abuse means doing something that hurts a child. Neglect means not giving or doing something that a child
Abuse or neglect hurts children in many ways. Young children are at special risk. 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.
Sometimes they die.
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.
Call the police or local child protective
services. You don't have to give your name. If you don't know who to call, a hospital may be able to tell you. Many of them have special programs
to deal with child abuse and neglect.
If a child is in immediate
danger or has been badly hurt, don't wait. Call
911 or other emergency services right
If it is your own child, get him or her to a safe place and
stay there. This may be the home of a close friend or family member or a
domestic violence shelter. To find help in your area, call a trusted health professional, a child abuse organization, or the police.
If you are a child or teen who is being abused, don't keep
the secret. Tell someone who can make a difference: a trusted family member,
teacher, counselor, or doctor.
National Child Abuse hotline is open 24 hours a day, 7 days a week to offer
information, advice, and support. Call 1-800-4-A-CHILD (1-800-422-4453).
If there is someone in your child's life who you think is close to becoming an abuser, you may be able to talk to that person about it and help the person learn more about managing stress and about how children grow and develop.
If you're afraid to talk to the person, make a specific plan for how you will protect your children if you think abuse is about to happen or has happened. Know who you will call and where you and your children will go.
protect your child from abuse:
To help other children:
Learning about child abuse and neglect:
Signs of abuse and neglect:
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.
Certain general symptoms that
may suggest that a child is experiencing some type of abuse or neglect
Children often get injured. But physical injuries may point to abuse when:
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:
A child with
symptoms of recent sexual abuse may:
Certain ways of behaving may also point to
sexual abuse. These include:
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.
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:
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
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:
Other emotional effects include:
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.
A risk factor is anything that makes you more likely to have a certain problem or disease.
People are more likely to abuse or neglect children if they:
The risk of abuse and
neglect increases when a child has a disability or other health issue, such
Another risk factor for children is not having a close bond with parents. Not having a close bond may be caused by:
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:
Call police or child protective services immediately
If the child is not in immediate danger, call your local
child protective services or police if:
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.
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
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:
children in the care of the same person may also be examined and have X-rays
if police or doctors think it's needed.
Tests that are often used to help confirm or
rule out abuse or neglect include:
Other exams and tests depend on the specific medical
problem suspected or observed. For example:
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
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.
always recommended for abused or neglected children. It usually focuses on:
young children, counseling may involve
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:
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.
cases, the parent can see the child only when someone else is present. Sometimes
a judge permanently ends the parent-child relationship.
Everyone can help prevent child abuse and neglect by showing concern for children and their well-being.
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.
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:
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
The Kempe Foundation is a world leader in programs that
treat abused children. The foundation focuses on the causes, effects, and
prevention of child abuse and has information for parents and
The American Academy of Pediatrics (AAP) offers a
variety of educational materials about parenting,
general growth and development, immunizations, safety, disease prevention, and more. AAP guidelines for various conditions and links to other
organizations are also available.
The Child Welfare Information Gateway is a national
resource for people seeking information about how to prevent, identify, and
treat child abuse and neglect. The Web site has information about family
support services, fostering and adopting a child, and child welfare issues.
There are also links for many toll-free crisis hotline numbers.
Childhelp is a nonprofit agency that provides parenting
advice, child abuse prevention, and basic information about the normal growth
and development of children. Also, Childhelp provides telephone numbers
and information about how to report suspected or observed child abuse or
neglect. Hotline counselors and referrals are available. The agency also
supports abused children through abuse prevention programs, preschool programs
(including Head Start), and community outreach. Other services include
referrals to residential treatment facilities, child advocacy
centers, group homes, and foster care.
This organization provides information on topics
related to child abuse and neglect. It offers various programs on child abuse
prevention, and it also directs efforts toward increasing public awareness of
child abuse and neglect. You can find out whether your state has a local
chapter by going to the website.
Other Works ConsultedAmerican Academy of Pediatrics (2007, reaffirmed 2011). Maltreatment of children with disabilities. Pediatrics, 119(5): 1018–1025. Also available online: http://pediatrics.aappublications.org/content/119/5/1018.full.American Academy of Pediatrics (2007, reaffirmed 2012). Evaluation of suspected child physical abuse. Pediatrics, 119(6): 1232–1241. Also available online: http://pediatrics.aappublications.org/content/119/6/1232.full.Chiesa A, Sirotnak AP (2012). Child abuse and neglect. In WW Hay et al., eds., Current Diagnosis and Treatment: Pediatrics, 21st ed., pp. 223–230. New York: McGraw-Hill.Dubowitz H, Lane WG (2011). Abused and neglected children. In RM Kliegman et al., eds., Nelson Textbook of Pediatrics, 19th ed., pp. 135–142. Philadelphia: Saunders.Dubowitz H, Lane WG (2011). Sexual abuse. In RM Kliegman et al., eds., Nelson Textbook of Pediatrics, 19th ed., pp. 142–146. Philadelphia: Saunders.Leventhal JM, Asnes AG (2011). Child maltreatment: Neglect to abuse. In CD Rudolph et al., eds., Rudolph's Pediatrics, 22nd ed., pp. 137–143. New York: McGraw-Hill.Ludwig S, Rostain A (2009). Family function and dysfunction. In WB Carey et al., eds., Developmental-Behavioral Pediatrics, 4th ed., pp. 103–117. Philadelphia: Saunders Elsevier.
December 7, 2012
Kathleen Romito, MD - Family Medicine & John Pope, MD - Pediatrics
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