Child Abuse – Signs and Tips

Child Abuse

Also called: Child Abuse, Abuse of Children

Summary

Child health experts define child abuse as any harm to or neglect of a child by another person that presents an imminent risk or results in serious physical or emotional harm and, in some cases, the death of a minor. Children can be abused by parents, caretakers or other individuals.

Abuse in children may be physical, sexual, mental or emotional. It can also be a combination of any of these forms and can occur among all genders, races, educational backgrounds and socioeconomic groups. However, such abuse is more common in families with a history of domestic violence, substance abuse problems and those living in poverty or facing other socioeconomic disadvantages, including unemployment.

Regardless of its nature, child abuse is physically and mentally harmful and almost always results in psychological damage for its victims. It can lead to increased anxiety and stress, low self-esteem, learning disorders and mental illnesses including major depression and post-traumatic stress disorder(PTSD). 

Recent research also suggests a link between child abuse and schizophrenia.

Prolonged abuse can also put children and adolescents at risk for developing substance abuse or dependence, high-risk sexual behaviors (e.g., unprotected sex, multiple sex partners), poor health, poor academic performance, suicidal ideation and untimely death.

Children are often unable to stop abuse while it is happening. However, adults can help stop abuse and initiate support for children dealing with the aftermath of abuse. The most important step is telling a trusted adult (e.g., relative, teacher, school counselor) about the abuse as soon as possible.

Abused children may find it difficult to talk about the abuse, either because of fear or a reluctance to betray someone they love or care about. Nonetheless, there is much that can be done to help an abused child.

Tips for helping a loved one cope with child abuse include:

  • Do not ignore signs of child abuse such as unexplained bruises, broken bones or other types of physical abuse. Behaviors including withdrawal from friends or family and mood changes such as increased anxietyand depression may also indicate abuse. Be aware if a child needs medical attention and take steps to provide it.
  • Talk to them in private and let them know help is available.
  • Promptly report child abuse to appropriate law enforcement agencies, such as the U.S. Child Protection Agency or the police.

In addition, children or adolescents who have been abused should be taken to a mental health professional, typically a child and adolescent psychiatrist for a psychiatric evaluation. This will help determine whether ongoing psychological treatment (e.g., psychotherapy) is necessary for the child to cope with abuse. The psychiatrist can also provide support to other family members affected by the abuse.A variety of health and social resources can provide timely assistance and support for victims of child abuse. These include national coalitions such as the Childhelp USA® National Child Abuse Hotline (1-800-422-4453) and local shelters, crisis centers and courts or other law enforcement agencies. Health care professionals, such as physicians, nurses, social workers, psychologists or school counselors may be able to provide referrals for such services. Other sources of information include telephone books and the Internet.

About abuse in children

Child abuse is defined by experts as any  harm to, or neglect of, a child by another person (e.g., parent, caretaker, other) that presents an imminent risk or results in serious physical or emotional harm and, in some cases, the death of a minor.

Abuse in children and adolescents can take various forms, ranging from physical abuse to sexual or mental abuse.  Research indicates that childhood abuse and neglect may cause important regions of the brain to fail to develop properly, resulting in impaired physical, mental and emotional development – a condition known as failure to thrive. It also suggests that the stress of chronic abuse may cause a “hyperarousal” response by certain areas of a child’s brain, which may result in hyperactivity.   

Regardless of the type of abuse inflicted, it almost always results in psychological damage for children and adolescents, especially if it is ongoing. Abuse can lead to increased anxiety and stress, sleep disturbances and low self-esteem. It can also put children at risk for developing emotional disorders or mental illnesses including attention deficit hyperactivity disorder(ADHD), conduct disorders, learning disorders, major depression, eating disorders (e.g., anorexia nervosa, bulimia nervosa) and post-traumatic stress disorder(PTSD). Recent research also suggests a link between child abuse and schizophrenia.

Ongoing abuse may also put children and teenagers at risk for later developing substance abuse or dependence, high-risk sexual behaviors (e.g., unprotected sex, multiple sex partners), poor health, poor academic performance, suicidal ideation and untimely death. In addition, children who have been exposed to abuse – even if they only witness it – are also more likely to experience domestic and psychological abuse as adults or to grow up to become abusive themselves. 

Abuse can occur among all people of all genders, races, educational backgrounds and socioeconomic groups. However, child abuse is more prevalent in families with a history of domestic violence, substance abuse problems and those living in poverty or facing other socioeconomic disadvantages, such as unemployment and lack of education.

In most cases, abuse and neglect in children are perpetrated by parents. Frequently the perpetrator is a young adult in his or her mid-20s without a high school diploma, living at or below the poverty level. The abuser is also often depressed, often has substance abuse problems and may have difficulty coping with stressful situations. In many instances, perpetrators have experienced abuse themselves. Most child deaths resulting from physical abuse are caused by fathers and other male caretakers. On the other hand, sexual abuse in children is most often perpetrated by a male friend of the child’s family, neighbor or other male relative.  

Recent estimates by the U.S. Department of Health and Human Services indicated that 906,000 children experienced child abuse and neglect in 2003. Pacific Islander, American Indian, Alaskan Native and African American children had the highest rates of victimization. Infants ages 3 and younger experienced the highest rate of abuse, with girls being slightly more victimized than boys.  

Types and differences of abuse in children

Abuse in children can take many forms. It may be limited to physical abuse or may combine any or all of the following:

  • Neglect.  The most common form of abuse in children in the United States. It occurs when a parent or other caretaker fails to provide basic necessities to a child including adequate food, housing, clothes, education, medical care or supervision.

  • Physical abuse. The willful infliction of physical pain or injury on a child. Examples of physical abuse include excessive shaking (shaken baby syndrome), shoving, punching, slapping, pinching, hitting, kicking, hair pulling, choking and other types of violent behavior including burning with cigarettes or scalding with hot water. In severe cases, physical abuse may result in the death of a child.

  • Sexual abuse. May include sexual exhibitionism by an adult or other caretaker, inappropriate touching of minors, photographing children in suggestive poses,  forcing children to look at pornography, forcing sexual contact with a third party or any other type of coerced sexual contact with a child or adolescent such as nudity, statutory rape, sodomy or incest. According to the Centers for Disease Control and Prevention (CDC), female children and adolescents are significantly more likely than males to experience sexual abuse.

  • Mental or emotional anguish. Occurs when a parent or other caretaker behaves in a way that causes fear, mental anguish and emotional pain or distress to children. It can range from name-calling or giving the “silent treatment” to intimidating and threatening a child. It can also include isolating a child from relatives, friends and regular activities.

  • Munchausen syndrome by proxy(MSBP). A rare form of child abuse in which a parent or other caretaker, typically a mother, induces real or apparent symptoms of disease in a child. As a result, physicians usually perform various diagnostic tests, prescribe medications and may even hospitalize a child or perform surgery to determine the cause of the child’s illness. The syndrome occurs due to psychological problems in the parent or caregiver, and the unusual behavior can escalate to the point of severe physical harm or even death of a child.

Signs of abuse in children

Sometimes children may have trouble recognizing that they are being abused. Recognizing abuse can be especially hard for a child who has grown up with it. Children may feel powerless and think that it is normal behavior or that nothing can be done about it.

Children might also erroneously think that they bring abuse on themselves by misbehaving or not living up to a caretaker’s expectations.

Recognizing abuse may save a child’s life. Abused and neglected children or adolescents often display the following signs or symptoms:

  • Multiple bruises, welts, sores or other injuries that do not seem to heal.

  • Always seem unclean and/or unusually hungry.

  • Appear fearful of one or both parents or other caretaker.

  • Nightmares or other sleep disturbances.

  • Regression to earlier stage of development (e.g., thumbsucking or bedwetting).

  • Aggressive, disruptive and sometimes illegal behavior (e.g., temper tantrums, stealing, attempts to run away). Also, unusually passive or withdrawn behavior.

  • Shying away from physical contact with other adults.

  • Problems in school (e.g., excessive absences, problems with learning and/or paying attention).

  • Emotional disorders such as depression, anxiety or suicidal ideation.

  • Experiencing flashbacks.

  • Substance abuse or drug dependence.

  • Acting out in sexually inappropriate ways.

  • Abdominal pain, genital pain or bleeding, urinary tract infection and/or sexually transmitted disease.

Coping tips for victims of child abuse

Without help, child abuse may continue and worsen. The first step towards ending this potentially life-threatening behavior is to realize that all people have the right to be treated with respect and not be physically, sexually or verbally abused.

The most effective way a child can end abuse is by telling a trusted adult about it as quickly as possible. These adults include parents and other relatives, neighbors, friends’ parents, pediatricians, sports coaches, teachers and school counselors.  Abused children may find this difficult, either out of fear or because they do not want to betray the abuser, who may be someone they love or care about.

If abuse does not stop after others find out about it – for example, if a week or more goes by with child abuse continuing or escalating – children and adolescents are urged to keep telling other trusted adults until it stops, and even contact the police if necessary.

Generally after adults find out about child abuse, a social worker or police officer may come to talk with the child in private. The abuse should then stop. If parents are responsible for abusing their children, they may have to move out of the family home to get proper help (e.g., counseling) or the child may be removed from the home.

Children are often unable to stop abuse while it is occurring, but there are numerous strategies for dealing with the aftermath of an abusive situation. Tips for coping with childhood abuse include:

  • Say “no!” as loudly as possible whenever anyone tries touching any part of one’s body in ways that hurt, feel bad or are confusing (e.g., hitting, touching private parts). The person may say it is only a game or that bad things will happen if anyone finds out, but the child should continue to object loudly. If other adults are nearby, they can help stop the abuse.
  • Express feelings. Children and adolescents who have been abused may experience feelings of anger, confusion, fear, guilt, sadness or grief. It is important to take time to express those feelings and not keep them inside. Crying, drawing, writing in a diary and talking to a school counselor can provide relief. If necessary, a school counselor can refer students to a mental health professional such as a child and adolescent psychiatrist.
  • Do not accept blame for the abuse. Many children may think that the abuse occurred because of something they did or did not do. Children who have been victimized should realize that no one deserves any kind of abuse. A school counselor or psychologist can help students come to this realization.
  • Participate in activities that boost self-esteem. These may include playing with friends and/or pets, practicing sports, drawing, listening to music, eating favorite foods or watching humorous movies.
  • Join local support groups for individuals who experienced childhood abuse. These groups can be especially helpful for people with limited personal support systems.

Helping loved ones cope with child abuse

Some abused children and adolescents may turn to their relatives, friends and other loved ones for support. Others may find it difficult to talk about the abuse because of fear or reluctance to betray someone they love or care about. Friends and family members can provide valuable assistance to those coping with child abuse.

Tips for helping a loved one cope with child abuse include:

  • Do not ignore signs of child abuse. These can include unexplained bruises, broken bones, sprains or other types of marks on the child that may indicate physical abuse. Behaviors including withdrawal from friends or family and mood changes such as increased anxiety or aggression and depression may also indicate abuse.
  • Recognize the need for medical attention. In some cases, victims of child abuse may not be able to take the necessary steps to secure medical treatment.
  • Talk to them privately and let them know help is available.
  • Tell them that they deserve better treatment and that the abuse is not their fault.
  • Remain supportive and tactful. It is extremely important to listen, not assume anything and let them describe the abuse in their own words.
  • Confirm their feelings. Let them know that it is normal to feel scared, confused, sad or however else they may be feeling. Doing so can help them feel safe and encourages trust.
  • Tell them that they did the right thing by telling and that they will soon receive  help. It is important that victims of child abuse know that the abuse will be reported to a person who is experienced in helping with these kinds of problems. This will help build a sense of trust and the child will not be surprised when they find out that other adults will be involved.
  • Promptly report child abuse to appropriate law enforcement agencies. For instance, if child abuse is occurring within a family a local child protection agency should be contacted. If an abuser is someone other than a family member, local police or another type of law enforcement agency should be notified. After the proper agency is notified of child abuse, they usually conduct an evaluation and take necessary action to protect the child.

Abused children or adolescents should be taken to a mental health professional, typically a child and adolescent psychiatrist for a psychiatric evaluation. The evaluation is generally performed to find out how the abuse has affected them and to determine whether ongoing psychological treatment (e.g., psychotherapy) is necessary. The psychiatrist can also provide support to other family members affected by the abuse.

Resources available for coping

In cases of emergency, child abuse victims are urged to get away from their abuser or perpetrator and contact a local law enforcement agency (e.g., police) as soon as possible. However, if danger is not immediate and life threatening there are various resources available for abused children and adolescents as well as concerned loved ones.

Victims of child abuse should realize that they are not alone. A variety of local health and social services exist that can provide timely assistance and support. These services typically address the underlying causes of child abuse as well as help stop it. Teachers and school counselors are safe sources who can help take action. Health care professionals, such as physicians, nurses, social workers or psychologists are also able to provide referrals for such services. Other sources of information include telephone books and the Internet.

For instance, national coalitions can provide crisis intervention and referrals to local and national resources, such as women’s shelters or crisis centers. These include:

  • Childhelp USA® National Child Abuse Hotline. 1-800-422-4453. www.childhelpusa.com
  • Stop It Now! 1-888-773-8368. www.stopitnow.com

Shelters and crisis centers usually provide 24-hour, emergency shelter for children and other caring relatives. They also provide advice on legal matters, advocacy and support services and evaluation and monitoring of child abusers. Some shelters have staff members who speak multiple languages.

Medical facilities such as clinics or hospitals can also provide invaluable assistance. These facilities treat injuries and report abuse in children and can also refer victims and their loved ones to safe housing and other local resources. Counseling or mental health centers are another helpful option because they provide treatment for the associated psychological trauma (e.g., post traumatic stress disorder[PTSD]). However, individuals in abusive relationships (e.g., domestic violence) should not attempt to convince a child abuser to attend family counseling. This type of family therapy is not appropriate for abusive relationships of any kind.Local courts and other law enforcement agencies can help relatives of child abuse victims obtain court orders, which legally mandate an abuser stay away from the child or face arrest. These are usually referred to as orders of protection or restraining orders. Courts and other law enforcement agencies can also refer relatives and other caretakers to local advocates, who are often available throughout the community, for assistance in completing all necessary paperwork and guidance in the legal process.

Questions for your doctor

Preparing questions in advance can help patients to have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions regarding abuse in children:

  1. How can I help my friend who is being abused by his/her parents?
  2. If I report my parent to the authorities for child abuse, will they be taken away?
  3. Do you know any shelters or crisis centers for victims of child abuse or domestic violence?
  4. I grew up in an abusive household. Am I at risk for becoming abusive towards my children?
  5. What can I do to prevent becoming abusive towards my children?
  6. Where can I get help so that I can stop hitting my child?
  7. How can I protect my children from being victims of sexual abuse and other types of crimes?
  8. I am scared my spouse may hurt me and/or my children if I report the child abuse to authorities. What should we do to protect ourselves?
  9. I suspect my child is being abused, how can I get him/her to confide in me?
  10. What will happen after I tell someone about the abuse?
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