Child Abuse and Neglect

Symptoms

Symptoms can be physical, psychological, or both.

Keep in mind that older children may not talk about the problem, because they fear or want to protect the offender. Or they don't believe they will be taken seriously.

General symptoms

Certain general symptoms that may suggest that a child is experiencing some type of abuse or neglect include:

• Slower-than-normal development. The child does not show the abilities and skills normally found in other children the same age, such as starting to talk or socialize with others. Some children regress, which means they slip backward, losing skills they had before.
• Failure to thrive. This is a term that means the child isn't gaining weight or height the way he or she should. Although this can be caused by a medical problem, it can also be a sign that the child is not being well cared for.
• Unusual interaction with a parent. The parent may not be interested in the child. Or the child may be constantly trying not to upset the parent. The child may actually be afraid of the parent.
• Mental health problems, such as having low self-esteem, anxiety, depression, or thoughts of suicide.
• Suddenly getting lower grades in school.
• Behaving in a way that isn't appropriate or that causes problems. In a young child, this could mean being unusually fussy, being afraid, or not being interested in activities. Children often act out what they have seen or experienced, such as violence or sexual activity. Older children may act out in unusual ways, such as having sex, fighting, using drugs, or running away.

Symptoms of physical abuse

Children often get injured. But physical injuries may point to abuse when:

• It's hard to see how they could have been caused by an accident. Suspicious injuries include:
  • Injuries that have a pattern, such as a straight line or a circle.
  • Injuries to areas of the body that usually are protected, such as the inside of the legs and arms, the back, the genitals, and the buttocks.
• The explanation for the injury changes. Or it's not a believable explanation.
• There are signs that the child has been hurt before.
• The child doesn't receive medical care for his or her injury.

Symptoms of emotional abuse

Emotional abuse means doing or saying things to hurt a child emotionally. For example, the adult may say things to make the child feel unwanted or worthless. A child who is emotionally abused may:

• Not care much about what is going on around him or her.
• Not react normally to pain, other people, or changes in his or her life.
• Avoid a particular parent or caregiver.
• Act more fearful, angry, or sad than would seem normal.
• Not do well in school.
• Hurt himself or herself on purpose.

Symptoms of sexual abuse

A child with symptoms of recent sexual abuse may:

• Not want to go to the bathroom.
• Show signs of discomfort or pain while sitting, urinating, or passing stools.
• Have discharge from the vagina or penis.
• Bleed through his or her pants.

Certain ways of behaving may also point to sexual abuse. These include:

• Knowing more than he or she should about sex.
• Running away from home.
• Attempting suicide.
• Being involved with drugs or prostitution.

Sexual abuse versus normal sexual play

Sexual abuse is very different from normal sexual play between children who have not reached puberty.

Normal sexual play between children of similar ages is usually touching and looking. No force is used.

Sexual abuse includes any sexual activity that the child is not able to understand or consent to. Besides obvious sexual acts, examples include fondling and showing pornography to a child.

Symptoms of neglect

Child neglect means not providing a child with his or her basic needs. A child's general appearance, home environment, and behavior patterns can show signs of neglect.

A child who is neglected may:

• Be very underweight or overweight.
• Be developmentally delayed.
• Be sick or tired most of the time.
• Be dirty or have poor personal hygiene.
• Not have the right clothes for the weather.

What Happens

Children who are abused or neglected may have long-term emotional and physical problems. Abuse and neglect in children younger than 7 years of age may lead to permanent behavior and personality changes.

Physical effects

• When physical abuse happens repeatedly or for a long time, it can cause permanent damage.
• Certain types of abuse, such as shaken baby syndrome, can be deadly. Some children may have permanent developmental problems or learning problems.
• A sexually abused child can get a sexually transmitted infection, such as HIV.
• A neglected child can have long-term health problems, such as not growing or developing normally.

Emotional effects

The mental and emotional effects depend on how bad the abuse or neglect is, how often it happens, how long it's been going on, and who the abuser is.

Mental health disorders that can be caused by abuse and neglect include:

• Anxiety .
• Depression .
• Borderline personality disorder . A person with this mental health condition may have trouble controlling his or her anger and impulses. He or she may have a low sense of self-worth and may have extreme worries about being abandoned.
• Post-traumatic stress disorder .
• Suicide or suicidal thoughts.
• Dissociation . With this condition, the mind separates itself from an event or the environment so it can maintain some degree of order and sense.
• Eating disorders .

Other emotional effects include:

• Low self-esteem . Children often unconsciously blame themselves and grow up with a poor self-image. This affects their relationships with others.
• Anger, hostility, or criminal behavior.
• Negative feelings. A person with a history of abuse or neglect may have trouble dealing with normal struggles.
• Substance use disorder.
• Emotional detachment. A person may have problems making friends. This can lead to feeling isolated and alone. Children may not learn how to feel sympathy for others.
• Impulsiveness. The person acts without thinking about the consequences. They may take risks, such as driving dangerously.
• Sexual problems. Abused or neglected children, especially those who are sexually abused, often have problems developing healthy feelings about sex as they reach adolescence and adulthood. Some may be overly active sexually. Others may be too afraid to be intimate with anyone.

Children who are abused or neglected are more likely to abuse other children and siblings and, later in life, their own children or elderly parents. They are also more likely to become involved in crime.

What Increases the Risk

A risk factor is anything that makes you more likely to have a certain problem or disease.

Risk factors for parents and caregivers

People are more likely to abuse or neglect children if they:

• Are living in poverty or near poverty. This is a major risk factor for child abuse and neglect.
• Have a history of:
  • Violence, including domestic violence.
  • Substance use disorder.
  • Abusing children, or having been abused themselves.
  • Mental health problems, such as depression.
• Have little knowledge about how children grow and what to expect from them.
• Have a high stress level that is not managed well. This often includes being a single or teen parent or having several young children close in age.
• Don't have good support. A parent or caregiver who doesn't have financial, emotional, and other types of support may have to deal with a variety of hardships alone.

Risk factors for children

The risk of abuse and neglect increases when a child has a disability or other health issue, such as:

• Being a premature baby. Babies born early often add emotional and financial stress to a family because they need longer and more expensive hospital care. They may also need to be watched closely once they are home.
• A physical disability, such as blindness or being confined to a wheelchair.
• Below-average intelligence .
• Developmental delays .
• A difficult temperament .
• Behavioral problems, such as ADHD.

Bonding problems

Another risk factor for children is not having a close bond with parents. Not having a close bond may be caused by:

• Parents not wanting the child.
• The birth of twins or other multiples.
• A long hospitalization of the newborn and separation from parents because of premature birth or health problems.
• Challenges related to fostering or adopting a child.
• Mental health problems in a caregiver. For example, a parent who is severely depressed may unintentionally neglect his or her child.
• A child with a major health problem or disability, such as blindness, deafness, or autism. These types of problems can make it hard for a parent to communicate with the child or for the child to give and receive affection.

When to Seek Help

Call 911 or other emergency services immediately if you see a child being abused or believe a child is in immediate danger, or you see that a child:

• Is not breathing. The 911 operator can guide you through CPR until help arrives.
• Is having trouble breathing.
• Is bleeding heavily.
• Has a changed level of consciousness.
• Is in shock.
• Shows symptoms of a head injury after being shaken.
• Has signs of severe dehydration.

Call police or child protective services immediately if you:

• Suspect an injury was caused by abuse.
• Suspect that abuse or neglect is placing a child's health at risk.
• Suspect that a child has seen or heard domestic violence within his or her family.
• Are worried that you or your spouse or partner may lose control and hurt your child.

If the child is not in immediate danger, call your local child protective services or police if:

• A child tells you about being abused or neglected.
• You notice possible physical abuse injuries.
• You see signs of sexual abuse.
• You notice signs of neglect.

Childhelp, a nonprofit agency, provides telephone numbers and information about how to report suspected or observed child abuse or neglect. The national Child Abuse hotline number is 1-800-4-A-CHILD (1-800-422-4453). The U.S. Administration of Children and Families, under the Department of Health and Human Services, has established a Children's Bureau that supports the states in the delivery of child welfare services designed to protect children and strengthen families.

Exams and Tests

Physical exam

An abused or neglected child who is taken to a doctor will first have a general physical exam. The doctor will review the child's medical history and ask parents or caregivers questions about the child's condition.

A child who is able to talk will be separated from the caregiver during the interview.

The law requires doctors to consider the possibility of abuse or neglect. Along with seeing signs of physical abuse or neglect, a doctor may become suspicious when:

• The injury is unusual or is not likely to be an accident, especially for the child's age.
• The parents or caregivers don't have a good explanation, or the explanation changes.
• The parents or caregivers say no one saw the injury happen.
• Medical records show that similar injuries or patterns of neglect have occurred in the past.
• The parents or caregivers put off taking the child to the doctor without a good reason.
• The doctor finds signs of sexual abuse.

Other children in the care of the same person may also be examined and have X-rays if police or doctors think it's needed.

Common tests

Tests that are often used to help confirm or rule out abuse or neglect include:

• Imaging tests such as X-ray, CT scan, or MRI. These types of tests can help determine whether a child's injuries include any broken bones. Some tests may also show signs of past injuries.
• Blood tests. Prothrombin time, partial thromboplastin time, and platelet count can help determine whether the child has a bleeding disorder. Other blood tests can be used to look for signs of organ damage.
• Urinalysis , to check for blood in the urine. This can be a sign of internal injuries.
• Specialized lab tests. For example, the doctor may take skin or hair samples or samples of fluids in or around the vagina to be tested.
• Lumbar puncture , also called spinal tap, which may reveal blood from a brain injury.
• Eye exam, to find out if damage has occurred that points to shaken baby syndrome.

Other tests

Other exams and tests depend on the specific medical problem suspected or observed. For example:

• Psychological testing may be requested for some children.
• Victims of suspected sexual abuse may be tested for sexually transmitted infections.

Tracking a child's injuries

Information about a child's injuries is carefully recorded. A detailed account of the injuries goes into the child's permanent health record.

This record usually includes photographs and drawings of the injuries.

Measurements such as weight, height, and head circumference are also taken and recorded to help establish a child's baseline growth pattern. Recording these measurements on growth charts can help identify failure to thrive that sometimes is related to neglect.

Treatment Overview

Early treatment gives an abused or neglected child the best chance for recovery.

Treatment for the child

The first step is to provide a safe environment to prevent further harm. The sooner this happens, the better the child's chance for physical and emotional recovery. This includes separating the child, as well as any other children in the household, from the person suspected of abuse.

Any physical injuries will be treated, either in a hospital or at a doctor's office, depending on how serious they are.

Counseling is always recommended for abused or neglected children. It usually focuses on:

• How they feel about themselves.
• Their past experiences.
• Fears and concerns they may have about the present and future.

For very young children, counseling may involve play therapy.

Treatment for parents or caregivers

Parents or caregivers who have abused or neglected a child also need treatment. The type of treatment depends on the specific abuse that occurred.

Some people need to learn more about how to raise and care for children. Others may need treatment for other serious problems, such as:

• Substance use disorder.
• Depression or other mental health problems.
• Low self-esteem.
• Violent behavior.

Parents who have lost custody of their children can sometimes regain it. It depends on how bad the abuse or neglect was and how far they have come in realizing what their problems are and how to prevent them.

In severe cases, the parent can see the child only when someone else is present. Sometimes a judge permanently ends the parent-child relationship.

Prevention

Everyone can help prevent child abuse and neglect by showing concern for children and their well-being.

Prevention tips for parents and caregivers

• Learn how to handle children when they misbehave . Avoid using physical punishment. Parenting classes are offered in most communities. Ask your doctor or call a local hospital for more information.
• Learn healthy ways to resolve conflicts and manage stress. For more information, see the topic Stress Management.
• Ask for help when you need it. Call a family member or friend to give you a break if you feel overwhelmed. Find out about community resources that can help you with child care or other services. Call a doctor or local hospital for information.
• Get treatment if you were ever a victim of abuse. Treatment can help problems like depression, substance use disorder, or violent behavior.
• Remove firearms and other dangerous weapons from your home.
• Learn more about how children grow at different stages in their lives. For example, lack of knowledge about why babies cry can make the crying a trigger for shaken baby syndrome. For more information, see:
  • Growth and Development, Ages 1 to 12 Months.
  • Growth and Development, Ages 12 to 24 Months.
  • Growth and Development, Ages 2 to 5 Years.
  • Growth and Development, Ages 6 to 10 Years.
  • Growth and Development, Ages 11 to 14 Years.
  • Growth and Development, Ages 15 to 18 Years.

Prevention tips for everyone

• Get to know the children in your neighborhood. Learn their names, and show you care simply by waving to them or asking about how they're doing at home and school.
• Give parents a break. Relieve a friend, neighbor, or relative who is feeling overwhelmed with child care and other issues.
• Learn the signs of child abuse and neglect.
• Encourage your community to offer services to help families who are at risk for abuse or neglect.
• Volunteer in child abuse programs.

How Child Abuse Is Reported

Laws about reporting abuse

The law requires certain people, such as doctors, social workers, and teachers, to report suspected child abuse and neglect. Usually the report is made to the police or to child welfare or child protection agencies. In some areas the law requires all citizens to report suspected abuse or neglect.

Police and child welfare workers investigate the report. If the government believes a crime has been committed, the suspected abuser is tried and, if found guilty, sentenced.

Investigators sometimes can't find enough evidence to charge someone with a crime. In this case, parents or caregivers may be referred to social services to lower the child's risk of being hurt.

Knowing when to call police

When you suspect a child is, or is at risk of, being abused or neglected, it is important to take action. Most abused children are not able to help themselves.

Many people don't know what to do about suspected abuse, because they:

• Are not sure what is considered abuse and neglect.
• Are afraid they'll cause the child more harm.
• Are worried that they will falsely accuse a parent or caregiver.
• Are afraid the abuser will hurt or harass them.
• Are worried about being sued.

Keep in mind that by reporting your suspicions, you may prevent a child from being seriously hurt or even killed and from having lifelong emotional problems. You can make reports anonymously. If you give your name, it is kept confidential.

Also, you can't be sued successfully if you make a report in good faith.