Abuse can happen to anyone, regardless of ethnicity, economic status, gender, or age, resulting in multiple forms of harm. Abuse against children who are still developing and learning, however, can have deeper and more dire consequences that impact victims for the rest of their lives. April is Child Abuse Prevention Month, a good time to learn more about this issue, its effects, and ways to help. This post is the first of a two-part series concerning children and will focus on child abuse.

Child Abuse vs. Childhood Domestic Violence

The Mayo Clinic defines child abuse as “any intentional harm or mistreatment to a child under 18 years old.” As with abuse of adults, there are several forms child abuse may take, including physical, emotional, sexual, medical, and neglect. The CDC reports that an estimated 1 in 7 children experience child abuse and neglect. In 2020, 1,750 children died of abuse and neglect in the United States. This is likely an underestimation due to lack of reporting and cases where abuse and neglect directly contributed to other primary causes of death. Unlike domestic violence, which by its very name is defined by a “domestic” relationship, child abuse can be perpetrated by any adult, or even adolescent, in the child’s life. This includes parents, guardians, caregivers, teachers, coaches, religious leaders, family friends, fellow students, etc.

Infographic with a smartphone and the words, "A survey of callers to the National Domestic Violence Hotline found that 85% reported that a partner or ex-partner had called them crazy, 73% said that a partner or ex-partner had deliberately done things to make them feel they were going crazy or losing their mind, 50% reported that a partner or ex-partner had threatened to report to the aurthorities that they were crazy as a way to keep them from getting certain important goals such as custody of the children, medication, or protective orders

Childhood domestic violence (CDV), by contrast, is when children are not the direct targets of abuse but are exposed to domestic violence at home. This can include seeing or hearing abuse, witnessing consequences of domestic violence (such as injuries or property damage), and experiencing police involvement. Researchers estimate that between 3.3 million and 10 million children are exposed to adult domestic violence each year, with one researcher estimating as many as one third of children in the US are exposed to intimate partner violence at some point in their childhood or adolescence.

mature woman lying curled up on her side in bed, covering her face with her hands

In at least 40% of homes where domestic violence is present, child(ren) are also being abused (DomesticShelters). This post will primarily focus on child abuse. Childhood domestic violence and its effects will be covered in more depth next month in part two of this series.

Types of Child Abuse

Physical

When a child is purposely physically injured or put at risk of harm.

Examples: hitting, kicking, shaking, burning, and not allowing the child to eat, drink, or use the bathroom.

Emotional

Injuring a child’s self-esteem or emotional well-being.

Examples: belittling, berating, name-calling, threatening, shaming, rejecting, isolating, and ignoring.

upset young woman sits in a chair crying while her boyfriend stands over her yelling aggressively
Sexual

Any sexual activity with a child.

Examples: sexual touching, sexual acts, penetration, indecent exposure, exposing a child to sexual activity/pornography, filming a child in a sexual manner, and sexual harassment.

Medical

Examples: Intentionally trying to make a child sick, not treating a medical condition, giving false information about a child’s illness/injury that requires medical attention, and unnecessary medical care.

Neglect

Failure to meet a child’s basic physical and emotional needs. (Note: failure to meet these needs through poverty alone is different from intentionally withholding them.)

Examples: Purposefully not providing adequate food, clothing, shelter, clean living conditions, affection, supervision, education, and dental/medical care.

upset young woman sits in a chair crying while her boyfriend stands over her yelling aggressively

The Power and Control Wheel was created by the Domestic Violence Intervention Project (DAIP) in Duluth, MN to develop a more detailed and nuanced model of the Cycle of Abuse. The following wheels are specific to child abuse and neglect and give more details of the different ways they can manifest.

upset young woman sits in a chair crying while her boyfriend stands over her yelling aggressively
upset young woman sits in a chair crying while her boyfriend stands over her yelling aggressively

Indicators of Child Abuse

While child abuse happens across all ages, ethnicities, genders, and socio-economic statuses, the risk of abuse is statistically higher for children who live in poverty, are under four years old, and for those with disabilities or special needs. The increased stress and burden on caregivers in these situations are factors that contribute to the increased risk of abuse for these children (Cleveland Clinic). For any child, there are signs that may be indicators of abuse. These often fall under the umbrella of “changes in behavior”, such as withdrawing from friends/usual activities, increased anger/hostility/hyperactivity/rebellious behavior, sudden loss of self-confidence, and changes in school performance. Abused children may develop depression, anxiety, unusual fears, sleep issues, and attempt self-harm. These are red flags only, not conclusive marks of abuse.

Below are some more specific signs and symptoms to look for in children that may indicate particular forms of abuse:

upset young woman sits in a chair crying while her boyfriend stands over her yelling aggressively

Certain behaviors from parents or guardians can also be red flags for child abuse. These include not showing concern for the child or recognizing their physical or emotional distress, blaming the child for problems, or belittling/berating the child. Parents using harsh discipline, demanding an inappropriate level of physical or academic performance, or severely limiting a child’s contact with others may also be signs of abuse. Indicators of physical abuse may include parents offering conflicting or unconvincing explanations for a child’s injuries (or no explanation at all) or repeatedly bringing the child in for medical evaluations for concerns not noted during a health care provider’s exam.

Adverse Childhood Experiences (ACEs)

Adverse childhood experiences (ACEs) fall into three general categories: abuse, neglect, and household disfunction (childhood domestic violence, family member(s) with mental illnesses or substance abuse issues, incarcerated relative(s), divorce, etc.). Most of today’s understanding of ACEs and their effects stem from a 1995-1997 CDC-Kaiser study of over 17,000 people. This study found that two thirds of participants reported at least one ACE, and one in five participants reported three or more ACEs. There was a direct correlation between the number of ACEs and increased health risks. The more ACEs in a person’s childhood, the greater the risk for negative physical, mental, and behavioral issues as an adult. An online ACE quiz is available from NPR. Those who experienced child abuse often have a high ACE score, and, thus, are at greater risk for a number of difficulties as an adult. Of course, a high ACE score is just an indicator, not a definitive determiner.

upset young woman sits in a chair crying while her boyfriend stands over her yelling aggressively

Lasting Impacts

The immediate effects of child abuse can often be seen as physical injuries, such as broken bones, cuts, and bruises, and in emotional and psychological problems, such as anxiety and post-traumatic stress disorder (PTSD). Children are still growing, physically and emotionally, and forming their world views, so abuse can also have an impact on their development that reverberates through the rest of their lives. Chronic abuse may result in toxic stress, which can actually change brain development and increase risk for issues such as learning, attention, and memory difficulties (CDC). Behaviors and conditioning acquired as a child can carry through to adults who believe that they are inherently powerless, shameful, guilty, and/or that abuse is normal, which informs their self-worth and relationships in negative ways.

upset young woman sits in a chair crying while her boyfriend stands over her yelling aggressively

As the ACE study showed, other long-term effects of child abuse include future violence victimization and perpetration, substance abuse, a greater tendency toward high-risk/harmful behaviors, lower education attainment, and limited job opportunities. Health issues at greater risk of development for abused and neglected children include cancer, heart disease, stroke, diabetes, sexually transmitted infections, depression, and obesity. While they cannot be completely reversed, the negative impacts of child abuse can be mitigated somewhat with positive intervention, self-awareness, and understanding. Plenty of abused children grow into healthy adults, many of whom funnel their trauma into helping others in similar situations.

How to Help Abused Children

Calling 911 is an immediate way to help a child if one knows or strongly suspects they are actively being abused. In Massachusetts, The Department of Children and Families looks into reports of abuse and neglect and works to make sure children are in safe and stable homes. The Child Help Hotline is another great resource for information on child abuse and resources to get assistance and/or guidance on the best ways to help in each individual case. They have crisis counselors available 24/7 via phone, text, or chat. Restraining orders can be taken out against abusers on behalf of children, usually by a parent or guardian, though in some states adolescents of a certain age can request one directly. Children who have experienced abuse may need medical care and would likely benefit from some form of trauma-informed therapy. Reassuring children that they are in a safe place and providing plenty of nurturing and love can help lessen the effects of abuse and help them heal in their own way and timeframe.

upset young woman sits in a chair crying while her boyfriend stands over her yelling aggressively

Individuals can help reduce the risk of abuse of children in their lives by offering love, attention, and support, encouraging children to share any problems with a trusted adult, and emphasizing that they can say no and don’t have to do anything they find uncomfortable or scary. Supervising children, looking into potential caregivers (short and long-term), and developing a network of supportive friends and relatives can help ensure children get the care they need and lessen the opportunity for situations where abuse can occur. There are also organizations, such as Circle of Parents, that provide parental support and education on dealing with the challenges of raising children without resorting to any form of abuse.

upset young woman sits in a chair crying while her boyfriend stands over her yelling aggressively

Beyond the terrible impact on children and families, child abuse also has an enormous measurable monetary cost on society. The lifetime economic burden of child abuse and neglect in the United States is approximately $592 billion, which is a similar amount to the cost of other high profile public health concerns such as heart disease and diabetes. There are things that can be done on a societal level to contribute to reducing child abuse and all its costs. These include socio-economic supports, strengthening household financial security, family-friendly workplace policies, and improved training and regulation/oversight of childcare and school programs. Education on parenting skills and family relationship approaches, as well as changes to societal norms to support positive parenting, also make a difference. Training healthcare providers to recognize signs of abuse and understand the impacts of ACEs can improve outcomes for those who do experience child abuse. (CDC)

upset young woman sits in a chair crying while her boyfriend stands over her yelling aggressively

Stay tuned for part-two of this blog series “Concerning Children” next month for more information about Childhood Domestic Violence!

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