Child Abuse

Written by Matt McMillen, William Moore
Medically Reviewed by Zilpah Sheikh, MD on April 13, 2025
13 min read

Child abuse refers to harm done to a child by a parent or someone else responsible for them, such as a family member, teacher, babysitter, coach, religious leader, or friend.

Federal law defines child abuse as “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.” The law also considers putting a child in danger to be child abuse.

“So even if harm doesn’t actually reach the child, it can be considered abusive or neglectful,” says child abuse pediatrician Kristin Crichton, DO, MPH. “The legal definition of child abuse is broad and encompasses many different types of maltreatment.”

And it’s not uncommon. According to the CDC, about 1 in 7 children experienced child abuse or neglect in the previous year. Because child abuse often goes unreported, the actual number might be even higher.

When you think of child abuse, your first thought may be of a child with bruises or other marks that raise red flags. But the signs aren’t always so clear. Abuse can be physical, sexual, or emotional. A child may also be neglected, meaning their caregivers don’t fulfill their basic needs, such as food or safety.

What makes abuse even harder to stop is that most of the time, the abuser is someone the child knows. They may not be willing to say something, as they may either want to protect that person or be afraid of what the abuser will do if they speak up.

It’s important to know how to spot different types of abuse, and what you can do if you suspect it.

Child abuse happens when someone harms a child’s body, emotional health, development, or well-being. There are four main types: physical abuse, sexual abuse, emotional abuse, and neglect. An abused child often experiences more than one type.

“So many children who are experiencing one form of maltreatment will experience another form as well,” says Crichton, who works with The Center for Family Safety and Healing at Nationwide Children’s in Columbus, Ohio.

Physical abuse 

This type of child abuse involves someone hurting a child’s body or putting them in physical danger. It doesn’t matter whether the child isn’t seriously hurt or if it doesn’t leave a mark. Any harm is abuse. This is a “nonaccidental injury of a child,” says Crichton.

Examples include:

  • Causing b urn injuries
  • Hitting, kicking, or biting
  • Holding the child underwater
  • Shaking or throwing the child
  • Throwing objects at the child
  • Tying up the child

Medical abuse. It’s a rare form of physical abuse, called medical child abuse (MCA). It involves a parent or caregiver seeking unnecessary and harmful, or potentially harmful, medical care for a child. Crichton says there are two different types of MCA:

  • Fabrication, in which the caregiver makes up or exaggerates a child’s symptoms to get more medical care
  • Induction, when a caregiver causes symptoms on purpose, such as giving insulin to a child who doesn’t have diabetes

Fabrication may result from a mental health condition called Munchausen syndrome by proxy.

Sexual abuse

This is any kind of sexual activity with a child. “It doesn’t have to involve touching,” says Crichton.

Child sexual abuse includes when someone:

  • Exposes the child to pornography
  • Forces a child to take part in pornographic pictures or videos
  • Has any sexual contact with the child, from kissing in a sexual way to having sex
  • Makes phone calls or sends emails, texts, or other messages that are sexual in any way
  • Shows the child someone else’s genitals, as with “flashing”
  • Tells “dirty” jokes or stories in the child’s presence

Emotional abuse

Also called psychological abuse, this is a pattern of behaviors that harm a child’s emotional well-being and growth. 

This type of child abuse is when someone:

  • Abuses others when the child is around, such as a parent, brother, sister, or pet
  • Fails to show love and affection
  • Ignores the child and doesn’t give emotional support and guidance
  • Shames, belittles, criticizes, or embarrasses the child
  • Teases, threatens, bullies, or yells at the child

“There are many different acts, but it’s really when a child doesn’t feel emotionally safe and cared for by their caregiver,” says Crichton.

Neglect

This child abuse occurs when a caregiver doesn’t give the child basic care and protection, such as:

  • Clothing
  • Food
  • Heat in cold weather
  • Housing with clean living conditions
  • Medical care

Medical neglect. In medical neglect, a parent or caregiver doesn’t offer necessary medical care for a child. For example, they might withhold an inhaler from a child with asthma.

Neglect can also happen when a child is left alone for long periods or in unsafe conditions. This is known as abandonment, which also happens when the parent or caregiver:

  • Can’t be identified or located
  • Leaves the child without concern for their health or safety
  • Fails to stay in contact with or offer support for the child

“There are lots of different kinds of neglect,” says Crichton. Some types of child abuse can fall into one or more of these categories:

Parental substance abuse

Sometimes, a parent or caregiver neglects or physically harms the child as a result of substance misuse.

Examples include:

  • When a parent can’t properly care for a child because they’re high on drugs or alcohol
  • Giving illegal drugs or alcohol to a child
  • Making methamphetamine (meth) while a child is around
  • A pregnant woman’s abuse of drugs or alcohol, which exposes her baby to these substances

Human trafficking

This is basically a type of slavery. Children are trafficked when they’re used for prostitution or pornography, which is often called commercial sexual exploitation of children. They may also be forced to beg, sell drugs, or work long hours for little pay.

Trafficking can be a form of physical abuse, sexual abuse, or both, depending on what it involves.

Kids can get cuts and bruises or show signs of stress for lots of reasons that are a normal part of childhood. So, it helps to know specific signs to look for, and trust your gut as you look at the whole picture of the child’s physical and emotional health.

Signs of physical abuse

Bruises, welts, or other injuries that can’t be explained or don’t match with the child’s story or the adult’s explanation can be signs of physical abuse.

Other signs of child abuse are:

  • Burns, especially from cigarettes, that can’t be explained
  • Injury marks that have a pattern, such as those from a hand, belt, or other objects
  • Injuries that are at different stages of healing
  • Medical or dental issues that go untreated

“It’s normal to have bruises on foreheads and knees and shins, but bruising on their abdomen or bruising to their neck or ear are not typical accidental areas,” Crichton says.

Kids who’ve been physically abused may also:

  • Avoid any kind of touch or physical contact
  • Be afraid to go home
  • Seem to always be on high alert
  • Wear clothing that doesn’t match the weather, such as long sleeves on hot days, to cover up bruises
  • Withdraw from friends and activities

Signs of sexual abuse 

Sometimes, these too can be hard to spot. And often, says Crichton, children may not know what to say.

“They may not know who to tell or really have the words to explain what has happened to them,” says Crichton. “If they’re young children, they may not have context for what has happened to their body.”

Signs that point to child sexual abuse include:

  • Avoiding a certain person for no clear reason
  • Bloody, torn, or stained underwear
  • Bruising or bleeding around the genitals
  • Pain or itching in the genital area, making it harder to walk or sit
  • Pregnancy or STDs, especially in children younger than 14
  • Refusing to change clothes in front of others
  • Running away from home
  • Sexual activity or knowledge that people usually have only when they’re older

Signs of emotional abuse 

Emotional abuse often happens along with other types of abuse. Children may show:

  • Constant worry about doing something wrong
  • Speech problems or delays in learning and emotional development
  • Depression and low self-esteem
  • Bad grades or other issues at school
  • Extreme behavior, such as being way too obedient or demanding
  • Headaches and stomachaches with no clear cause
  • Lack of closeness to a parent or caregiver
  • Little interest in friends and activities

Signs of neglect 

As with other forms of child abuse, neglect can cause both physical and emotional problems. These are possible indicators of neglect:

  • Always looking dirty
  • Being left alone or in the care of other young children
  • Eating more than usual or saving food for later
  • Missing school often
  • Poor weight gain and growth
  • Not getting medical, dental, or mental health care (medical neglect)
  • Seeming withdrawn, or apathetic
  • Acting antisocial, destructive, or very scared
  • Having problems with speech, eating, or substance use

You may see the same signs of neglect in children whose parents or caregivers abuse alcohol or other drugs.

Signs of child trafficking 

A child might be involved in trafficking if they:

  • Miss school often
  • Run away from home
  • Have sudden changes in their dressing style or relationships
  • Have an older “boyfriend” or “girlfriend”
  • Talk about needing to pay off a debt
  • Often care for children who aren’t members of their family
  • Answer to questions in ways that seem rehearsed

Child abuse harms children in many ways. It has both immediate and long-term effects that can last a lifetime. In some cases, child abuse can be fatal.

“We know that we have about 2,000 kids every year that die in this country, so it can be life-threatening,” says Crichton.

The impact depends on many factors, such as:

  • The type of abuse and its severity
  • The duration and frequency of the abuse
  • The relationship between the child and the abuser
  • Where the child was in their development when the abuse happened

Short-term effects of child abuse

Child abuse can cause injuries right away, such as bruises, cuts, pain, or other signs of harm. Babies are particularly vulnerable, says Crichton. They can have serious head trauma if shaken violently. This could cause seizures and paralysis but also more subtle symptoms, such as becoming fussy and vomiting. In addition to injuries, sexual abuse can result in sexually transmitted diseases.

In the short term, child abuse can also have emotional consequences. Crichton says some children may begin to act out aggressively. Others may become withdrawn, isolate themselves, and no longer engage in activities they used to. In some cases, children may revert to old behaviors. For example, a potty-trained child may start wetting the bed again. Teens who are abused may start to engage in risky behaviors, such as drug abuse and sex.

“It’s a kind of dysregulation of their normal activities and behaviors as a result of the trauma of being abused,” says Crichton.

Long-term effects of child abuse

Physical abuse can cause long-lasting or permanent harm. Head trauma, for example, can have devastating neurological effects and may result in learning disabilities, developmental problems, and physical handicaps, such as blindness. In extreme cases, the harm done may be so bad that the child requires life support machines for the rest of their life.

Crichton says that the toxic stress of being abused as a child can harm the way your body functions. This may increase their risk of serious health problems in adulthood, such as heart disease, chronic lung disease, and cancer later in life. Children who are abused also have a higher risk of mental disorders, such as depression, anxiety, memory problems, and posttraumatic stress disorder (PTSD).

Other possible long-term effects of child abuse include:

  • Suicidal thoughts and suicide attempts
  • Abuse of others or accepting abuse as normal
  • Putting others first and ignoring their own health and well-being
  • Difficulty trusting other people
  • Sexual issues, such as having risky sex or avoiding sex
  • Chronic pain, such as frequent headaches, stomach pains, and fibromyalgia
  • Low self-esteem
  • Substance or alcohol use disorder

There’s plenty you can do to prevent child abuse, both in your own home and community. One critical step is to manage parental stress. If you have a baby, for example, be aware that the baby will cry, sometimes for a long time. That’s normal, even if it can be really frustrating and stressful.

“I think just recognizing how challenging it is to be a caregiver to a young infant and kind of normalizing that is really important,” says Crichton. “We can prevent a lot of these really severe abusive head injuries by helping caregivers know it’s OK to give yourself a break.”

As your child gets older, talk to them about their bodies and what’s OK and what isn’t OK in terms of contact with others.

“Let them know that they’re in charge of their bodies and who touches it,” says Crichton. “So even if it’s grandma wanting to give them a hug, if they don’t want to give someone a hug, they don’t have to.”

And if someone does touch them in a wrong way, make sure they have a safe person to tell and that they feel heard. Also, help them understand they have done nothing wrong.

“I tell my own daughter, you’re never in trouble if you’re asking me for help, no matter what you need to tell me,” says Crichton.

Other steps that you can take to prevent child abuse in your home include:

  • Give your child love, attention, and support to build trust and open communication.
  • Don’t leave a young child unsupervised.
  • Make sure their caregivers are people you know and trust.
  • Teach your child how to stay safe when using social media and the internet.
  • Enroll in a parent training class to learn the best ways to build a strong relationship with your child.
  • Ask for help when you need it from family, friends, and others.
  • Seek support groups for parents and caregivers.

If you suspect child abuse, it’s important to report it. It isn’t a private matter or a family problem. A child’s physical and emotional well-being, and maybe even their life, could be in danger.

You don’t need proof to report abuse. If you suspect it, call your local child protective services, police, a hospital, or a hotline, such as the Childhelp National Child Abuse Hotline at 800-422-4453. You don’t have to give your name.

If you suspect child trafficking, call the National Human Trafficking Hotline at 888-373-7888.

Depending on the situation, there are many ways you can help the child:

  • If they need medical care right away, call 911.
  • Take the child to the hospital. Doctors can check for signs of abuse and give medical care.
  • Keep the child safe. If you think a babysitter or day care worker hurt your child, keep your child away from them and call the police. If you think a parent or caregiver is the problem, make sure the child is not alone with that person.
  • If the abuse happened at school, tell the principal about it. But report it to your local or state child protection agency, too.
  • Help the child get therapy to start healing the emotional damage of the abuse.
  • Urge the child to talk to you about what happened. But don’t make it an interrogation. Focus on listening.
  • Make sure they feel supported and know this is not their fault.
  • It’s best not to confront the abuser yourself. Instead, contact the police or a child protection agency, and let them handle it.

Child abuse pediatrics

A child abuse pediatrician is a doctor who has training in recognizing the signs of child abuse. Crichton calls the “biomechanics of injury in children.” For example, if a child comes to the ER with an injury that makes the medical staff suspect abuse, a child abuse pediatrician may be called in to examin the child.

To find out if a child has been abused, the pediatrician looks at the child’s medical history and test results and examines the child. They also talk with others involved in the child’s care and safety, such as doctors and child protective services.

“Their role, however, is limited to identifying or ruling out child abuse. They are not involved in determining who abused the child,” says Crichton. “Child abuse pediatricians typically work at large hospitals and child advocacy centers, where children are seen primarily for concerns about sexual abuse.”

Child abuse can cause long-term physical and emotional harm. In some cases, it can even lead to death. Many children experience more than one type of abuse. The signs of child abuse can show up suddenly, but some may be subtle. Knowing about the signs can help identify children who are experiencing abuse. If you report the abuse, you could save a life.

How to heal after childhood abuse

This usually includes treating any injuries the child has and getting them help from a therapist who understands how abuse affects kids. The goal is to help the child heal both physically and emotionally.

What are the four main safeguarding issues?

The four major types of abuse that educators watch for are physical abuse, sexual abuse, emotional abuse, and neglect. Many abused children experience more than one type of abuse.

How do children cope with abuse?

Children may deal with abuse in different ways. Some might pull away from their usual activities. Others may stop taking care of their hygiene. Older children, such as teens, might turn to drugs or alcohol to deal with what they’re going through.

What is multi-abuse?

Also called multi-type abuse, this happens when a child experiences more than one type of child abuse, such as physical abuse and sexual abuse.