The Child Abuse Prevention and Treatment Act (United States Department of Health and Human Services, 2013) defines child maltreatment as any recent act or failure to act on the part of a parent or caretaker which results in death, serious physical or emotional harm, sexual abuse or exploitation; or an act or failure to act, which presents an imminent risk of serious harm (p. viii). Child abuse occurs when a parent or caretaker inflicts, or allows someone to inflict, serious physical injury other than by accidental means. Child neglect is the failure of a parent or caretaker to provide for a child’s needs to the degree that the child’s health, safety, and well-being are threatened with harm. Each state has its own definition of child abuse based on federal law, and most states recognize four major types of maltreatment: neglect, physical abuse, sexual abuse, and psychological maltreatment. Each of the forms of child maltreatment may be identified alone, but they can occur in combination.

Video 1. What are Child Abuse and Neglect discusses the different types of abuse and interventions to prevent maltreatment.

Child Protective Services (CPS) agencies received an estimated 3.5 million referrals involving approximately 6.4 million children, and 2.1 million referrals (60%) were investigated. This is a rate of 28.3 per 1,000 children in the national population. Three-fifths of child abuse reports are made by professionals, including teachers, law enforcement personnel, and social services staff. The rest are made by anonymous sources, other relatives, parents, friends, and neighbors.

Child maltreatment may come in several forms, the most common being neglect (78.3%), followed by physical abuse (10.%), sexual abuse (7.6%), psychological maltreatment (7.6%), and medical neglect (2.4%) (Child Help, 2011). Some children suffer from a combination of these forms of abuse. The majority (81.2%) of perpetrators are parents; 6.2 percent are other relatives.

Nationally, an estimated 1,520 children die from abuse and neglect, and nearly three-quarters (73.9%) of all child fatalities were younger than three years old. Boys had a higher child fatality rate (2.36 per 100,000 boys) than girls (1.77 per 100,000 girls). More than 85 percent (86.8%) of child fatalities were comprised of White (39.3%), African-American (33.0%), and Hispanic (14.5%) victims, and 78.9% of child fatalities were caused by one or both parents (United States Department of Health and Human Services, 2013).

As most reports of abuse and neglect come from professionals working with children, they need to be aware of the potential signs of abuse and neglect. The following signs exhibited by children and their parents may signal the presence of child abuse or neglect.

The Child:

• Shows sudden changes in behavior or school performance
• Has not received help for physical or medical problems brought to the parents’ attention
• Has learning problems (or difficulty concentrating) that cannot be attributed to specific physical or psychological causes
• Is always watchful, as though preparing for something bad to happen
• Lacks adult supervision What Is Child Abuse and Neglect?
• Is overly compliant, passive, or withdrawn
• Comes to school or other activities early, stays late, and does not want to go home
• Is reluctant to be around a particular person
• Discloses maltreatment

The Parent:

• Denies the existence of—or blames the child for—the child’s problems in school or at home
• Asks teachers or other caregivers to use harsh physical discipline if the child misbehaves
• Sees the child as entirely bad, worthless, or burdensome
• Demands a level of physical or academic performance the child cannot achieve
• Looks primarily to the child for care, attention, and satisfaction of the parent’s emotional needs
• Shows little concern for the child The Parent and Child:
• Rarely touch or look at each other
• Consider their relationship entirely negative
• States that they do not like each other

The above list may not be all the signs of abuse or neglect. It is essential to pay attention to other behaviors that may seem unusual or concerning. In addition to these signs and symptoms, Child Welfare Information Gateway provides information on the risk factors and perpetrators of child abuse and neglect fatalities

Neglect

Neglect is the failure of a parent, guardian, or other caregivers to provide for a child’s basic needs. There are many forms of neglect: physical, medical, educational, emotional, and abandonment.

Physical is a failure to provide for the child’s physical needs. Parents must provide their children with food and water. They also need safe, appropriate shelter. Shelter may be more than just a roof of their head. Is the home structurally safe? Is there a means for keeping the house a safe temperature? Is there water for hygiene? Are there any health and safety issues with the home? Parents are also required to provide appropriate supervision for the child to keep them safe. Appropriate may be challenging to define. Many states do not provide strict rules as to when children may be unsupervised or for how long, or when children can be responsible for caring for younger siblings. That is due to variations in maturity. Some 10-year-olds can be trusted to stay home alone for short periods, and some 15-year-olds cannot be left unsupervised for any amount of time.

Medical neglect is the failure to provide necessary medical or mental health treatment that a child needs. If a child is injured or sick and requires medical intervention, it is the parents’ responsibility to be sure that the child gets help. The same is true if the child were having a mental health crisis or needed psychological intervention for their health and safety. Finally, dental issues that cause the child pain or infection would also be a medical requirement. Medical neglect can be another challenge to define. For example, would never take a child to a doctor for a physical be neglect? What about the failure to get the child vaccinated? In many states, failure to provide preventative medical care would not be considered neglect.

Educational neglect is a failure to educate a child. All children have the right to free public education, but it is the parents’ responsibility to make sure that the child gets to school—at least for the time in which school is compulsory. In most states, kindergarten is not mandatory. Similarly, after a certain age, teens are no longer required to attend school. Educational neglect would not apply in these situations. If a parent chooses not to send their child to a public school, it is then their responsibility to ensure that the child receives an appropriate education. This education could be through a private school or homeschooling. Each state has its own regulations around what is considered acceptable for private or homeschooling education. Some states have strict rules that require regular submission of lessons, updates regarding student progress, and mandates for all children to take standardized exams. Other states require no more than a letter from the parent stating that the child will be homeschooled, no follow-up on the child’s learning. Educational neglect may also be a failure for the parent to attend to special education needs, even if the child is in public school. Parents that do not comply with requests to get their child tested, meet for planning meetings, or sign off on educational plans may impede their child from receiving the special education services that they require.

Emotional neglect is the failure to meet a child’s emotional needs. This behavior could range from being inattentive or emotionally unavailable to the child to being outright rejecting. Children need affection, love, support, and social interaction. For younger children, this primarily comes from their caregivers, but even older children need to feel the love from their parents.

Abandonment includes situations where the parent’s identity or whereabouts are unknown, the child has been left alone in circumstances where the child suffers serious harm, or the parent has failed to maintain contact with the child or provide reasonable support for a specified period. If a parent cannot be present to care for their child, it is their responsibility to arrange for safe, appropriate care.

Consider the possibility of neglect when the child:

• Is frequently absent from school
• Begs or steals food or money Lacks needed medical or dental care, immunizations, or glasses
• Is consistently dirty and has severe body odor
• Lacks sufficient clothing for the weather
• Abuses alcohol or other drugs
• States that there is no one at home to provide care

Consider the possibility of neglect when the parent or other adult caregiver:

• Appears to be indifferent to the child
• Seems apathetic or depressed
• Behaves irrationally or in a bizarre manner
• Is abusing alcohol or other drugs

Many parents do not purposely neglect their children; factors such as cultural values, the standard of care in a community, and poverty can lead to a hazardous level of neglect. If information or assistance from public or private services are available, and a parent fails to use those services, child welfare services may intervene (U.S. Department of Health and Human Services).

Physical Abuse is nonaccidental physical injury (ranging from minor bruises to severe fractures or death) as a result of punching, beating, kicking, biting, shaking, throwing, stabbing, choking, hitting (with a hand, stick, strap, or other objects), burning, or otherwise harming a child, that is inflicted by a parent, caregiver, or other people who have responsibility for the child. Such injury is considered abuse regardless of whether the caregiver intended to hurt the child. Physical abuse in children may come in the form of beating, kicking, throwing, choking, hitting with objects, burning, or other methods. Physical discipline, such as spanking or paddling, is not considered abuse as long as it is reasonable and causes no bodily injury to the child (Child Welfare Information Gateway, 2008).

This issue is somewhat controversial among modern-day people in the United States. While some parents feel that physical discipline, or corporal punishment, is an effective way to respond to bad behavior, others feel that it is a form of abuse. According to a poll conducted by ABC News, 65 percent of respondents approve of spanking, and 50 percent said that they sometimes spank their child.

Consider the possibility of physical abuse when the child:

• Has unexplained burns, bites, bruises, broken bones, or black eyes
• Has fading bruises or other marks noticeable after an absence from school
• Seems frightened of the parents and protests or cries when it is time to go home
• Shrinks at the approach of adults
• Reports injury by a parent or another adult caregiver
• Abuses animals or pets

Consider the possibility of physical abuse when the parent or other adult caregiver:

• Offers conflicting, unconvincing, or no explanation for the child’s injury, or provides an explanation that is not consistent with the injury
• Describes the child as “evil” or in some other very negative way
• Uses harsh physical discipline with the child
• Has a history of abuse as a child
• Has a history of abusing animals or pets

The tendency toward physical punishment may be affected by culture and education. Those who live in the South are more likely than those who live in other regions of the United States to spank their child. Those who do not have a college education are also more likely to spank their child (Crandall, 2011). Studies have shown that spanking is not an effective form of punishment and may lead to aggression by the victim, particularly in those who are spanked at a young age (Berlin 2009).

Sexual abuse includes activities by a parent or caregiver such as fondling a child’s genitals, penetration, incest, rape, sodomy, indecent exposure, and exploitation through prostitution or the production of pornographic materials. Sexual abuse is defined as “the employment, use, persuasion, inducement, enticement, or coercion of any child to engage in, or assist any other person to engage in, any sexually explicit conduct or simulation of such conduct for the purpose of producing a visual depiction of such conduct; or the rape, and in cases of caretaker or inter-familial relationships, statutory rape, molestation, prostitution, or other forms of sexual exploitation of children, or incest with children” (Child Welfare Information Gateway, 2008).

Researchers estimate that 1 out of 4 girls and 1 out of 10 boys have been sexually abused (Valente, 2005). The median age for sexual abuse is 8 or 9 years for both boys and girls (Finkelhor et al. 1990). Most boys and girls are sexually abused by a male. Childhood sexual abuse is defined as any sexual contact between a child and an adult or a much older child. Incest refers to sexual contact between a child and family members. In each of these cases, the child is exploited by an older person without regard for the child’s developmental immaturity and inability to understand the sexual behavior (Steele, 1986).

Although rates of sexual abuse are higher for girls than for boys, boys may be less likely to report abuse because of the cultural expectation that boys should be able to take care of themselves and because of the stigma attached to homosexual encounters (Finkelhor et al. 1990). Girls are more likely to be victims of incest, and boys are more likely to be abused by someone outside the family. Sexual abuse can create feelings of self-blame, betrayal, and feelings of shame and guilt (Valente, 2005). Sexual abuse is particularly damaging when the perpetrator is someone the child trusts. Victims of sexual abuse may suffer from depression, anxiety, problems with intimacy, and suicide (Valente, 2005). Sexual abuse has additional impacts, as well. Studies suggest that children who have been sexually abused have an increased risk of eating disorders and sleep disturbances. Further, sexual abuse can lead to Post Traumatic Stress Disorder.

Consider the possibility of sexual abuse when the child:

• Has difficulty walking or sitting
• Suddenly refuses to change for gym or to participate in physical activities
• Reports nightmares or bedwetting
• Experiences a sudden change in appetite
• Demonstrates bizarre, sophisticated, or unusual sexual knowledge or behavior
• Becomes pregnant or contracts a venereal disease, particularly if under age 14
• Runs away • Reports sexual abuse by a parent or another adult caregiver
• Attaches very quickly to strangers or new adults in their environment

Consider the possibility of sexual abuse when the parent or other adult caregiver:

• Is unduly protective of the child or severely limits the child’s contact with other children, especially of the opposite sex
• Is secretive and isolated
• Is jealous or controlling with family members

Being sexually abused as a child can have a powerful impact on self-concept. The concept of false self-training (Davis, 1999) refers to holding a child to adult standards while denying the child’s developmental needs. Sexual abuse is just one example of false self-training. These abused children are held to adult standards of desirableness and sexuality while their level of cognitive, psychological, and emotional immaturity are ignored. Consider how confusing it might be for a 9-year-old girl who has physically matured early to be thought of as a potential sex partner. Her cognitive, psychological, and emotional state does not equip her to make decisions about sexuality or, perhaps, to know that she can say no to sexual advances. She may feel like a 9-year-old in all ways and be embarrassed and ashamed of her physical development. Girls who mature early have problems with low self-esteem because of the failure of others (family members, teachers, ministers, peers, advertisers, and others) to recognize and respect their developmental needs. Overall, youth are more likely to be victimized because they do not have control over their contact with offenders (parents, babysitters, etc.) and have no means of escape (Finkelhor and Dzuiba-Leatherman, in Davis, 1999).

Psychological maltreatment is a pattern of behavior that impairs a child’s emotional development or sense of self-worth. This behavior may include constant criticism, threats, or rejection, as well as withholding love, support, or guidance. Emotional abuse is often difficult to prove, and therefore, child protective services may not be able to intervene without evidence of harm or mental injury to the child. Emotional abuse is almost always present when other types of maltreatment are identified.

Consider the possibility of emotional maltreatment when the child:

• Shows extremes in behavior, such as overly compliant or demanding behavior, extreme passivity, or aggression
• Is either inappropriately adult (parenting other children, for example) or inappropriately infantile (frequently rocking or head-banging, for example)
• Is delayed in physical or emotional development
• Has attempted suicide
• Reports a lack of attachment to the parent

Consider the possibility of emotional maltreatment when the parent or other adult caregiver:

• Constantly blames, belittles, or berates the child
• Is unconcerned about the child and refuses to consider offers of help for the child’s problems
• Overtly rejects the child

Risk Factors for Maltreatment

Child abuse occurs at all socioeconomic and education levels and crosses ethnic and cultural lines. Just as child abuse is often associated with stresses felt by parents, including financial stress, parents who demonstrate resilience to these stresses are less likely to abuse (Samuels 2011). Young parents are typically less capable of coping with stresses, particularly the stress of becoming a new parent. Teenage mothers are more likely to abuse their children than their older counterparts. As a parent’s age increases, the risk of abuse decreases. Children born to mothers who are fifteen years old or younger are twice as likely to be abused or neglected by age five than are children born to mothers ages twenty to twenty-one (George and Lee 1997).

Drug and alcohol use is also a known contributor to child abuse. Children raised by substance abusers have a risk of physical abuse three times greater than other kids, and neglect is four times as prevalent in these families (Child Welfare Information Gateway 2011). Other risk factors include social isolation, depression, low parental education, and a history of being mistreated as a child. Approximately 30 percent of abused children will later abuse their own children (Child Welfare Information Gateway 2006).

Child abuse and neglect can have lifelong implications for victims, including the impact the physical, mental, and emotional wellbeing. While the physical wounds heal, there are several long-term consequences of experiencing the trauma of abuse or neglect. Children who are maltreated are at risk of experiencing cognitive delays and emotional difficulties, among other issues. Childhood trauma also negatively affects nervous system and immune system development, putting children who have been maltreated at a higher risk for health problems as adults

Injury, poor health, and mental instability occur at a high rate in this group, with 80 percent meeting the criteria of one or more psychiatric disorders, such as depression, anxiety, or suicidal behavior, by age twenty-one. Abused children may also suffer from cognitive and social difficulties. Behavioral consequences will affect most, but not all, of child abuse victims. Children of abuse are 25 percent more likely, as adolescents, to suffer from difficulties like poor academic performance and teen pregnancy, or to engage in behaviors like drug abuse and general delinquency. They are also more likely to participate in risky sexual acts that increase their chances of contracting a sexually transmitted disease (Child Welfare Information Gateway 2006). Other risky behaviors include drug and alcohol abuse. As these consequences can affect healthcare, education, and criminal systems, the problems resulting from child abuse do not just belong to the child and family, but to society as a whole.