abuse others or accept abuse.
• Attempt suicide.
• Care for others at the expense of their own well-being.
• Have sexual issues, including engaging in risky sexual behavior, becoming sexually promiscuous or avoiding sex entirely.
• Have trouble trusting people.

Adult survivors may also have medical and behavioral problems such as:

• Chronic pain, daily headaches, fibromyalgia and abdominal pain.
• Depression.
• Low self-esteem.
• Substance use order or alcohol use disorder.
• Toxic stress, which can affect brain development and increase the risk for PTSD and learning, attention and memory problems.

How can I improve the long-term health of a child who has experienced abuse?

Seek out a mental health professional. Therapy can help the child process what happened to them, learn to build healthy relationships and reduce the lasting effects of the abuse. Managing the emotional impact of abuse can improve children’s long-term physical health, too.

How do I help a child who confided about abuse?

If a child confides about abuse, take the child seriously. Don’t brush it off or assume they’re being dramatic or making things up. To keep the child safe:

• Encourage open discussion. Listen as the child talks, and allow them to explain what happened in their words. Comfort them and remind them you’re available to talk or listen.
• Remind the child that it is not their fault. They are not responsible for the abuse.
• Ensure the child stays safe by separating the child from the abuser.
• Contact a healthcare provider who can guide you on next steps.
• Get additional support, such as counseling, therapy or support groups.
• Be patient. Children recover at different rates. Support the child during the recovery process.

What should I ask my child’s doctor?

If your child has experienced abuse, talk to your child’s pediatrician. Ask:

• What physical medical care does my child need now?
• What type of therapy will help my child?
• Will family therapy be beneficial to us?
• How can I help my child recover?
• Is there anything we should avoid doing or saying?
• How else can I keep my child safe?

A note from Cleveland Clinic

Unfortunately, child abuse is common. Children who experience abuse are at risk for health problems both now and in the future, but there is hope for recovery. Learn to recognize the signs of child abuse, such as a child acting strangely or differently. If you suspect abuse, keep the child safe from the abuser and seek professional help. Physical and mental health care can help reduce the lasting effects of child abuse. Talk to your healthcare provider (or your child’s) about ways to stop and prevent child abuse.