Any intentional harm or mistreatment to a child under 18 years old is considered child abuse. Child abuse takes many forms, which often occur at the same time.
- Physical abuse. Physical child abuse occurs when a child is purposefully physically injured.
- Sexual abuse. Sexual child abuse is any sexual activity with a child, such as fondling, oral-genital contact, intercourse or exposure to child pornography.
- Emotional abuse. Emotional child abuse means injuring a child's self-esteem or emotional well-being. It includes verbal and emotional assault — such as continually belittling or berating a child — as well as isolating, ignoring or rejecting a child.
- Neglect. Child neglect is failure to provide adequate food, shelter, affection, supervision, education or medical care.
Most child abuse is inflicted by someone the child knows and trusts, often a parent or other relative. If you suspect child abuse, report the abuse to the proper authorities.
SYMPTOMS
A child who's being abused may feel guilty, ashamed or confused. He or she may be afraid to tell anyone about the abuse, especially if the abuser is a parent, other relative or family friend. In fact, the child may have an apparent fear of parents, adult caregivers or family friends. That's why it's vital to watch for red flags, such as:
- Withdrawal from friends or usual activities
- Changes in behavior — such as aggression, anger, hostility or hyperactivity — or changes in school performance
- Depression, anxiety or a sudden loss of self-confidence
- An apparent lack of supervision
- Frequent absences from school or reluctance to ride the school bus
- Reluctance to leave school activities, as if he or she doesn't want to go home
- Attempts at running away
- Rebellious or defiant behavior
- Attempts at suicide
Specific signs and symptoms depend on the type of abuse. Keep in mind that warning signs are just that — warning signs. The presence of warning signs doesn't necessarily mean that a child is being abused.
Physical abuse signs and symptoms
- Unexplained injuries, such as bruises, fractures or burns
- Injuries that don't match the given explanation
- Untreated medical or dental problems
Sexual abuse signs and symptoms
- Sexual behavior or knowledge that's inappropriate for the child's age
- Pregnancy or a sexually transmitted infection
- Blood in the child's underwear
- Statements that he or she was sexually abused
- Trouble walking or sitting
- Abuse of other children sexually
Emotional abuse signs and symptoms
- Delayed or inappropriate emotional development
- Loss of self-confidence or self-esteem
- Social withdrawal
- Depression
- Headaches or stomachaches with no medical cause
- Avoidance of certain situations, such as refusing to go to school or ride the bus
- Desperately seeks affection
Neglect signs and symptoms
- Poor growth or weight gain
- Poor hygiene
- Lack of clothing or supplies to meet physical needs
- Taking food or money without permission
- Eating a lot in one sitting or hiding food for later
- Poor record of school attendance
- Lack of appropriate attention for medical, dental or psychological problems, even though the parents have been notified
- Emotional swings that are inappropriate or out of context to the situation
- Indifference
Parental behavior
Sometimes a parent's demeanor or behavior sends red flags about child abuse. Warning signs include a parent who:
- Shows little concern for the child
- Appears unable to recognize physical or emotional distress in the child
- Denies that any problems exist at home or school, or blames the child for the problems
- Consistently blames, belittles or berates the child and describes the child with negative terms, such as "worthless" or "evil"
- Expects the child to provide him or her with attention and care and seems jealous of other family members getting attention from the child
- Uses harsh physical discipline or asks teachers to do so
- Demands an inappropriate level of physical or academic performance
- Severely limits the child's contact with others
- Offers conflicting or unconvincing explanations for a child's injuries or no explanation at all
Although most child health experts condemn the use of violence in any form, some people still use corporal punishment (such as spanking) as a way to discipline their children. Corporal punishment has limited effectiveness in deterring behavior and is associated with aggressive behavior in the child. Any corporal punishment may leave emotional scars.
Parental behaviors that cause pain or physical injury — even when done in the name of discipline — could be child abuse.
RISK FACTORS
Child abuse occurs across all social and economic levels and ethnic groups. Factors that may increase a person's risk of becoming abusive include:
- A history of being abused or neglected as a child
- Physical or mental illness, such as depression or post-traumatic stress disorder (PTSD)
- Family crisis or stress, including domestic violence and other marital conflicts, single parenting, or young children in the family, especially several children under age 5
- A child in the family who is developmentally or physically disabled
- Financial stress or unemployment
- Social or extended family isolation
- Poor understanding of child development and parenting skills
- Alcoholism or other forms of substance abuse
COMPLICATIONS
Some children overcome the physical and psychological effects of child abuse, particularly those with strong social support who can adapt and cope with bad experiences. For many others, however, child abuse has lifelong consequences. For example, child abuse may result in physical, behavioral, emotional and mental issues. Examples include:
Physical issues
- Death
- Physical disabilities and health problems
- Learning disabilities
- Attention-deficit/hyperactivity disorder (ADHD)
- Substance abuse
Behavioral issues
- Delinquent or violent behavior
- Abuse of others
- Withdrawal
- Suicide attempts
- Frequent, casual sex with many different partners (sexual promiscuity) or teen pregnancy
Emotional issues
- Low self-esteem
- Difficulty establishing or maintaining relationships
- Challenges with intimacy and trust
- An unhealthy view of parenthood that may perpetuate the cycle of abuse
- Inability to cope with stress and frustrations
Mental disorders
- Eating disorders
- Personality disorders
- Depression
- Anxiety
- Post-traumatic stress disorder (PTSD)
TREATMENTS AND DRUGS
Talk therapy, also called psychotherapy, can help a child who has been abused learn to trust again, as well as teach the child about normal behavior and relationships. Therapy can also teach children conflict management and boost self-esteem. Several different types of therapy may be effective, such as:
- Trauma-focused cognitive behavioral therapy. This type of therapy helps an abused child to better manage distressing feelings and to deal with trauma-related memories. Eventually, the nonabusing parent and the child are seen together so the child can let the nonabusing parent know exactly what happened.
- Child-parent psychotherapy. This treatment focuses on improving the parent-child relationship and on building a stronger attachment between the two.
Psychotherapy can help parents discover the roots of abuse, learn effective ways to cope with life's inevitable frustrations and learn healthy parenting strategies. If the child is still in the home, social services may schedule home visits and make sure essential needs, such as food, are available.
Children who are placed in foster care because their home situation is too dangerous will also need mental health services and therapies.
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