Child abuse or child maltreatment is physical, sexual, and/or psychological maltreatment

or neglect of a child or children, especially by a parent or a caregiver. Child abuse may include any
act or failure to act by a parent or a caregiver that results in actual or potential harm to a child, and
can occur in a child's home, or in the organizations, schools or communities the child interacts with.
The terms child abuse and child maltreatment are often used interchangeably, although some
researchers make a distinction between them, treating child maltreatment as an umbrella term to
cover neglect, exploitation, and trafficking.
Different jurisdictions have developed their own definitions of what constitutes child abuse for the
purposes of removing children from their families or prosecuting a criminal charge.

History

The whole of recorded history contains references to acts that can be described as child abuse or
child maltreatment, but professional inquiry into the topic is generally considered to have begun in
the 1960s.[1] The July 1962 publication of the paper "The Battered Child-Syndrome" authored
principally to pediatric psychiatrist C. Henry Kempe and published in The Journal of the American
Medical Association represents the moment that child maltreatment entered mainstream awareness.
Before the article's publication, injuries to children—even repeated bone fractures—were not
commonly recognized as the results of intentional trauma. Instead, physicians often looked for
undiagnosed bone diseases or accepted parents' accounts of accidental mishaps such as falls or
assaults by neighborhood bullies.[2]:100–103
The study of child abuse and neglect emerged as an academic discipline in the early 1970s in the
United States. Elisabeth Young-Bruehl maintains that despite the growing numbers of child
advocates and interest in protecting children which took place, the grouping of children into "the
abused" and the "non-abused" created an artificial distinction that narrowed the concept of children's
rights to simply protection from maltreatment, and blocked investigation of the ways in which children
are discriminated against in society generally. Another effect of the way child abuse and neglect
have been studied, according to Young-Bruehl, was to close off consideration of how children
themselves perceive maltreatment and the importance they place on adults' attitudes toward them.
Young-Bruehl writes that when the belief in children's inherent inferiority to adults is present in
society, all children suffer whether or not their treatment is labeled as "abuse".

Types

Physical abuse[edit]
Among professionals and the general public, there is disagreement as to what behaviors
constitute physical abuse of a child.[15] Physical abuse often does not occur in isolation, but as part of
a constellation of behaviors including authoritarian control, anxiety-provoking behavior, and a lack of
parental warmth.[16] The WHO defines physical abuse as:
Intentional use of physical force against the child that results in – or has a high likelihood of resulting
in – harm for the child's health, survival, development or dignity. This includes hitting, beating,
kicking, shaking, biting, strangling, scalding, burning, poisoning and suffocating. Much physical
violence against children in the home is inflicted with the object of punishing.[14]

Joan Durrant and Ron Ensom write that most physical abuse is physical punishment "in intent, form,
and effect".[17] Overlapping definitions of physical abuse and physical punishment of children highlight
a subtle or non-existent distinction between abuse and punishment.[18] For instance, Paulo Sergio
Pinheiro writes in the UN Secretary-General's Study on Violence Against Children:
Corporal punishment involves hitting ('smacking', 'slapping', 'spanking') children, with the hand or
with an implement – whip, stick, belt, shoe, wooden spoon, etc. But it can also involve, for example,
kicking, shaking or throwing children, scratching, pinching, biting, pulling hair or boxing ears, forcing
children to stay in uncomfortable positions, burning, scalding or forced ingestion (for example,
washing children's mouths out with soap or forcing them to swallow hot spices).[19]

Most nations with child abuse laws deem the deliberate infliction of serious injuries, or actions that
place the child at obvious risk of serious injury or death, to be illegal.[citation needed] Bruises, scratches,
burns, broken bones, lacerations — as well as repeated "mishaps," and rough treatment that could
cause physical injuries — can be physical abuse.[20] Multiple injuries or fractures at different stages of
healing can raise suspicion of abuse.
The psychologist Alice Miller, noted for her books on child abuse, took the view that humiliations,
spankings and beatings, slaps in the face, etc. are all forms of abuse, because they injure the
integrity and dignity of a child, even if their consequences are not visible right away.[21]
Often, physical abuse as a child can lead to physical and mental difficulties in the future, including
re-victimization, personality disorders, post-traumatic stress disorder, dissociative disorders,
depression, anxiety, suicidal ideation, eating disorders, substance abuse, and aggression. Physical
abuse in childhood has also been linked to homelessness in adulthood.[22]

Sexual abuse[edit]
Main articles: Child sexual abuse and child-on-child sexual abuse
Child sexual abuse (CSA) is a form of child abuse in which an adult or older adolescent abuses a
child for sexual stimulation.[23] Sexual abuse refers to the participation of a child in a sexual act aimed
toward the physical gratification or the financial profit of the person committing the act.[20][24] Forms of
CSA include asking or pressuring a child to engage in sexual activities (regardless of the
outcome), indecent exposure of the genitals to a child, displaying pornography to a child,
actual sexual contact with a child, physical contact with the child's genitals, viewing of the child's
genitalia without physical contact, or using a child to produce child pornography.[23][25][26] Selling the
sexual services of children may be viewed and treated as child abuse rather than simple
incarceration.[27]
Effects of child sexual abuse on the victim(s) include guilt and self-
blame, flashbacks, nightmares, insomnia, fear of things associated with the abuse (including objects,
smells, places, doctor's visits, etc.), self-esteem difficulties, sexual dysfunction, chronic
pain, addiction, self-injury, suicidal ideation, somatic complaints, depression,[28] post-traumatic stress
disorder,[29] anxiety,[30] other mental illnesses including borderline personality
disorder[31] and dissociative identity disorder,[31] propensity to re-victimization in adulthood,[32] bulimia
nervosa,[33] and physical injury to the child, among other problems.[34] Children who are the victims are
also at an increased risk of sexually transmitted infections due to their immature immune systems
and a high potential for mucosal tears during forced sexual contact.[35] Sexual victimization at a young
age has been correlated with several risk factors for contracting HIV including decreased knowledge
of sexual topics, increased prevalence of HIV, engagement in risky sexual practices, condom
avoidance, lower knowledge of safe sex practices, frequent changing of sexual partners, and more
years of sexual activity.[35]
In the United States, approximately 15% to 25% of women and 5% to 15% of men were sexually
abused when they were children.[36][37][38] Most sexual abuse offenders are acquainted with their
victims; approximately 30% are relatives of the child, most often brothers, sisters, fathers, mothers,
uncles or cousins; around 60% are other acquaintances such as friends of the family, babysitters, or
neighbours; strangers are the offenders in approximately 10% of child sexual abuse cases.[36] In over
one-third of cases, the perpetrator is also a minor.[39]
In 1999 the BBC reported on the RAHI Foundation's survey of sexual abuse in India, in which 76%
of respondents said they had been abused as children, 40% of those stating the perpetrator was a
family member.[40]
United States federal prosecutors registered multiple charges against a South Korean man for
reportedly running the world's "largest dark web child porn marketplace." Reportedly, the English
translated website "Welcome to Video", which has now been taken consisted of more than 200,000
videos or 8TB of data showing sexual acts involving infants, children and toddlers and processed
about 7,300 Bitcoin, i.e. $730,000 worth of transactions.[41]

Psychological abuse[edit]
Main article: Psychological abuse
There are multiple definitions of child psychological abuse:

 In 2013, the American Psychiatric Association (APA) added Child Psychological Abuse to

the DSM-5, describing it as "nonaccidental verbal or symbolic acts by a child's parent or
caregiver that result, or have reasonable potential to result, in significant psychological harm to
the child."[42]
 In 1995, APSAC defined it as: spurning, terrorizing, isolating, exploiting, corrupting, denying
emotional responsiveness, or neglect" or "A repeated pattern of caregiver behavior or extreme
incident(s) that convey to children that they are worthless, flawed, unloved, unwanted,
endangered, or only of value in meeting another's needs"[43]
 In the United States, states laws vary, but most have laws against "mental injury"[44]
 Some have defined it as the production of psychological and social defects in the growth of a
child as a result of behavior such as loud yelling, coarse and rude attitude, inattention, harsh
criticism, and denigration of the child's personality.[20] Other examples include name-calling,
ridicule, degradation, destruction of personal belongings, torture or killing of a pet,
excessive criticism, inappropriate or excessive demands, withholding communication, and
routine labeling or humiliation.[45]
In 2014, the APA stated that:[46]

 "Childhood psychological abuse [is] as harmful as sexual or physical abuse."

 "Nearly 3 million U.S. children experience some form of [psychological] maltreatment
annually."
 Psychological maltreatment is "the most challenging and prevalent form of child abuse and
neglect."
 "Given the prevalence of childhood psychological abuse and the severity of harm to young
victims, it should be at the forefront of mental health and social service training"
In 2015, additional research confirmed these 2014 statements of the APA.[47][48]
Victims of emotional abuse may react by distancing themselves from the abuser, internalizing the
abusive words, or fighting back by insulting the abuser. Emotional abuse can result in abnormal or
disrupted attachment development, a tendency for victims to blame themselves (self-blame) for the
abuse, learned helplessness, and overly passive behavior.[45]

Neglect[edit]
Main article: Child neglect
Child neglect is the failure of a parent or other person with responsibility for the child, to provide
needed food, clothing, shelter, medical care, or supervision to the degree that the child's health,
safety or well-being may be threatened with harm. Neglect is also a lack of attention from the people
surrounding a child, and the non-provision of the relevant and adequate necessities for the child's
survival, which would be a lack of attention, love, and nurturing.[20]
Some observable signs of child neglect include: the child is frequently absent from school, begs or
steals food or money, lacks needed medical and dental care, is consistently dirty, or lacks
appropriate clothing for the weather.[49] The 2010 Child Maltreatment Report (NCANDS), a
yearly United States federal government report based on data supplied by state Child Protective
Services (CPS) Agencies in the U.S., found that neglect/neglectful behavior was the "most common
form of child maltreatment ".[50]
Neglectful acts can be divided into six sub-categories:[8]

 Supervisory neglect: characterized by the absence of a parent or guardian which can lead to
physical harm, sexual abuse, or criminal behavior;
 Physical neglect: characterized by the failure to provide the basic physical necessities, such
as a safe and clean home;
 Medical neglect: characterized by the lack of providing medical care;
 Emotional neglect: characterized by a lack of nurturance, encouragement, and support;
 Educational neglect: characterized by the caregivers lack to provide an education and
additional resources to actively participate in the school system; and
 Abandonment: when the parent or guardian leaves a child alone for a long period of time
without a babysitter or caretaker.
Neglected children may experience delays in physical and psychosocial development, possibly
resulting in psychopathology and impaired neuropsychological functions including executive
function, attention, processing speed, language, memory and social skills.[51] Researchers
investigating maltreated children have repeatedly found that neglected children in the foster and
adoptive populations manifest different emotional and behavioral reactions to regain lost or secure
relationships and are frequently reported to have disorganized attachments and a need to control
their environment. Such children are not likely to view caregivers as being a source of safety, and
instead typically show an increase in aggressive and hyperactive behaviors which may disrupt
healthy or secure attachment with their adopted parents. These children seem to have learned to
adapt to an abusive and inconsistent caregiver by becoming cautiously self-reliant, and are often
described as glib, manipulative and disingenuous in their interactions with others as they move
through childhood.[52] Children who are victims of neglect can have a more difficult time forming and
maintaining relationships, such as romantic or friendship, later in life due to the lack of attachment
they had in their earlier stages of life.

Effects[edit]
Child abuse can result in immediate adverse physical effects but it is also strongly associated
with developmental problems[53] and with many chronic physical and psychological effects, including
subsequent ill-health, including higher rates of chronic conditions, high-risk health behaviors and
shortened lifespan.[54][55]
Maltreated children may grow up to be maltreating adults.[56][57][58] A 1991 source reported that studies
indicate that 90 percent of maltreating adults were maltreated as children.[59] Almost 7 million
American infants receive child care services, such as day care, and much of that care is poor.[53]

Emotional[edit]
Child abuse can cause a range of emotional effects. Children who are constantly ignored, shamed,
terrorized or humiliated suffer at least as much, if not more, than if they are physically assaulted.
[60]
 According to the Joyful Heart Foundation, brain development of the child is greatly influenced and
responds to the experiences with families, caregivers, and the community.[61] Abused children can
grow up experiencing insecurities, low self-esteem, and lack of development. Many abused children
experience ongoing difficulties with trust, social withdrawal, trouble in school, and forming
relationships.[60]
Babies and other young children can be affected differently by abuse than their older counterparts.
Babies and pre-school children who are being emotionally abused or neglected may be overly
affectionate towards strangers or people they haven't known for very long.[62] They can lack
confidence or become anxious, appear to not have a close relationship with their parent, exhibit
aggressive behavior or act nasty towards other children and animals.[62] Older children may use foul
language or act in a markedly different way to other children at the same age, struggle to control
strong emotions, seem isolated from their parents, lack social skills or have few, if any, friends.[62]
Children can also experience reactive attachment disorder (RAD). RAD is defined as markedly
disturbed and developmentally inappropriate social relatedness, that usually begins before the age
of 5 years.[63] RAD can present as a persistent failure to start or respond in a developmentally
appropriate fashion to most social situations. The long-term impact of emotional abuse has not been
studied widely, but recent studies have begun to document its long-term consequences. Emotional
abuse has been linked to increased depression, anxiety, and difficulties in interpersonal relationships
(Spertus, Wong, Halligan, & Seremetis, 2003).[63] Victims of child abuse and neglect are more likely
to commit crimes as juveniles and adults.[64]
Domestic violence also takes its toll on children; although the child is not the one being abused, the
child witnessing the domestic violence is greatly influential as well. Research studies conducted
such as the "Longitudinal Study on the Effects of Child Abuse and Children's Exposure to Domestic
Violence", show that 36.8% of children engage in felony assault compared to the 47.5% of
abused/assaulted children. Research has shown that children exposed to domestic violence
increases the chances of experienced behavioral and emotional problems (depression, irritability,
anxiety, academic problems, and problems in language development).[65]
Overall, emotional effects caused by child abuse and even witnessing abuse can result in long-term
and short-term effects that ultimately affect a child's upbringing and development.

Physical[edit]

Rib fractures in an infant secondary to child abuse

The immediate physical effects of abuse or neglect can be relatively minor (bruises or cuts) or
severe (broken bones, hemorrhage, or even death). In some cases the physical effects are
temporary; however, the pain and suffering they cause a child should not be discounted. Rib
fractures may be seen with physical abuse, and if present may increase suspicion of abuse, but are
found in a small minority of children with maltreatment-related injuries.[66][67]
The long-term impact of child abuse and neglect on physical health and development can be:

 Shaken baby syndrome. Shaking a baby is a common form of child abuse that often results
in permanent neurological damage (80% of cases) or death (30% of cases).[68] Damage results
from intracranial hypertension (increased pressure in the skull) after bleeding in the brain,
damage to the spinal cord and neck, and rib or bone fractures.[69]
 Impaired brain development. Child abuse and neglect have been shown, in some cases, to
cause important regions of the brain to fail to form or grow properly, resulting in impaired
development.[70][71] Structural brain changes as a result of child abuse or neglect include overall
smaller brain volume, hippocampal atrophy, prefrontal cortex dysfunction, decreased corpus
callosum density, and delays in the myelination of synapses.[72][73] These alterations in brain
maturation have long-term consequences for cognitive, language, and academic abilities.[74] In
addition, these neurological changes impact the amygdala and hypothalamic-pituitary-adrenal
(HPA) axis which are involved in stress response and may cause post-traumatic stress disorder
(PTSD) symptoms.[73]
 Poor physical health. In addition to possible immediate adverse physical effects, household
dysfunction and childhood maltreatment are strongly associated with many chronic physical and
psychological effects, including subsequent ill-health in childhood,[75] adolescence[76] and
adulthood, with higher rates of chronic conditions, high-risk health behaviors and shortened
lifespan.[54][55] Adults who experienced abuse or neglect during childhood are more likely to suffer
from physical ailments such as allergies, arthritis, asthma, bronchitis, high blood pressure, and
ulcers.[55][77][78][79] There may be a higher risk of developing cancer later in life,[80] as well as possible
immune dysfunction.[81]
 Exposure to violence during childhood is associated with shortened telomeres and with
reduced telomerase activityThe increased rate of telomere length reduction correlates to a
reduction in lifespan of 7 to 15 years.
 Data from a recent study supports previous findings that specific neurobiochemical changes
are linked to exposure to violence and abuse, several biological pathways can possibly lead to
the development of illness, and certain physiological mechanisms can moderate how severe
illnesses become in patients with past experience with violence or abuse.[83]
 Recent studies give evidence of a link between stress occurring early in life
and epigenetic modifications that last into adulthood.