Child Abuse

Overview, Causes, & Risk Factors

The Child Abuse Prevention and Treatment Act of 1973 was enacted to protect children. It defines child abuse (and neglect) as "the physical treatment and mental injuring, sexual abuse, negligent treatment, or maltreatment of a child under the age of 18 by a person who is responsible for the child's welfare under circumstances which indicate that the child's health and welfare is harmed or threatened thereby."

A non-accidental injury to a child is physical abuse. Failure to provide a child with basic emotional and physical needs is neglect. Neglect includes not providing a child with basic medical care. Sexual abuse is defined as any sexual activity between an adult and a child.

What are the causes and risks of the injury?

Children of all ages, ethnic and cultural groups, and socioeconomic levels are at risk for abuse. Certain factors put some children at higher risk for being abused. Three particular areas of stress have been shown to increase the risk of abuse to a child.

Child-produced stress factors

These stress factors include a child who may be:

an adopted child or foster child

behaviorally different, such as children with attention deficit disorder

mentally different, such as children with communication

education, including reading, writing, and basic math

motor function

personal care, such as bathing, dressing, eating, and toileting

social skills

thinking skills, such as decision making, problem solving, and self-direction

working

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physically different, such as children with physical disabilities

substantially different from other family members in temperament

temperamentally difficult

Social-situational stress factors

These stress factors include:

parental relationship with dominant-submissive patterns

physical or social isolation

poor housing or frequent moves

poverty or unemployment

punishing child-rearing style

significant change in family finances

strained parent-child relationship, including unwanted children

violent parental relationship

Parent-produced stress factors

These stress factors include parents who have the following characteristics:

depression

history of abuse as a child

lack of education about basic child-rearing

low self-esteem

psychiatric illness or character disorder

substance abuse

unrealistic expectations of their children

Symptoms & Signs

What are the signs and symptoms of the injury?

Children who have been abused often have a variety of psychological problems and symptoms. Therefore, no single symptom will necessarily indicate that abuse has occurred. Many symptoms of abuse are also symptoms of other disorders or problems. For this reason, it is extremely important to have the child evaluated by an experienced healthcare provider.

Emotional and behavioral symptoms of child abuse may include:

acting out sexually

aggressive or violent behavior

acute situational anxiety

generalized anxiety disorder

panic disorder

post-traumatic stress disorder

phobias

obsessive compulsive disorders

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delay in developmental milestones

depression

feelings of guilt and shame

frequent mood swings

low self-esteem

paranoid thoughts

problems in relating to peers

school and academic problems

self-destructive or suicidal behaviors

sleep problems and nightmares

social withdrawal

The following physical symptoms may result from child abuse:

bleeding into the retina or the conjunctiva of the eye

blood in the urine

bone fractures

burns

failure to achieve expected or normal weight and height growth

frequent urinary tract infections

multiple bruises, often at various stages of healing

rectal or vaginal irritation or discharge

sudden and severe abdominal pain

unexplained cuts, swelling, and bruises

Diagnosis & Tests

How is the injury recognized?

Child abuse is typically recognized in several ways. Often, a professional will be the first to recognize and report suspected abuse. This may be a teacher, day care worker, or healthcare provider. In other instances, a family member or neighbor suspects abuse. Once abuse is suspected, the child should be evaluated by a healthcare provider.

The provider's evaluation will vary depending upon the type of abuse suspected. Unless sexual abuse is suspected, a gynecologic or rectal exam is not routinely performed. Unless the abuse is recent and rather severe, sexual abuse typically does not leave any physical marks.

If physical abuse is suspected, the healthcare provider will do a complete physical exam. For any injury or condition associated with child abuse, the provider should thoroughly question the caretaker.

Sometimes abuse is diagnosed indirectly. During an examination, a healthcare provider may notice evidence of old injuries.

Prevention & Expectations

What can be done to prevent the injury?

Providing information about the risks of abuse is important. Developing trust within communities helps people talk about abuse. Education about community resources for victims of abuse is key. Reading about child abuse raises awareness.

Ask directly about signs that may indicate abuse. For instance, if a neighbor child has unexplained bruising, ask that child how the injury occurred. Even though a child may not tell you exactly what happened, his or her reaction can give you more information about the situation. Simply asking the right questions can sometimes reduce the risk factor of social isolation. Showing concern can give the child confidence that there is someone to turn to.

Treatment & Monitoring

What are the treatments for the injury?

A child suspected of having been abused should be evaluated immediately. The treatment will be dependent upon the injury or condition.

There are long-term emotional and psychological problems from being a victim of child abuse. Children who have been abused may benefit from counseling with a therapist. The counselor will help them work through feelings of low self-esteem, anger, and helplessness. They may also help the children learn and use new tools to protect themselves.

The parents or caretakers of the child should also receive counseling. Information about parenting skills and alternative discipline methods can be helpful. Anger management techniques can be learned.

Unfortunately, there are times when a caretaker is not able to adequately care for the child. In these instances, the child typically has to be removed from the home to protect them from further abuse.

What are the side effects of the treatments?

In general, there are no side effects from treatment of child abuse. If medications are used to treat physical or mental conditions, they may have side effects.

What happens after treatment for the injury?

Child abuse can cause long-term psychological and physical problems for the child. Long-term counseling may be needed to help the child work through feelings and develop a healthy self-concept.