Child Abuse

Overview

Definition

There are three main types of child abuse:

Physical Abuse - Injury, suffering, or death of a child under the age of 18 resulting from acts committed by the child's caretaker.
Neglect - Injury, suffering, or death of a child as a result of not providing something the child needs. The child's need may be food, a clean home, supervision, medical care, schooling, etc.
Sexual Abuse - Involvement of a child under 18 years of age in sexual activities by an adult (includes exhibitionism, fondling, etc).

National Incidence

For every 1,000 children, 44 reports of suspected child abuse are filed each year. One-third of these reports are confirmed.¹
Child protective services agencies determined that almost 1 million children were identified as victims of substantiated or indicated abuse or neglect in 1996, nearly an 18 percent increase since 1990.¹

Recognizing Child Abuse

If a child, or a child's caretaker, describes an event leading to the injury that doesn't match the actual degree of injury or the child's level of development, abuse is a possible explanation. Sexual abuse is often recognized only after the victim discloses the abuse. Injuries to, or infections of, the genitalia or rectum are another sign of sexual abuse.

Are There Common Characteristics of People Involved in Child Abuse?

The Abused Child

A child who is being physically or sexually abused may:

Be a "difficult child"
Be hyperactive, temperamental
Be a special needs child - may have a mental or physical handicap
Be an unwanted child
Begin to do poorly in school
Have sleep disturbances and nightmares
Have poor self-esteem and peer relationships
Have a fear of adults.

A child who is being sexually abused may:

Act out sexually, masturbate excessively
Act sexually mature for age
Have enuresis or encopresis (difficulty controlling bladder or bowel movements).

The Abusive Parent

A parent who is abusive toward his/her children may:

Have low self-esteem,
Be depressed, have a "short fuse" or be quick-tempered
Have poor parenting skills, unrealistic expectations of child, or be an unprepared young parent
Have been abused as a child
Be a substance abuser.

The Family

The family in which physical or sexual abuse takes place may be affected by:

Marital stress, death in family, pregnancy
Social isolation, poor support structure
Being in a lower socioeconomic group, economic crisis
Poor parent-child relationships.

Common Injuries

The most common injuries caused by physical abuse are:

Head trauma causes the greatest number of deaths and long-term disabilities resulting from abuse.

It can be hard to tell the difference between bruises from normal activities and those from abuse. Some things to look for include:

A high number of bruises
Bruises located on fleshy body parts
Color of bruises.

When numerous bruises are found over the "fleshy" body parts, such as the abdomen, genitalia, buttocks or thighs, inflicted injury should be suspected. Many injuries and behaviors that make one suspicious of abuse can be related to other things and should be looked at in the context of the bigger picture. If a number of the clues presented here are evident, then you should consider reporting the situation to local police or child protective services.

¹ U.S. Department of Health and Human Services. Child Maltreatment 1996: Reports from the States to the National Child Abuse and Neglect Data System (Washington, D.C.: U.S. Government Printing Office, 1998).

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Last Reviewed: Oct 24, 2001

Robert Shapiro, MD
Professor of Clinical Pediatrics
Department of Emergency Medicine
Cincinnati Children’s Hospital Medical Center
University of Cincinnati