It's hard to imagine someone intentionally hurting a child, yet nearly a million children are abused every year just in the United States alone. And these are only the reported incidents of child abuse — many more cases are unreported and undetected, often because children are afraid to tell somebody who can help.

Most of the time, kids know their abusers and the abuse occurs in the home. This makes it difficult for kids to speak up. They may feel trapped by the affection they feel for their abusers or fearful of the power the abusers have over them — so they stay silent. That's why it's especially important to be able to recognize the signs of child abuse.

What Is Child Abuse?

Child abuse happens when a parent or other adult causes serious physical or emotional harm to a child.

In the United States, the laws defining what constitutes child abuse vary from state to state, but generally speaking, child abuse can take these forms:

• physical abuse
• sexual abuse
• neglect and abandonment
• emotional or psychological abuse

The most serious cases of child abuse can end in death. Those who survive may suffer emotional scars that can linger long after the physical bruises have healed. Kids who are abused are more likely to have problems building and maintaining relationships throughout their lives. They're also more likely to have low self-esteem, depression, thoughts of suicide, and other mental health issues.

Physical Abuse

When people think of child abuse, their first thought probably is of physical abuse — such as striking, kicking, or shaking a child. Physical abuse can also include:

• holding a child under water
• tying a child up
• intentionally burning a child or scalding a child with hot water
• throwing an object at a child or using an object to beat a child
• starving a child or failing to provide a child with food

Abusive head trauma, or shaken baby syndrome, is a specific form of physical abuse. It's the leading cause of death in child abuse cases in the U.S. Most incidents last just a few seconds, but that's enough time to cause brain damage or even kill a baby.

Sexual Abuse

Sexual abuse happens when a child is raped or forced to commit a sexual act. But it's also any sort of sexual contact with a child or any behavior that is meant to sexually arouse the abuser. So, in addition to having sex with a child, fondling a child's genitals or making a child touch someone else's genitals, sexual abuse also includes:

• making a child pose or perform for pornographic pictures or videos
• telling a child dirty jokes or stories
• showing a child pornographic material
• forcing a child to undress
• "flashing" a child or showing them one's genitals

Neglect

Neglect is any action — or inaction — on the part of a caregiver that causes a child physical or emotional harm. For example, withholding food, warmth in cold weather, or proper housing is considered neglectful. Basically, anything that interferes with a child's growth and development constitutes neglect. This also includes:

• failing to provide medical care when a child is injured or sick
• locking a child in a closet or room
• placing a child in a dangerous situation that could lead to physical injury or death

Abandonment is a type of neglect. This occurs when a child is left alone for extended periods of time or suffers serious harm because no one was looking after him or her.

Emotional Abuse

Emotional abuse or psychological abuse is a pattern of behavior that has negative effects on a child's emotional development and sense of self-worth. Ignoring a child or withholding love, support, or guidance is considered emotional abuse. So is threatening, terrorizing, belittling, or constantly criticizing a child.

Substance Abuse

The use of alcohol, tobacco, or illicit drugs can hinder a caregiver's judgment and put a child in danger, leading to things like neglect or physical abuse. But in some states, substance abuse is also considered a form of child abuse on its own.

Examples of child abuse due to a substance abuse problem in the house include:

• allowing a child to drink alcohol or take illegal drugs
• manufacturing, ingesting, or distributing illegal drugs in the presence of a child
• exposing a fetus to illegal drugs or other substances while pregnant

Profile of an Abuser

It would be simpler if all child abusers followed a pattern and were easy to recognize. The truth is that child abusers come from all walks of life. They can be parents, other family members, teachers, coaches, and family friends. Virtually anyone who has access to a child is in a position to mistreat the child. Fortunately, the vast majority of people don't.

Sometimes, people who abuse kids can show some behavioral signs. For example, parents who abuse their children may avoid other parents in the neighborhood, may not participate in school activities, and might be uncomfortable talking about their children's injuries or behavioral problems.

Adults who sexually abuse children typically know the kids beforehand. Rarely will a sexual abuser pick a child at random. The abuser may use this relationship to his or her advantage, telling the child to keep the relationship a secret or warning that the child will be hurt or in trouble if he or she tells anyone.

Many times, people who abuse children were themselves abused as kids. This cycle of abuse can be hard to break and can pass down for generations within a family.

Signs of Abuse

It's sometimes difficult to tell the difference between the ordinary scrapes and scratches of childhood and a physical sign of child abuse. Multiple bruises or those that keep coming back, black eyes, and broken bones are certainly red flags, but other signs — like a child's emotional health — are also telling.

Here are some ways that kids who are being abused might react:

• Being sad or angry. Kids who are being abused may act withdrawn, fearful, depressed, have low self-esteem, or engage in self-harm, like cutting. The most depressed kids might contemplate suicide or attempt suicide. Other kids become bullies and have problems managing their anger and other strong emotions. Many have nightmares or trouble sleeping.
• Relationship troubles. Those who are abused usually have trouble developing and maintaining relationships. They are often unable to love or trust others, especially adults, whom they can be fearful of. A telling sign that something's just not right is when a child fails to seek comfort from a parent or other caregiver who is an abuser.
• "Acting out" or engaging in risky behavior. Kids who are being abused sometimes act out in class and are disruptive. They may lose interest in activities they once loved or lose focus on their schoolwork — and their grades suffer. Drug and alcohol abuse, as well as sexual promiscuity, are also common.

Other kids might not act out in the typical ways, but will avoid going home after school or doing any activity that would cause them to spend time alone with the abuser.

In addition to kids who are being abused, those who witness abuse (but are not the victims themselves — like siblings) sometimes show similar signs.

But just because a child is showing these signs, it doesn't necessarily point to abuse. Children who are going through stressful situations, like parents' separation or divorce, a family move, or the loss of a friend or family member, may undergo a change in their mood or disposition.

If You Suspect Abuse

Abuse is not a private family matter, although it most often occurs within families and often is kept as a family secret. Once you suspect child abuse, you need to act to protect the child from further possible harm. It doesn't matter if you're wrong: it's better to be wrong than sorry.

Here's what to do:

• If you suspect that a child is being abused, it's your responsibility to contact your local child protective services agency, police, hospital, or emergency hotline. If necessary, you may remain anonymous. The child's safety is the immediate issue: you could save his or her life by removing the child from a dangerous situation as soon as possible.
• If you think you may have abused your own child, or you're worried that you might, make sure the child is somewhere safe away from you, and then speak with a friend, relative, or health care professional. It may be that you just need someone to talk to or you may want to seek counseling. Speaking with a trained professional can be an effective way to work through the reasons behind your abusive feelings.
• If you suspect that someone you know, such as a babysitter or childcare provider, is abusing a child, keep the child away from that person until authorities have been notified. If you suspect the person may abuse the child again, make sure any future contact between the child and that person is supervised. Never threaten a person or take the law into your own hands. Let the legal system decide an appropriate punishment for an abuser.

Pediatricians recommend that children who are suspected abuse victims be brought to a hospital, where the initial diagnosis can be made and treatment can be given. Hospitals are havens for abused kids, especially battered children who may need X-rays or cultures for a diagnosis to be made. Imaging can indicate broken bones, which are often the only sign that infants and very young children have been abused, as they aren't able to speak of the abuse themselves.

Psychological help is also strongly recommended. Without it, children who have been abused may suffer emotional problems or repeat the pattern of abuse with their own kids.

Break the Silence

While not all suspicions and accusations of child abuse turn out to be true, all deserve serious attention and immediate action. Child abuse can rob kids of the joy of growing up and affect them negatively for years to come.

But abuse doesn't have to ruin a child's life, as long as it's stopped and dealt with. The earlier abuse can be identified and stopped, the less destructive it will be. Healing from the abuse and dealing with its aftermath can also start that much earlier.

So take any accusations of abuse seriously until you know for sure whether or not they're true. All children deserve to be heard, protected, and helped, no matter what.

Reviewed by: Neil Izenberg, MD; D'Arcy Lyness, PhD; and Allan R. De Jong, MD,
Date reviewed: January 2012