Overview

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 purposely physically injured or put at risk of harm by another person.
• Sexual abuse. Child sexual abuse is any sexual activity with a child. This can involve sexual contact, such as intentional sexual touching, oral-genital contact or intercourse. This can also involve noncontact sexual abuse of a child, such as exposing a child to sexual activity or pornography; observing or filming a child in a sexual manner; sexual harassment of a child; or prostitution of a child, including sex trafficking.
• 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.
• Medical abuse. Medical child abuse occurs when someone gives false information about illness in a child that requires medical attention, putting the child at risk of injury and unnecessary medical care.
• Neglect. Child neglect is failure to provide adequate food, clothing, shelter, clean living conditions, affection, supervision, education, or dental or medical care.

In many cases, child abuse is done 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. The child may be afraid to tell anyone about the abuse, especially if the abuser is a parent, other relative or family friend. 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 unusual fears, or a sudden loss of self-confidence
• Sleep problems and nightmares
• An apparent lack of supervision
• Frequent absences from school
• Rebellious or defiant behavior
• Self-harm or attempts at suicide

Specific signs and symptoms depend on the type of abuse and can vary. 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, broken bones (fractures) or burns
• Injuries that don't match the given explanation
• Injuries that aren't compatible with the child's developmental ability

Sexual abuse signs and symptoms

• Sexual behavior or knowledge that's inappropriate for the child's age
• Pregnancy or a sexually transmitted infection
• Genital or anal pain, bleeding, or injury
• Statements by the child that he or she was sexually abused
• Inappropriate sexual behavior with other children

Emotional abuse signs and symptoms

• Delayed or inappropriate emotional development
• Loss of self-confidence or self-esteem
• Social withdrawal or a loss of interest or enthusiasm
• Depression
• Avoidance of certain situations, such as refusing to go to school or ride the bus
• Appears to desperately seek affection
• A decrease in school performance or loss of interest in school
• Loss of previously acquired developmental skills

Neglect signs and symptoms

• Poor growth
• Excessive weight with medical complications that are not being adequately addressed
• Poor personal cleanliness
• Lack of clothing or supplies to meet physical needs
• Hoarding or stealing food
• Poor record of school attendance
• Lack of appropriate attention for medical, dental or psychological problems or lack of necessary follow-up care

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
• Blames the child for the problems
• Consistently belittles or berates the child, and describes the child with negative terms, such as "worthless" or "evil"
• Expects the child to provide attention and care to the parent and seems jealous of other family members getting attention from the child
• Uses harsh physical discipline
• 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
• Repeatedly brings the child for medical evaluations or requests medical tests, such as X-rays and lab tests, for concerns not seen during the health care provider's examination

Physical punishment

Child health experts condemn the use of violence in any form, but some people still use physical punishment, such as spanking, to discipline their children. While parents and caregivers often use physical punishment with the intention of helping their children or making their behavior better, research shows that spanking is linked with worse, not better, behavior. It's also linked to mental health problems, difficult relationships with parents, lower self-esteem and lower academic performance.

Any physical punishment may leave emotional scars. Parental behaviors that cause pain, physical injury, or emotional trauma — even when done in the name of discipline — could be child abuse.