By John Stirling, MD, FAAP & Amy Gavril, MD, MSCI, FAAP
The thought of anyone harming your child may seem unbearable, but at least half a million children across the U.S. endure some form of neglect or abuse every year. These experiences can cause lifelong health problems, making child maltreatment an issue no parent can ignore.
Though you may find it hard to even consider your child being hurt in this way, learning more about the risks and warning signs will benefit your whole family. Here's what you need to know about child maltreatment—what might cause it, the lasting harm it can do to kids and what steps you can take to protect your child.
The roots of abuse and neglect—and what can help prevent it
In our
clinical report on preventing child maltreatment, the American Academy of Pediatrics (AAP) focuses on relational health: the
safe, stable, nurturing relationships that support a child's growth and development.
Why is relational health important?
Kids grow up in families, and in turn, families are part of a larger community that responds to the values and pressures in society. This means the risks—and the answers—for child abuse and neglect are interwoven with family, community, culture and much more.
A network of caring relationships can help families cope with the worst times using the best possible tools, reducing the chances that any child will suffer from abuse or neglect. For example, families can help
protect children by:
Dealing with stress and setbacks in healthy ways
Fostering relationships that help them cope with challenges
Knowing the basics of parenting and child development
Making sure kids have safe places to live and healthy food to eat
Seeking out trustworthy sources of
child care, medical care and transportation
Helping kids learn to
handle difficult feelings and tell difficult truths
Staying close to family, friends, neighbors, teachers and others who can provide all-around support
Overcoming challenges to building resilience
Factors beyond a family's control can make it harder for them to build this kind of resilience. For example, when parents have money troubles, they may find homes or apartments in safer
neighborhoods are too expensive. Healthy food, safe child care and affordable medical treatment can be hard to find in many areas of the U.S., even for families with good incomes.
Past life experiences also shape the way parents act in the present. Those who grew up with
violence,
trauma and neglect may find themselves caught in the same patterns they knew as children. It can be hard to build positive parenting skills when your family legacy is filled with fears that never healed.
The lasting health effects of child abuse and neglect
Decades of
research have linked child maltreatment with poor adult health. Abuse and neglect can cause immediate damage to a child's brain, literally changing the way they think and learn.
Kids who suffer from abuse and neglect may face higher lifetime risks for:
Mental health struggles such as
depression,
anxiety and
substance use
Chronic pain affecting the back, abdomen, stomach, face, chest and other areas
Gut health problems such as irritable bowel syndrome, diarrhea or constipation
Disordered eating such as
bulimia and anorexia
Unhealthy sleep
Heart and lung disease and
obesity
Learning how healthy relationships work
Children who are maltreated may not learn how healthy relationships work, making it hard for them to find love and support later in life. Unless they have the resources to overcome their abuse, victims
may later abuse or neglect their own spouses, children, family members or friends.
How common is child maltreatment?
Findings reported by the U.S. Department of Health and Human Services (HHS) show that:
In 2022, about 7.5 million kids were identified as possible victims of maltreatment
Of these cases, 3 million led to investigations or other responses
Nearly 559,000 children were confirmed as victims of abuse or neglect
Around 1,990 children died in cases of maltreatment
Shocking as they are, these numbers may not tell the whole story, since many cases of abuse and neglect are never reported. Parents and other adults may be afraid to come forward because they fear what will happen when they report what has happened. Many feel guilty and ashamed, even if they didn't directly harm their child.
The many forms of child maltreatment
Each state has different ways of defining maltreatment, but all are guided by federal laws such as the Child Abuse Prevention and Treatment Act (CAPTA). This law defines maltreatment as any recent act, or failure to act, that leads to a child's death, or to serious physical or emotional harm, sexual abuse or exploitation. Here are examples of how this might look.
Physical abuse
Physical abuse happens when a child's body is hit, kicked,
shaken, burned or otherwise harmed. In 2022, around 17% of all young victims were physically abused, the HHS reports.
Sexual abuse
Sexual abuse means any sexual activity a child cannot understand or consent to. This may include touching, oral sex or genital or anal penetration. Children can also suffer sexual harm through
exhibitionism,
voyeurism or exposure to
pornography, including being forced to take part in creating images or videos of sexual acts. In 2022, almost 11% of all children mistreated in the U.S. experienced some form of sexual abuse.
Psychological or emotional abuse
Psychological or emotional abuse can involve any form of maltreatment described above, but it may also mean verbal abuse. This happens when a child faces constant criticism, ridicule, blame or shame from parents or other adults. Around 7% of all child abuse victims in 2022 suffered this kind of abuse.
Neglect
Neglect can take many forms. HHS figures for 2022 suggest that nearly 75% of all children involved in maltreatment cases faced some form of neglect, such as:
Physical neglect: failure to provide food, clothing, shelter and other essentials that keep kids healthy and safe.
Emotional neglect: lack of love, comfort, affection and support to help children feel secure in the world.
Medical neglect: lack of regular checkups or immediate care when kids are sick or hurt.
Educational neglect: failure to offer regular schooling, whether in a public or private settings or through homeschooling that prepares kids for college or careers.
Supervisory neglect: failure to keep an eye on children and safeguard them from dangers at home, school or in the community.
Why you may not know right away when your child experiences abuse
Parents often think that they will immediately know if their child has been abused, but often, the signs stay hidden. Kids may be afraid to tell anyone about it because:
They worry about being blamed, or actually believe they caused the abuse.
Their abuser has threatened them in some way.
They know and maybe even feel close to their abuser and don't want to hurt them.
They think no one will believe them or help them.
Babies and children under 5 years old—who make up
nearly 40% of maltreated kids—may not have the words to explain what happened to them, making it difficult or even impossible for them to ask for help.
Signs that might mean a child has been maltreated
Below is a list of possible signs that a child has experienced abuse or neglect. Keep in mind that, by themselves, these signals do not "prove" a child has been harmed. Instead, they suggest that parents should keep a watchful eye out and contact their child's doctor if they sense something is wrong.
Physical signs
Injuries in infants who can't crawl or walk yet
In children under 4 years old, bruises on the torso, ears or neck
Bruises, cuts or burns that don't make sense, based on what adults say about the possible causes
Failure to gain weight or sudden, dramatic weight gain
Pain, bleeding or discharge from the child's sex organs
Testing positive for a
sexually transmitted disease
Head and body aches that don't seem to be linked with a medical cause
Behavioral and emotional signs
Keep in mind that these symptoms may mean that your child is facing some other form of stress that has nothing to do with abuse or neglect. However, you should contact your child's doctor if these signs start to interfere with your child's everyday life.
Nightmares or new or unusual fears they can't put aside
Signs of
depression or
anxiety
Bedwetting that comes on suddenly, or reversal of toilet training
Attempts to run away from home
Sexual talk or actions that seem
inappropriate for your child's age
Sudden drop in self-confidence
Struggles in school, sports or community activities
Passive or aggressive behavior that seems unusual for your child
Craving love and attention or withdrawing into their own world
Big appetite, often to the point of stealing and hiding food
How to manage your own fears and get help for your child
If you're struggling, realize that your child needs you to protect them. In fact, you may be the only one who can help them through this. Their lifelong health is at stake, so you'll need to show courage and resolve in finding care for your child (and possibly for yourself).
Get medical help. If your child's life is in danger—for example, they can't breathe or there are broken bones or heavy bleeding—go to the nearest emergency room. If your child is medically stable but shows signs of maltreatment, call their doctor to book an urgent visit.
Prepare yourself to answer lots of questions. State laws generally require doctors, teachers, child care workers and others who work with kids
to report suspected abuse. This may lead to an investigation that can feel stressful and troubling. The questions asked may seem to suggest you are the cause of your child's suffering.
Keep in mind that, since most abuse and neglect cases
involve people that kids already know, child protection officials must ask about every part of your child's life. This includes what happens at home. Do your best to answer honestly without taking these questions personally. Remind yourself that you are doing the hard work of protecting your child from further harm.
Know that you're not alone. No matter what happened to your child, there are helpful resources for you and your family. Your child's doctor can recommend local support groups, courses and online information to help you gain perspective. If you need specialized support, including classes to strengthen your parenting skills, your pediatrician can point you in the right direction. Counselors, therapists and fellow parents can provide the caring network you need,
especially if you yourself are a survivor of abuse or neglect.
Remember that kids who get help early can survive—and even thrive. Children whose parents, caregivers or guardians act quickly when they suspect abuse will feel seen and supported. It may take time and intensive treatment to help your child feel safe again, but you are giving them the best possible chance to heal—and live a long, healthy life.
How a child abuse pediatrician (CAP) can help
Since kids in virtually every community can suffer maltreatment, some pediatricians specialize in child abuse prevention. These doctors study risks and triggers for abuse and neglect, including the daily stresses that millions of families face. They are well-qualified to help parents, caregivers, guardians and families deal with the effects of abuse and put strategies in place to ensure that children feel protected and loved.
Your pediatrician may know a CAP in your area who can join your child's care team. To learn more about CAPs and the services they provide, explore
this article.
Where the AAP stands
The AAP views child maltreatment as one of the most serious threats to a child's health and development. We work closely with medical professionals across the country and around the world to share research and support practices that help prevent abuse and neglect and identify it early when it happens. The AAP also helped develop "The Physical Signs of Child Sexual Abuse" to help doctors spot symptoms of sexual abuse so they can offer effective treatment for children and families.
5 things to remember about child maltreatment
Child maltreatment is a serious threat to your child's health, now and throughout life.
National statistics may underestimate the impact of abuse and neglect, partly because adults fear what will happen if they disclose what they see.
Even though you may feel very reluctant to face the situation, your child is counting on you to keep them safe.
Report all signs of possible abuse or neglect to your child's doctor or another medical professional.
Trust that, even though this experience will be stressful for everyone, you are doing the right thing for your child – and you are never alone.
More information
About Dr. Stirling
 John Stirling, MD, FAAP, is lead author of the AAP clinical report, "The Pediatrician’s Role in Preventing Child Maltreatment."
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About Dr. Gavril
Amy Gavril, MD, MSCI, FAAP, a member of the AAP Council on Child Abuse & Neglect, is board-certified in both general pediatrics and child abuse pediatrics. Dr. Gavril is co-author of " The Pediatrician’s Role in Preventing Child Maltreatment." |