The signs of child abuse and neglect are not always visible. Abuse is not always marked by distinct physical signs like a bruise or a black eye. Child abuse and neglect can range from ignoring a child’s needs to serious physical or emotional harm, sexual abuse, or exploitation. In the U.S., at least 1 in 7 children have experienced child abuse and neglect in the last year, though for every incident of child abuse that is reported, an estimated two incidents go unreported. This kind of abuse can have severe long-term effects on health and well-being, and leaves lasting mental and emotional scars in children. In 2021, an estimated 5 children died each day of abuse and neglect, 66% of those fatalities being children younger than 3 years old. For many children, ending the abuse can seem impossible, but help is available. Child abuse and neglect are preventable. If you suspect a child is or has been the victim of abuse, speaking out as early as possible can get them the help they need. Because of this, understanding the risks and signs of child abuse and neglect is important, life-saving knowledge.

What is Child Abuse and Neglect?

Child abuse and neglect are defined by any act or failure to act on part of a parent, caretaker, or another person in a custodial role (such as a teacher, coach, etc.) which results in serious harm, the potential threat of harm, or death to child under the age of 18. There are four common types of abuse:

  • Physical Abuse: Physical abuse is defined by intentional injury or harm done to a child by their caregiver. This could include hitting, burning (such as with hot water or cigarette burns), shaking, unreasonable restraining of a child (tying up a child, locking a child in a room for long periods of time), or any other physical act aimed at intentionally hurting a minor.
  • Emotional Abuse: Emotional abuse is any act or verbal abuse aimed at intentionally damaging the emotional well-being or self-worth of a child. This can be name-calling, rejection or withholding love, gaslighting and manipulation (i.e. “You’re acting crazy” in response to calling out abuse), threatening, or shaming (body shaming, hurtful criticism, etc.)
  • Sexual Abuse: Sexual abuse is any act voluntarily or involuntarily involving a minor, coercion into sexual acts, or forceful sexual action with a child. Exploitation of a minor that allows children to engage in or be exposed to inappropriate sexual situations also falls under this category of abuse. Of the sexual abuse cases involving children that are reported, 90% of the children who are victims know their abuser, and 30-40% of those children are abused by a family member.
  • Neglect: Neglect is defined by a parent or caretaker’s failure to meet a child’s basic physical and emotional needs. Failure to provide basic physical needs, (food, shelter, and clothing), and personal or medical needs (education, access to medical care) are all forms of neglect. Neglect can also be a failure to meet the psychological needs of a minor, such as having their feelings validated and appropriately responded to.

Another form of child neglect, abandonment, is classified as any time a parent’s location is unknown for long periods of time, or when a child has been left in a situation with the potential to cause serious harm. Parental substance abuse, known as exposing a child prenatally to substances, the distribution to or making of controlled substances in the presence or residence of a child, or a caretaker using controlled substances in a way that impairs their ability to care for a child is also a form of child abuse and neglect.

What is the Difference Between Child Abuse and Discipline?

Ongoing research about the most effective forms of discipline discuss the difference between physical discipline and disciplinary tactics that focus on teaching children better behavior, as opposed to punishing them for “bad” behavior. Disciplinary tactics that reinforce teaching children better behavior like natural or logical consequences, positive reinforcement of good behavior, and collaboration to reach proactive solutions promote healthy conflict resolution and better outcomes for the emotional well-being of children into adulthood. Children need care that promotes positive emotional health and supports their ability to learn healthy coping mechanisms for stressful situations, emotional distress, overcoming fears, and accepting disappointments and frustrations. A study conducted by Joy Osofsky, Ph.D. and Hiram Fitzgerald in the WAIMH Handbook of Infant Mental Health found that parents and caretakers are essential resources for children in managing emotions by “providing positive affirmations, conveying love and respect and [causing] a sense of security.” Parents who approached their children with respect and focused on working with their children to improve conduct rather than punishing bad behavior found that practices leading to anxiety and depression later in life were less internalized, minimizing aggressive behaviors, and promoting social and cognitive competence.

While all states in the U.S. have laws permitting the use of “reasonable” corporal punishment, they all prohibit non-accidental inflicted injuries. Corporal punishment is the use of physical force with the intention of causing a child to experience pain or discomfort to correct or punish a certain behavior. This can be spanking, hitting, slapping, or smacking, often using the hands, or a hard object such as a stick or a belt. Physical discipline is extremely common; it is estimated that 6 in 10 children worldwide ages 2 to 14 experience physical discipline from a caregiver. Though physical discipline has been widely studied by many different research facilities across the world, the stigma of commenting on what happens behind closed doors is perpetuated the lack of evidence due to the under-reporting of physical punishment from children in families with traditional power relationships. Despite the lack of evidence, the research that has been conducted on corporal punishment consistently links physical discipline with aggression, behavioral problems, poor self-esteem, and bullying other children. Evidence suggests that physical discipline doesn’t reduce defiant behavior and does not promote long-term positive conduct in children. It links physical punishment to risks of harm to a child’s cognitive, behavioral, social, and emotional development. It was also found that parents who were physically punished are more likely to physically punish their own children.

Due to the taboo nature of discussing parental boundaries and discipline in many cultures and communities, research like this is not as widely integrated into what is and isn’t socially acceptable parenting behaviors. Regardless, when a caretaker develops the inability to control the extent of reasonable corporal punishment, in extreme cases, physical punishment can lead to more severe punishment, stepping over the line into child abuse. Putting it into perspective, licensed psychologist Jaclyn Halpern, PsyD. says “Discipline is not punishment, so it is easy to distinguish it from abuse. However, there is often a fine line between punishment and abuse.” She goes on to talk about a child’s inability to self-regulate, stating that “they yell, cry, scream, or hit, often over a prolonged period.” Caregivers, frustrated that they are unable to control their children’s behavior, may try several forms of discipline before being unable to control themselves and ultimately shaking or hitting their child. This kind of abuse if uncontrolled can turn into neglect if a caretaker shifts from sending a child to time-out to locking a child in a room without food or bathroom access for long periods of time.

Signs of Child Abuse and Neglect

Warning signs that children may be experiencing child abuse or neglect may not always be immediately visible and can vary depending on the type of abuse they may be experiencing.

Warning Signs of Physical Abuse:

  • Unexplained injuries or repeated injuries with similar explanations such as fractures, bruises, broken bones or burns
  • Injuries that don’t match the explanation given; explanations that are inconsistent or seem forced or rehearsed
  • Injuries that aren’t compatible with the child’s developmental ability
  • Child may seem overly fearful or paranoid, may flinch at sudden movements or sounds, or may seem afraid to go home
  • Wearing weather inappropriate clothing to cover injuries

Warning Signs of Emotional Abuse:

  • Delayed or inappropriate emotional development
  • Extreme behaviors or responses (extremely or fearfully compliant, overly demanding or aggressive)
  • Lack of self-confidence or self-esteem
  • Social withdrawal, excessive fearfulness or anxiety
  • Acting either inappropriately adult or inappropriately infantile
  • Either desperately seeks affection or is overly-avoidant of attention
  • Loss of previously acquired development skills
  • Unattachment from parent or caregiver

Warning Signs of Sexual Abuse:

  • Sensitivity or extreme reactions to being touched
  • Inappropriate sexualized behavior with toys, during play, or toward others
  • Displayed knowledge of sexual acts inappropriate for their age
  • Trouble walking or sitting
  • Genital pain, bleeding, or injury
  • Strong efforts to avoid a specific person(s) without obvious reason
  • Hesitance or avoidance of changing clothes in front of others or participate in physical activities
  • Signs of STD’s or pregnancy, especially under the age of 14

Warning Signs of Neglect:

  • Poor growth or cognitive development
  • Medical complications or injuries are not addressed
  • Excessive weight or malnutrition
  • Poor personal hygiene
  • Wearing ill-fitting, or weather inappropriate clothing (in some cases)
  • Frequently unsupervised time with unknown whereabouts or being left allowed to play in unsafe situations or conditions
  • Being frequently late or missing from school due to inability to get there
  • Hoarding or stealing food or other basic needs

Warning Signs in Parental/Caretaker Behavior:

  • Shows little concern for their child’s well-being, development, or school performance
  • Appearing unable to identify signs of physical or emotional distress in their child
  • Blames child for problems, in school or at home
  • Uses especially harsh or unreasonable discipline
  • Consistently belittles or berates child, or talks about child in a particularly cruel or demeaning way
  • Demands an unusually high level of physical or academic performance from child
  • Severely limits child’s contact with others
  • Offers conflicting or inconsistent explanations of child’s injuries or behavior, or not explanation at all
  • Jealousy when child shows attention to other family members, friends, etc.

What can I do to Prevent Child Abuse or Neglect?

At FirstMed Health and Wellness, we take child abuse and neglect seriously. All FirstMed employees, contractors, therapists, and providers are mandated reporters. We will always report signs, admissions, or child confessions of child abuse or neglect, and will always help victims and survivors of abuse who come into our clinics asking for help. If you’re concerned that your child or a child that you know has been or is being abused or neglected, seek help immediately. Contact your local police department or a local child welfare agency for advice. For Nevada residents, you can call:

  • Clark County CPS: (702) 399-0081
  • Washoe County CPS: 1 (833) 900-SAFE (7233)
  • All Other Counties CPS: 1 (833) 803-1183

Do your part to prevent child abuse. Educate yourself and others about the risks and signs of child abuse, teach children their rights, report abuse if you see or suspect it, and discipline your children thoughtfully. Invest in the children in your community by encouraging the leaders in your community to be supportive of children and their families. Ask your local and national lawmakers to support legislation to better protect children and help vulnerable children and their families. For more information on how you can prevent child abuse and neglect before it happens, visit https://preventchildabuse.org/ to learn more about how you can become an advocate for family friendly policies at national, state and local levels.


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Category: Child & Adolescent Health