Child Abuse and Neglect

Effects on a Child's Health

Children who are abused or neglected may have long-term emotional and physical problems.

Young children are at special risk. Abuse and neglect in children younger than 7 years of age may lead to permanent behavior and personality changes. They may not grow properly. They may have learning problems. They may feel bad about themselves and not trust other people. They may be scared or angry.

Physical effects

• When physical abuse happens repeatedly or for a long time, it can cause permanent damage.
• Certain types of abuse, such as abusive head traumaabusive head trauma, can be deadly. Some children may have permanent developmental problemsdevelopmental problems or learning problemslearning problems.
• A sexually abused child can get a sexually transmitted infectionsexually transmitted infection.
• 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 conditions that can be caused by abuse and neglect include:

• Anxiety.
• Substance use disorderSubstance use disorder.
• Depression.
• Borderline personality disorderBorderline personality disorder. A person with this mental health condition may have trouble controlling their anger and impulses. They may have a low sense of self-worth and may have extreme worries about being abandoned.
• Post-traumatic stress disorderPost-traumatic stress disorder.
• Suicide or suicidal thoughts.
• DissociationDissociation. 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.
• 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.

Children often believe that abuse or neglect is their fault. They may think that they did something wrong and deserve what happened. It is up to adults who care to protect them.

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When to Call a Doctor

Call 911 anytime you think a child may need emergency care. For example, call if:

• You witness child sexual or physical abuse.
• You believe that a child is in immediate danger.

Call your doctor now or seek immediate medical care if:

• You think that a child may be in danger from sexual or physical abuse. You can also call your local police or child protection services. Another resource to call if you are concerned about a child's well-being is the Childhelp hotline at 1-800-4-A-CHILD (1-800-422-4453).

Contact your doctor if:

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

Exams and Tests

Here are some ways that child abuse and neglect are diagnosed.

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 may 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.

Tests such as an X-rayX-ray, CT scanCT scan, or MRIMRI can help determine whether a child's injuries include any broken bones. Some tests may also show signs of past injuries.

Blood tests.

Blood tests can be used to look for signs of organ damage.

Urinalysis.

This test checks for blood in the urine, which 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.

This is also called a spinal tap. It may reveal blood from a brain injury.

Eye exam.

This test is done to find out if damage has occurred that points to abusive head traumaabusive head trauma.

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 infectionssexually 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.

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Treatment Overview

Treatment for the child

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

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 therapyplay therapy.

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How Child Abuse Is Reported

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.

But 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.

If you're unsure about what to do, here are some things to keep in mind about how the law works.

• You may be able to make reports anonymously. If you give your name, it is kept confidential.
• You can't be sued successfully if you make a report in good faith.
• 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.