By John Stirling, MD, FAAP & Amy Gavril, MD, MSCI, FAAP
The thought of anyone harming a 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.
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.
How common is child maltreatment?
Findings reported by the U.S. Department of Health and Human Services (HHS) show that more than half a million children are confirmed to be victims of child abuse or neglect. Nearly 2,000 victims die of maltreatment every year.
Shocking as these numbers are, they may not tell the whole story. That's because many cases of abuse and neglect are never reported.
Parents and other adults may be afraid to accept that a child has been abused, or to come forward because they fear what will happen when they report. Many feel guilty and ashamed, even if they didn't directly harm their child.
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.
While children are sometimes assaulted by a stranger, the vast majority of child maltreatment occurs at the hands of someone in a position of trust.
Neglect
Neglect is the most common and dangerous form of maltreatment and 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.
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.
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. Remember that most kids are abused by adults they know. Kids may be afraid to tell anyone about it because:
They worry about being blamed, or mistakenly 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
There are no reliable signs that a child has been abused, but parents may be concerned when an injury is unexplained or when the explanation does not appear to fit. Many forms of child maltreatment do not result in visible injuries. However, all increase a child's anxiety. This can affect their normal behavior in a variety of ways.
Any sudden, continued change in behavior deserves attention. Parents should keep a watchful eye out and contact their child's doctor if they sense something is wrong.
The roots of abuse and neglect—and what can help prevent it
It is hard to imagine anyone harming a child in their care. But there are times when severe or chronic stress can overcome a caregiver's restraint, resulting in injury. Poor understanding of child development may lead to harsh and dangerous discipline practices. Drug or alcohol use or mental health challenges may impair judgement. A family's lack of social or economic support may be associated with neglect.
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 depend on their caregivers to help them develop self-control and social skills. Their families, in turn 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. Children skilled at self-management and social interactions are said to be resilient. For example, families can help
protect children and help them be resilient by:
Knowing the basics of parenting and child development
Dealing with stress and setbacks in healthy ways
Helping kids learn to
handle difficult feelings and tell difficult truths
Fostering relationships inside and outside the family that help them cope with challenges
Making sure kids have safe places to live and healthy food to eat
Seeking out trustworthy sources of
child care, medical care and transportation
Overcoming challenges to building resilience
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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.
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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.
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Drug and alcohol use, mental health problems and intimate partner violence between caregivers, if not addressed can impair a parent's judgement and self-restraint. This can contribute to child neglect or injury.
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:
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 to manage your own fears and get help for your child
A parent's first reaction to any sign of maltreatment might be overwhelming fear and guilt. You may assume you'll be blamed for what happened—which could cause delays in asking for help.
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.
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 can lead to an investigation that can feel troubling. But 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, know that there are helpful resources for you and your family. 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 preventing, diagnosing and treating child abuse. 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 guide parents, caregivers, guardians and families through the system. They can help 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 if needed. To learn more about CAPs and the services they provide, explore
this article.
Remember
Child maltreatment is a serious threat to a child's health, now and throughout life. Detecting abuse early and providing support is hard, but can make a lifelong difference to a child. Report concerns of possible abuse or neglect to your child's doctor or another medical professional. Even though you may feel very reluctant to face the situation, your child is counting on you to keep them safe.
More information
About Dr. Stirling
 John Stirling, MD, FAAP, is a Child Abuse Pediatrician and 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." |