12 What is Child Abuse and Neglect? Recognizing Signs and Symptoms

The first step in helping children who have been abused or neglected is learning to recognize the signs of maltreatment. The presence of a single sign does not necessarily mean that child maltreatment is occurring in a family, but a closer look at the situation may be warranted when these signs appear repeatedly or in combination. This factsheet is intended to help you better understand the Federal definition of child abuse and neglect; learn about the different types of abuse and neglect, including human trafficking; and recognize their signs and symptoms. It also includes additional resources with information on how to effectively identify and report maltreatment and refer children who have been maltreated.

How Is Child Abuse and Neglect Defined in Federal Law?

Federal legislation lays the groundwork for State laws on child maltreatment by identifying a minimum set of actions or behaviors that define child abuse and neglect. The Federal Child Abuse Prevention and Treatment Act (CAPTA), as amended and reauthorized by the CAPTA Reauthorization Act of 2010, defines child abuse and neglect as, at a minimum, “any recent act or failure to act on the part of a parent or caretaker which results in death, serious physical or emotional harm, sexual abuse or exploitation (including sexual abuse as determined under section 111), or an act or failure to act which presents an imminent risk of serious harm” (42 U.S.C. 5101 note, § 3).

Additionally, it stipulates that “a child shall be considered a victim of ‘child abuse and neglect’ and of ‘sexual abuse’ if the child is identified, by a State or local agency employee of the State or locality involved, as being a victim of sex trafficking1 (as defined in paragraph (10) of section 7102 of title 22) or a victim of severe forms of trafficking in persons described in paragraph (9)(A) of that section” (42 U.S.C. § 5106g(b)(2)).

Most Federal and State child protection laws primarily refer to cases of harm to a child caused by parents or other caregivers; they generally do not include harm caused by other people, such as acquaintances or strangers. Some State laws also include a child’s witnessing of domestic violence as a form of abuse or neglect.

For State-specific laws pertaining to child abuse and neglect, see Child Welfare Information Gateway’s State Statutes Search page at https://www.childwelfare.gov/ topics/systemwide/laws-policies/state/.

To view civil definitions that determine the grounds for intervention by State child protective agencies, visit Information Gateway’s Definitions of Child Abuse and Neglect at https://www.childwelfare.gov/topics/ systemwide/laws-policies/statutes/define/.

What Are the Major Types of Child Abuse and Neglect?

Within the minimum standards set by CAPTA, each State is responsible for providing its own definitions of child abuse and neglect. Most States recognize four major types of maltreatment: physical abuse, neglect, sexual abuse, and emotional abuse. Additionally, many States identify abandonment, parental substance use, and human trafficking as abuse or neglect. While some of these types of maltreatment may be found separately, they can occur in combination. This section provides brief definitions for each of these types.

Physical abuse is a nonaccidental physical injury to a child caused by a parent, caregiver, or other person responsible for a child and can include punching, beating, kicking, biting, shaking, throwing, stabbing, choking, hitting (with a hand, stick, strap, or other object), burning, or otherwise causing physical harm.² Physical discipline, such as spanking or paddling, is not considered abuse as long as it is reasonable and causes no bodily injury to the child. Injuries from physical abuse could range from minor bruises to severe fractures or death.

Neglect is the failure of a parent or other caregiver to provide for a child’s basic needs. Neglect generally includes the following categories:

• Physical (e.g., failure to provide necessary food or shelter, lack of appropriate supervision)
• Medical (e.g., failure to provide necessary medical or mental health treatment, withholding medically indicated treatment from children with life-threatening conditions)³
• Educational (e.g., failure to educate a child or attend to special education needs)
• Emotional (e.g., inattention to a child’s emotional needs, failure to provide psychological care, permitting a child to use alcohol or other drugs)

Sometimes cultural values, the standards of care in the community, and poverty may contribute to what is perceived as maltreatment, indicating the family may need information or assistance. It is important to note that living in poverty is not considered child abuse or neglect. However, a family’s failure to use available information and resources to care for their child may put the child’s health or safety at risk, and child welfare intervention could be required. In addition, many States provide an exception to the definition of neglect for parents who choose not to seek medical care for their children due to religious beliefs.⁴

Sexual abuse includes activities by a parent or other caregiver such as fondling a child’s genitals, penetration, incest, rape, sodomy, indecent exposure, and exploitation through prostitution or the production of pornographic materials. Sexual abuse is defined by CAPTA as “the employment, use, persuasion, inducement, enticement, or coercion of any child to engage in, or assist any other person to engage in, any sexually explicit conduct or simulation of such conduct for the purpose of producing a visual depiction of such conduct; or the rape, and in cases of caretaker or interfamilial relationships, statutory rape, molestation, prostitution, or other form of sexual exploitation of children, or incest with children”(42 U.S.C. 5106g(a)(4)).

Emotional abuse (or psychological abuse) is a pattern of behavior that impairs a child’s emotional development or sense of self-worth. This may include constant criticism, threats, or rejection as well as withholding love, support, or guidance. Emotional abuse is often difficult to prove, and, therefore, child protective services may not be able to intervene without evidence of harm or mental injury to the child (Prevent Child Abuse America, 2016).

Abandonment is considered in many States as a form of neglect. In general, a child is considered to be abandoned when the parent’s identity or whereabouts are unknown, the child has been left alone in circumstances where the child suffers serious harm, the child has been deserted with no regard for his or her health or safety, or the parent has failed to maintain contact with the child or provide reasonable support for a specified period of time. Some States have enacted laws—often called safe haven laws—that provide safe places for parents to relinquish newborn infants. Information Gateway produced a publication as part of its State Statutes series that summarizes such laws.

Infant Safe Haven Laws is available at https://www.childwelfare.gov/topics/systemwide/laws-policies/statutes/safehaven/.

Parental substance use is included in the definition of child abuse or neglect in many States. Related circumstances that are considered abuse or neglect in some States include the following:

• Exposing a child to harm prenatally due to the mother’s use of legal or illegal drugs or other substances
• Manufacturing methamphetamine in the presence of a child
• Selling, distributing, or giving illegal drugs or alcohol to a child
• Using a controlled substance that impairs the caregiver’s ability to adequately care for the child

For more information about this issue, see Information Gateway’s Parental Substance Use as Child Abuse at https://www.childwelfare.gov/topics/systemwide/laws-  policies/statutes/parentalsubstanceuse/.

A child may directly disclose to you that he or she has experienced abuse or neglect. Childhelp’s Handling Child Abuse Disclosures defines direct and indirect disclosure and provides tips for supporting the child. It is available

at https://www.childhelp.org/story-resource-center/ handling-child-abuse-disclosures/.

While it’s important to know the signs of physical, mental, and emotional abuse and neglect, which are provided later in this factsheet, the following signs of general maltreatment also can help determine whether a child needs help:

Child

• Shows sudden changes in behavior or school performance
• Has not received help for physical or medical problems brought to the parents’ attention
• Has learning problems (or difficulty concentrating) that cannot be attributed to specific physical or psychological causes
• Is always watchful, as though preparing for something bad to happen
• Lacks adult supervision
• Is overly compliant, passive, or withdrawn
• Comes to school or other activities early, stays late, and does not want to go home
• Is reluctant to be around a particular person
• Discloses maltreatment

Parent

• Denies the existence of—or blames the child for— the child’s problems in school or at home
• Asks teachers or other caregivers to use harsh physical discipline if the child misbehaves
• Sees the child as entirely bad, worthless, or burdensome
• Demands a level of physical or academic performance the child cannot achieve
• Looks primarily to the child for care, attention, and satisfaction of the parent’s emotional needs
• Shows little concern for the child

Human trafficking is considered a form of modern slavery and includes both sex trafficking and labor trafficking. Sex trafficking is recruiting, harboring, transporting, providing, or obtaining someone for a commercial sex act, such as prostitution, pornography, or stripping. Labor trafficking is forced labor, including drug dealing, begging, or working long hours for little pay (Child Welfare Information Gateway, 2018). Although human trafficking includes victims of any sex, age, race/ ethnicity, or socioeconomic status, children involved in child welfare, including children who are in out-of-home care, are especially vulnerable (Child Welfare Information Gateway, 2018).

For more information, see Information Gateway’s webpage on human trafficking at https://www. childwelfare.gov/topics/systemwide/trafficking/ and the State statutes on the definitions of human trafficking at https://www.childwelfare.gov/topics/systemwide/ laws-policies/statutes/definitions-trafficking/.

Parent and child

• Touch or look at each other rarely
• Consider their relationship entirely negative
• State consistently they do not like each other

The preceding list is not a comprehensive list of the signs of maltreatment. It is important to pay attention to other behaviors that may seem unusual or concerning. Additionally, the presence of these signs does not necessarily mean that a child is being maltreated; there may be other causes. They are, however, indicators that others should be concerned about the child’s welfare, particularly when multiple signs are present or they occur repeatedly.

For information about risk factors for maltreatment as well as the perpetrators, see the webpage Risk Factors That Contribute to Child Abuse and Neglect, which is available at https://www.childwelfare.gov/topics/can/factors/, and the webpage Perpetrators of Child Abuse & Neglect, which is available at https://www.childwelfare.gov/topics/ can/perpetrators/.

Signs of Physical Abuse

A child who exhibits the following signs may be a victim of physical abuse:

• Has unexplained injuries, such as burns, bites, bruises, broken bones, or black eyes
• Has fading bruises or other noticeable marks after an absence from school
• Seems scared, anxious, depressed, withdrawn, or aggressive
• Seems frightened of his or her parents and protests or cries when it is time to go home
• Shrinks at the approach of adults
• Shows changes in eating and sleeping habits
• Reports injury by a parent or another adult caregiver
• Abuses animals or pets

Consider the possibility of physical abuse when a parent or other adult caregiver exhibits the following (Prevent Child Abuse America, 2018):

• Offers conflicting, unconvincing, or no explanation for the child’s injury or provides an explanation that is not consistent with the injury
• Shows little concern for the child
• Sees the child as entirely bad, burdensome, or worthless
• Uses harsh physical discipline with the child
• Has a history of abusing animals or pets

Signs of Neglect

A child who exhibits the following signs may be a victim of neglect (Tracy, 2018a):

• Is frequently absent from school
• Begs or steals food or money
• Lacks needed medical care (including immunizations), dental care, or glasses
• Is consistently dirty and has severe body odor
• Lacks sufficient clothing for the weather
• Abuses alcohol or other drugs
• States that there is no one at home to provide care

Consider the possibility of neglect when a parent or other caregiver exhibits the following (Tracy, 2018b):

• Appears to be indifferent to the child
• Seems apathetic or depressed
• Behaves irrationally or in a bizarre manner
• Abuses alcohol or other drugs

Signs of Sexual Abuse

A child who exhibits the following signs may be a victim of sexual abuse (American Academy of Child and Adolescent Psychology, 2014; Rape, Abuse and Incest National Network [RAINN], 2018a):

• Has difficulty walking or sitting
• Experiences bleeding, bruising, or swelling in their private parts
• Suddenly refuses to go to school
• Reports nightmares or bedwetting
• Experiences a sudden change in appetite
• Demonstrates bizarre, sophisticated, or unusual sexual knowledge or behavior
• Becomes pregnant or contracts a sexually transmitted disease, particularly if under age 14
• Runs away
• Reports sexual abuse by a parent or another adult caregiver
• Attaches very quickly to strangers or new adults in their environment

Consider the possibility of sexual abuse when a parent or other caregiver exhibits the following (RAINN, 2018b):

• Tries to be the child’s friend rather than assume an adult role
• Makes up excuses to be alone with the child
• Talks with the child about the adult’s personal problems or relationships

Signs of Emotional Maltreatment

A child who exhibits the following signs may be a victim of emotional maltreatment (Prevent Child Abuse America, 2016):

• Shows extremes in behavior, such as being overly compliant or demanding, extremely passive, or aggressive
• Is either inappropriately adult (e.g., parenting other children) or inappropriately infantile (e.g., frequently rocking or head-banging)
• Is delayed in physical or emotional development
• Shows signs of depression or suicidal thoughts
• Reports an inability to develop emotional bonds with others

Consider the possibility of emotional maltreatment when the parent or other adult caregiver exhibits the following (Prevent Child Abuse America, 2016):

• Constantly blames, belittles, or berates the child
• Describes the child negatively
• Overtly rejects the child

References

American Academy of Adolescent Psychology. (2014). Sexual abuse. Retrieved from https://www.aacap.org/ AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Child-Sexual-Abuse-009.aspx

Bick, J., & Nelson, C. A. (2016). Early adverse experiences and the developing brain. Neuropsychopharmacology, 41, 177–196. Retrieved from https://www.nature.com/ articles/npp2015252. doi: 10.1038/npp.2015.252

Child Welfare Information Gateway. (2018). Human trafficking: Protecting our youth. Retrieved from https:// www.childwelfare.gov/pubPDFs/trafficking_ts_2018.pdf

Fuller-Thomson, E., Baird, S. L., Dhrodia, R., & Brennenstuhl, S. (2016). The association between adverse childhood experiences (ACEs) and suicide attempts in a population-based study. Child: Care, Health and Development, 42, 725–734. doi: 10.1111/ cch.12351

Prevent Child Abuse America. (2016). Fact sheet: Emotional child abuse. Retrieved from http://www. preventchildabuse.org/images/docs/  emotionalchildabuse.pdf

Prevent Child Abuse America. (2018). Recognizing child abuse: What parents should know. Retrieved from https://nic.unlv.edu/pcan/files/ recognizing_abuse.pdf

Rape, Abuse and Incest National Network. (2018a). Child sexual abuse. Retrieved from https://rainn.org/articles/ child-sexual-abuse

Rape, Abuse and Incest National Network. (2018b). Warning signs for young children. Retrieved from https://www.rainn.org/articles/warning-signs- young-children

Tracy, N. (2018a). Signs of child neglect and how to report child neglect. Retrieved from https://www.healthyplace. com/abuse/child-abuse-information/signs-of-child-neglect-and-how-to-report-child-neglect

Tracy, N. (2018b). What is child neglect? Retrieved from https://www.healthyplace.com/abuse/child-abuse-  information/what-is-child-neglect

Signs of Neglect and Abuse

Neglect

Neglect is a situation in which a parent or caretaker fails, refuses, or is unable, for reasons other than poverty, to provide the necessary care, food, clothing, or medical or dental care, which seriously endangers the physical, mental, or emotional health of the child. Signs of child neglect include the following:

• Exhibits poor hygiene or body odor • Is inappropriately dressed for the weather. ⁴
• Demonstrates needed medical or dental care
• Is left alone unsupervised for long periods of time
• Appears malnourished
• Is constantly hungry or begs for or steals food
• Demonstrates exhibits extreme willingness to please
• Is frequently absent from school
• Arrives early and stays late at school, play areas, or other people’s home

Physical Abuse

Physical abuse is defined as an injury inflicted on a child by other than accidental means. Physical injury includes, but is not limited to, lacerations,

fractured bones, burns, internal injuries, severe or frequent bruising, or great bodily harm. Signs of physical abuse in children are as follows:⁵

• Bruises and/or welts on the face, neck, chest, back, or soft muscle areas less prone to bruising by natural play or accidents (e.g., abdomen, breasts, underarm, inner thigh)
• Injuries in the shape of an object (e.g., belt or cord)
• Unexplained burns on palms, soles of feet, or back; a line of demarcation from submerging in hot liquids (e.g., ankles, buttocks, wrists); burns in the shape of an object (e.g., fork, cigarette)
• Fractures that do not fit the story of how an injury occurred
• Delay in seeking medical help
• Extremes in behavior (e.g., very aggressive or withdrawn and shy)
• Afraid to go home
• Frightened of parents
• Fearful of other adults
• Failure to thrive

However, some injuries are not visible to observation, such as shaken baby syndrome, a serious brain injury resulting from forcefully shaking an infant or toddler.

Resources

1. Administration for Children & Families. (2021). Child maltreatment 2019. [Report]. U.S. Department of Health & Human Services. https://www.acf.hhs.gov/cb/report/child-maltreatment-2019
2. Administration for Children & Families. (2021). Child maltreatment 2019. [Report]. U.S. Department of Health & Human Services. https://www.acf.hhs.gov/cb/report/child-maltreatment-2019
3. “bc-english-ashfnb” by A Safe Haven for Newborns is used under Fair Use. Access for free at https://asafehavenfornewborns.com/international-safe-haven/
4. Wisconsin Department of Children and Families. (n.d.). Signs of child abuse and neglect. https://dcf.wisconsin.gov/cps/signs Figure 15.4
5. Wisconsin Department of Children and Families. (n.d.). Signs of child abuse and neglect. https://dcf.wisconsin.gov/cps/signs

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