Child Abuse

Child abuse is intentionally hurting or neglecting a child. Often, the abuser is someone the child knows. It can be a parent, family member, family friend or another type of caregiver (like a babysitter or teacher).

Child abuse laws in states across the U.S. generally follow the same definition. Deliberately hurting or mistreating a child under 18 is abuse, and it’s a crime. Child abuse is also common. In 2021, about 600,000 children in the U.S. experienced child abuse. About 1,820 children died from abuse that same year.

Experts classify child abuse and neglect as adverse childhood experiences (ACEs). Experiences like this can have lifelong effects, especially if they go untreated.

What are the different types of child abuse?

Child abuse can take many forms. They include:

• Physical abuse: Examples include striking a child (hitting, slapping, punching, kicking or pushing) or burning them. For young children, shaking is a form of abuse. This form also includes not letting children eat, drink or use the bathroom.
• Emotional abuse: This is usually verbal (spoken). It includes insults, constant criticism, unreasonable or harsh demands, screaming or yelling, or making threats.
• Sexual abuse: Examples include rape, incest, fondling and indecent exposure. It also includes using a child in pornography or showing pornography to a child.
• Medical abuse: This can include making your child sick on purpose, or not getting them medical care when you know they need it.
• Neglect: This means not providing a child with basic needs. Those include food, shelter, education, medical attention and emotional support.

Is spanking child abuse?

State laws on child abuse vary when it comes to physical punishments like spanking. In general, physical punishment crosses the line and becomes abuse when it causes injuries like bruises, swelling or broken skin.

Research also shows that spanking can affect how your child develops socially. Spanking has links to lower self-esteem and doing worse in learning activities and school. It may also affect your relationship with your child.

Before you spank your child, consider asking yourself the following:

• Is this about teaching or is it about fear?
• Does my child know I love them?
• What lesson would spanking my child now teach them?
• How will I feel about spanking my child later?

How does sexual abuse affect a child?

Children who experience sexual abuse often show a pattern of behaviors or changes. Some examples include:

• Acting in sexually inappropriate ways
• Having chronic belly pain, headaches or other physical symptoms
• Regression, where a child shows behaviors from earlier ages, like bedwetting or thumb-sucking
• Running away
• Self-harm and other self-destructive behaviors
• Severe, unexplained changes in how your child acts

Other changes are also possible, but many are harder to notice. Examples include:

• Anxiety and depression
• Having trouble learning or concentrating
• Symptoms of post-traumatic stress disorder (PTSD)
• Delays in emotional development
• Low self-esteem
• Recurring nightmares
• Thoughts about suicide and/or attempting it

Who has higher risks of child abuse and neglect?

Children with certain circumstances have a higher risk of abuse or neglect. Examples include:

• Living in poverty (abuse rates are five times higher for children in families below the national poverty level)
• Being under 4 years old
• Having special needs

What are the signs of child abuse?

Signs of child abuse aren’t always obvious. A sudden change in mood or behavior without a clear cause can be a warning sign.

Physical signs of child abuse include:

• Hygiene issues like a lack of bathing or clean clothes
• Injuries like bruises, welts, sores or other skin issues that don’t heal
• Medical or dental needs that don’t get care
• Pain in or around their genital area
• Unusual discharge or pain
• Vaginal bleeding that isn’t from a menstrual cycle

Emotional signs of child abuse include:

• Fear of one or both parents or caregivers (like babysitters, daycare workers, teachers or coaches)
• Fear of an activity or place
• Crying often or in situations that seem inappropriate
• Regression (returning to behaviors like those of younger children)

Behavioral signs of child abuse include:

• Acting differently from other children, especially if the change is sudden
• Frequent absences from school
• Being withdrawn
• Bullying others their own age or younger, or being bullied themselves
• Having a hard time learning and paying attention
• Avoiding physical contact with adults, older children or children their own age
• Overachievement or being overly eager to please
• Behaviors or comments that are unusual or sexualized, especially those that seem more mature or pornographic

Who can be an abuser?

It’s common for an abuser to be someone a child knows and is close to, like:

• A parent or other family member
• A family friend
• A caregiver
• Anyone close to the child (like a teacher, coach or religious leader)
• Other children who’ve experienced abuse and are re-enacting what happened to them

Why do people abuse children?

Several situations might contribute to a person abusing a child. Examples include:

• A history of abuse: People who hurt children may have a history of being abused, too. A history of abuse can also cause adults to ignore signs of abuse. But a history of abuse doesn’t guarantee someone will abuse others. Most people who experienced child abuse don’t harm children.
• Difficulty caring for children: Sometimes, adults hurt children because they don’t know how to discipline them. Other times, they have unrealistic expectations for how their child will behave.
• Feelings of anger: Some people who abuse others have overwhelming feelings of anger when they face an obstacle. Examples include issues with family, money, work or relationships. Their frustration and anger may lead to abusive acts. And in some cases, a person who abuses does so because they see the child as the source of an issue, causing them to act out against the child.
• Untreated mental health conditions: People who have depression, substance use disorder or personality disorders have a higher risk of abusing children.

If you’ve abused or neglected a child or see signs of child abuse, seek help from a local mental health agency. Getting help can reduce a child’s long-term trauma or reduce its effects.

How do healthcare providers detect child abuse?

Healthcare providers carefully evaluate a child when looking for physical and behavioral signs of abuse. Local or regional authorities may also be part of the investigation.

Diagnosing child abuse may involve:

• A physical exam
• Lab tests
• Imaging tests like X-rays

Healthcare providers 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 (when possible)

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

The treatments for a child who experienced abuse can vary. If they have physical injuries, seem dazed or lose consciousness, they need immediate medical treatment. Their healthcare provider will provide guidance on follow-up visits and visits to other specialists as needed.

Children who experience abuse often need behavioral health care. Counseling and therapy can help reduce long-term harm and lower the risk of future abuse. Mental health professionals can help children with self-esteem and trust issues that often develop after abuse. Mental health care also helps children learn about healthy relationships and conflict management that will help them later in life.

Therapy can also help parents of children who experience abuse. They can learn to cope, learn what contributes to abuse and develop healthy parenting strategies.

How do I report child abuse?

It’s important to act if you notice child abuse happening.

Talk to the child. If you notice behavior changes or if children start reacting in troubling ways, start a conversation. These discussions (within healthy boundaries) can help children develop trust and tell you if and when they don’t feel safe. And let them know it’s OK to tell you something, even if what they tell you would upset someone else.

Find help. Don’t let fear or embarrassment stand in the way of getting help. If you suspect a child is experiencing abuse, call or contact:

• 911 (or your local emergency number) if you suspect a child is in immediate danger
• Your local child protective agency, law enforcement or hospital
• The Childhelp National Child Abuse Hotline (1-800-422-4453), which takes calls 24/7
• A pediatrician or other healthcare provider
• A religious or spiritual advisor, who can provide counseling and support

You should also remember to do the following:

• Keep the child away from a possible abuser until authorities are notified.
• Don’t leave the child alone with the abuser in the future.
• Never threaten someone suspected of abuse or take the law into your own hands.

If you think you’ve abused a child or are at risk for doing so:

• Reach out to a friend, family member or healthcare professional.
• Make sure the child stays somewhere safe and away from you during this time.
• Talk to a counselor or other mental health provider who can help you understand and work through your feelings.

What’s the outlook for children who’ve been abused?

Children who experience abuse often have:

• Immediate injuries like cuts, bruises and broken bones
• Frequent injuries
• Learning challenges
• Emotional and behavioral issues, like depression and anxiety
• Difficulty with social skills
• Fear of adults or certain places
• Toxic stress, which can disrupt brain development, raise their risk of developing PTSD and cause issues with learning, attention and memory

Untreated child abuse can have lasting effects. Older children and adults who experienced child abuse have a higher risk of social and emotional issues. They may:

• Abuse others or accept further abuse
• Harm themselves or attempt suicide
• Put caring for others ahead of taking care of themselves
• Have issues with sex, like engaging in risky sexual behaviors or avoiding sex entirely
• Have trouble forming relationships and trusting people

Adults who experienced abuse as a child may have long-term issues, like:

• Chronic pain, headaches, fibromyalgia or abdominal pain
• Depression and low self-esteem
• Substance use or alcohol use disorders

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

Children who experienced abuse need mental health care and support. Therapy can help children process their experiences and develop positive coping methods. It can also help them build healthy relationships and limit the effects of abuse. This can help their long-term physical health, too.

How do I help a child who confided in me about abuse?

If a child tells you they’ve experienced abuse, take them seriously. Don’t brush it off or assume they’re making it up or exaggerating.

To keep the child safe from further abuse, you should:

• Listen to the child. Let them explain what happened. Try to help them feel safe and let them know you’re available to listen and talk.
• Tell them it isn’t their fault. Let them know they aren’t responsible and shouldn’t feel ashamed.
• Provide safety. Keep the child away from the person behind the abuse.
• Call a healthcare provider. They can guide you on next steps.
• Seek further help. Examples include counseling, therapy and support groups.
• Be patient and supportive. Recovery isn’t an overnight process. It takes time, and not all children recover at the same pace.

What is child abuse clearance?

Child abuse clearance is a process a person goes through to show that they aren’t a perpetrator. Foster parents need this type of clearance. You’ll also need child abuse clearance if you want to work or volunteer with children. It’s part of the application process to help employers select potential employees. Child abuse clearance laws vary from state to state.