Understanding Child Abuse

Child abuse encompasses any form of maltreatment by an adult that is violent or threatening to a child. While physical abuse, characterized by visible injuries, is often the most shocking, abuse can also be less obvious. Neglect, for instance, involves ignoring a child’s needs, placing them in unsafe situations, exposing them to sexual situations, or making them feel worthless or stupid. These forms of abuse can leave deep, lasting scars on children.

Child abuse and neglect are serious public health problems and adverse childhood experiences (ACEs) with long-term impacts on health and well-being, as well as significant human, societal, and economic consequences.

How is Child Abuse and Neglect Defined in Federal Law?

The Federal Child Abuse Prevention and Treatment Act (CAPTA), as amended by the CAPTA Reauthorization Act of 2010, defines child abuse and neglect as, at a minimum, “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 (including sexual abuse as determined under section 111), or an act or failure to act which presents an imminent risk of serious harm” (42 U.S.C. 5101 note, § 3).

There is no single definition of child abuse. Some definitions focus on the behaviors or actions of adults, while others consider abuse to occur if there is harm or the threat of harm to the child. Any global approach to child abuse must account for differing cultural standards and expectations regarding parenting.

It is essential to recognize that child abuse and neglect are pervasive issues affecting communities worldwide.

Historical Evolution of Child Abuse Recognition and Response

The recognition and response to child abuse—whether physical, sexual, emotional, or neglectful—have evolved significantly over the centuries. Historically, children were often viewed as the property of their parents or guardians, a perspective that permitted harsh and sometimes brutal treatment. This perception of children as property contributed to their vulnerability to abuse throughout history.

Ancient and Medieval Practices

In ancient civilizations such as Egypt, Carthage, Rome, Greece, and the Aztec empire, children faced severe practices including abandonment, ritual sacrifice, and harsh disciplinary measures. For instance, in Rome, fathers had the legal authority to severely punish disobedient children, including the right to kill them. Sexual exploitation and the sale of children were prevalent in Greek and Roman societies, with women often complicit in these abuses.

During the Middle Ages in Europe, infanticide and the abandonment of deformed infants were common. The Roman Catholic Church’s belief that deformed infants were evil omens contributed to these practices. In England, the law of the thirteenth century differentiated between severe beatings that caused death and those that did not, reflecting a legal system that tolerated abuse within the family. Parents and teachers often beat children, believing such discipline was in the child’s best interest.

Early Modern Era

The first documented trial related to child abuse occurred in 1639 in Salem, Massachusetts. Marmaduke Perry, a master, was charged with the death of his apprentice due to ill-treatment. Despite evidence suggesting abuse, conflicting testimonies complicated the case, leading to Perry’s acquittal. This case highlighted the lack of legal protection for children from abusive guardians.

In the early eighteenth century, laws such as those in Virginia began to address the mistreatment of servants, but these protections did not extend to children abused by their own families. Familial abuse was often considered a private matter, while abuses by outsiders were condemned.

19th and 20th Century Reforms

The industrialization of the nineteenth century saw children working long hours under hazardous conditions in factories and mills. This exploitation led to reform movements. As middle-class attitudes shifted, children began to be seen as symbols of family status, resulting in a decline in child labor and the implementation of child labor laws.

The 1874 case of Mary Ellen, who suffered severe abuse, marked a turning point. Social worker Etta Wheeler appealed to the ASPCA for help, arguing that children deserved similar protections as animals. This case increased awareness and led to legislative changes in child welfare.

In 1912, the U.S. established its first federal child welfare agency, the Children's Bureau. This period saw significant legal advancements, including the Keating-Owen Child Labor Act of 1916, which sought to regulate child labor but was initially struck down by the Supreme Court. Subsequent legislation, such as the Fair Labor Standards Act of 1938, reinforced protections for working children.

Internationally, the League of Nations' 1924 Geneva Declaration on the Rights of the Child and the United Nations' 1948 Universal Declaration of Human Rights set standards for children's rights and welfare. The 1959 Declaration of the Rights of the Child expanded these rights further.

In the 1960s, the term "battered child syndrome" was introduced, leading to mandatory reporting laws for child abuse in the U.S. By 1967, most states required professionals to report suspected abuse. The 1978 Child Abuse Prevention and Treatment and Adoption Reform Act further broadened the definition of abuse and promoted adoption assistance.

Recent Developments

The late 20th and early 21st centuries have seen continued progress. The 1989 Convention on the Rights of the Child established comprehensive standards for child rights globally. In the U.S., laws such as the PROTECT Act of 2003 introduced national Amber Alert programs and addressed child exploitation more rigorously.

This historical trajectory highlights a gradual but significant shift from viewing children as property to recognizing their inherent rights and the need for protective measures.

Types of Child Abuse

While some of the types of maltreatment may be found separately, they can occur in combination. There is no single type of abuse, but all forms result in serious emotional harm to the child. Most U.S. states recognize four major types of maltreatment: physical abuse, neglect, sexual abuse, and emotional abuse. Additionally, some states classify abandonment, parental substance abuse, and human trafficking as forms of abuse or neglect. It is important to note that living in poverty, by itself, is not considered child abuse or neglect.

Physical Abuse

Physical abuse refers to any non-accidental act that causes physical harm to a child or adolescent. This harm may result from behaviors such as punching, beating, kicking, biting, shaking, throwing, stabbing, choking, hitting with objects, and burning. The injuries can range from minor bruises to severe fractures and, in extreme cases, death.

Each year, approximately three million cases of child abuse are reported in the United States, involving nearly 5.5 million children. Physical abuse is the second most common form of child maltreatment, affecting children of all ages, races, ethnicities, and socioeconomic backgrounds. However, children aged 0-3 are the most vulnerable to serious injuries and fatalities, with an alarming five children dying every day as a result of abuse, most of whom are under three years old.

Physical abuse often arises from physical punishment that escalates or from a caregiver's anger. While abuse can happen outside the home, it most commonly involves someone the child knows, such as a parent or caregiver. Factors contributing to physical abuse include the child’s young age, special needs, parental substance abuse, and domestic violence in the home.

Signs of Physical Abuse

• Unexplained injuries or injuries with patterns (e.g., straight lines or circles)
• Injuries in areas usually protected, such as the back, buttocks, or genitals
• Conflicting or implausible explanations for injuries
• Recurrent injuries attributed to the child being "clumsy"
• Presence of both old and new injuries
• A child wearing long sleeves or high-collared clothing to hide injuries
• Frequent absences or tardiness at school without a valid reason
• Difficulty walking or awkward movements
• Hypervigilance or being constantly "on alert"
• Fear of parents, crying, or protesting when it is time to go home
• Cowering or shrinking away from adult approaches

Physical abuse often involves the following dynamics:

• Unpredictability: The child never knows what might trigger the parent's anger. There are no clear boundaries or rules, creating an environment where the child is constantly "walking on eggshells."
• Anger-driven violence: Abusive parents act out of anger or a desire for control rather than a goal to lovingly teach or discipline the child. The more intense the parent's anger, the more severe the abuse.
• Using fear to control behavior: Abusive parents may believe that instilling fear is the best way to ensure compliance. However, children do not learn how to behave—they learn how to avoid being hit.

Parental Warning Signs of Physical Abuse

Consider the possibility of physical abuse when a parent or caregiver:

• Offers conflicting, unconvincing, or no explanation for the child’s injury
• Describes the child in highly negative terms, such as calling them "evil"
• Uses harsh physical discipline as punishment
• Has a history of being abused as a child

The Long-Term Impact of Physical Abuse

The emotional scars left by physical abuse can persist long after the physical wounds have healed. Abused children often face significant challenges at home, in school, and in their social relationships. Psychological effects may include low self-esteem, excessive fear, anxiety, eating disorders, concentration difficulties, hostility, depression, lethargy, aggression, and sleep disturbances. Many abused children develop a deep distrust of others and struggle with basic social skills and communication.

Children may be reluctant to disclose abuse for various reasons, including:

• Fear of angering or provoking further harm from their abuser
• Concern about getting the abuser into trouble
• Fear of being removed from their home
• Belief that the abuse is justified
• Fear of not being believed
• Feelings of shame or guilt

Diagnosing physical abuse can be challenging, particularly when there are no visible injuries. Medical professionals assess the child’s physical, emotional, and social well-being while observing interactions with caregivers. Physicians and mental health professionals have a legal obligation to report suspected abuse to authorities. Failure to treat physical abuse can result in lifelong consequences, including cognitive delays, severe emotional issues, and physical disabilities. Early intervention is crucial to ensuring the child’s safety and recovery. Suspected abuse must prompt immediate action from pediatricians, social workers, or child protective agencies to protect the child.

Preventing Physical Abuse

Preventing child abuse requires vigilance from healthcare providers, educators, and the community. Pediatricians must conduct thorough physical exams, take detailed histories, and maintain a high level of suspicion in potential abuse cases. Early detection and intervention are critical for protecting children from the devastating effects of physical abuse. If left unchecked, physical abuse can cause severe and lasting damage.

There is substantial evidence that providing parents with education and support can significantly reduce the use of physical punishment and improve children's behavior. Corporal punishment triggers harmful psychological and physiological responses, including pain, sadness, fear, anger, shame, and guilt. These emotional reactions lead to physiological stress and adverse changes in brain structure and function. Studies consistently link physical punishment to a wide range of negative outcomes, including:

• Direct physical harm, including severe injuries or death
• Mental health issues such as depression, anxiety, low self-esteem, and suicide attempts
• Impaired cognitive and socio-emotional development
• Lower academic and occupational success
• Increased aggression and antisocial behavior
• Damaged family relationships

Emotional or Psychological Abuse

Emotional abuse, often referred to as psychological abuse, involves the continual mistreatment of a child in a way that harms their emotional and mental well-being. It can take many forms, including deliberately scaring, humiliating, isolating, or ignoring a child. Unlike physical abuse, emotional abuse does not leave visible scars but can have an equally damaging, if not more profound, long-term impact on a child's mental and emotional health. Emotional abuse can occur alone or alongside other forms of abuse, making it difficult to detect and differentiate from other abusive behaviors.

Some common behaviors associated with emotional abuse include:

• Humiliating or constantly criticizing a child
• Threatening, shouting at, or name-calling
• Making the child the subject of jokes or using hurtful sarcasm
• Blaming or scapegoating the child
• Forcing a child to perform degrading acts
• Denying a child's individuality or attempting to control their life
• Pushing a child beyond their limits or ignoring their boundaries
• Exposing a child to distressing situations, such as domestic violence or substance abuse
• Failing to foster a child's social development or isolating them from peers
• Ignoring the child or being emotionally unavailable
• Manipulating the child or refusing to express positive feelings toward them

Types of Emotional Maltreatment

• Spurning: Verbal and nonverbal caregiver acts that reject and degrade a child.
• Terrorizing: Caregiver behavior that poses a threat of physical harm, death, or abandonment, or places the child or their loved ones in hazardous situations.
• Isolating: Caregiver actions that persistently restrict the child's chances to engage and communicate with peers or adults, thereby impeding their social interactions.
• Exploiting/Corrupting: Caregiver acts that encourage the child to develop inappropriate behaviors (e.g., self-destructive, antisocial, criminal, or other maladaptive behaviors).
• Denying Emotional Responsiveness: Caregiver behaviors that disregard the child's efforts and needs for interaction, such as a lack of affection, care, and love, and displaying emotional detachment in their interactions with the child.

Signs of Emotional Abuse

Emotional abuse can be difficult to recognize because its signs are often subtle and vary widely. Children may not disclose their experiences until they reach a breaking point, so vigilance is crucial. Common indicators of emotional abuse include:

• Lack of confidence or self-assurance
• Difficulty managing emotions or showing extreme emotional reactions
• Struggling to form or maintain relationships
• Age-inappropriate behavior

Signs in Different Age Groups

Babies and Toddlers:

• Overly affectionate to strangers
• Wary or anxious demeanor
• Lack of bonding with a parent
• Aggressive or cruel behavior towards others

Older Children:

• Using advanced language for their age
• Knowledge of inappropriate topics
• Emotional outbursts
• Isolation from parents
• Poor social skills and few friends

If a child confides in you about emotional abuse, it's important to listen carefully and validate their feelings, reassure them that telling you was the right thing to do. Make it clear that the abuse is not their fault. Take their disclosure seriously. Avoid confronting the alleged abuser. Explain the next steps and report the abuse promptly.

Emotional abuse can have lasting effects on a child’s social, emotional, and physical health. These effects may include:

Behavior Problems:

• Clinginess or attention-seeking behavior
• Indifference towards consequences
• Delinquent behaviors like stealing or running away

Emotional Development Issues:

• Difficulty expressing and controlling emotions
• Low self-confidence and anger issues
• Trouble forming healthy relationships
• Higher levels of depression and health issues in adulthood

Mental Health Problems:

• Increased risk of depression, anxiety, and suicidal thoughts
• Development of eating disorders and self-harm tendencies
• Issues with language development
• Difficulty forming healthy relationships

Emotional abuse is one of the most prevalent yet underreported forms of child abuse due to its subtle nature and lack of physical evidence. It can occur in any family, though it is more common in households facing financial difficulties, single-parent families, or homes with substance abuse or divorce.

Law enforcement and child protective services often struggle to intervene in emotional abuse cases due to the absence of clear evidence. Educational programs and counseling for parents can reduce emotionally abusive behaviors. Early recognition and intervention can prevent escalation and help mitigate the long-term effects of emotional abuse.

Neglect

Neglect is the failure of a parent or caregiver to provide for a child’s basic needs, and it is the most common form of child maltreatment. Neglect accounts for 75% of reports to Child Protective Services (CPS), with 76% of victims being neglected, 16% physically abused, 10% sexually abused, and 0.2% sex trafficked.

Neglect involves the failure to provide essential necessities, such as food, shelter, or supervision. Examples include:

• Not feeding the child or intentionally withholding food
• Living in unsanitary or dangerous conditions due to inadequate shelter
• Failing to supervise the child properly, such as leaving them with incapable caregivers or unsupervised for long periods
• Inadequate clothing or personal hygiene, leading to severe diaper rashes or skin conditions
• Failing to seek medical or dental care, resulting in untreated injuries or chronic conditions

Parental substance use can also constitute neglect. This includes situations where a child is prenatally exposed to harmful substances due to the mother’s drug use, controlled substances are manufactured or stored in the child’s environment, and caregivers use drugs in a way that impairs their ability to care for the child.

In 19 states, abandonment is also considered a form of neglect. This typically occurs when:

• The parent's whereabouts are unknown
• The child is left alone and suffers harm as a result
• There has been a lack of contact or support from the parent for a prolonged period

Neglect can also manifest in educational settings when a parent fails to ensure their child receives an education or special education services. Emotional neglect includes ignoring a child's emotional needs, failing to provide psychological care, or allowing substance abuse.

Federal guidelines recognize that cultural values and poverty can influence how neglect is defined. However, neglect involves significant failures in meeting a child's essential needs, not just minor lapses in care.

Healthcare providers play a critical role in identifying and managing child abuse. They must report suspected abuse to CPS, ensuring the child receives protection and necessary medical and psychological care. An interprofessional approach, involving child-abuse specialists, social workers, and mental health professionals, is essential for effective management and prevention.

Evaluation and Management

Evaluation and management involve thorough history-taking, physical examination, and appropriate use of laboratory and imaging studies to confirm abuse and rule out other conditions. Immediate stabilization and appropriate reporting are critical steps in the management of suspected abuse cases.

Neglect Categories

Neglect manifests itself in the following areas:

• Physical Neglect: Failing to provide necessary food, shelter, or supervision.
• Emotional Neglect: Ignoring a child's emotional needs or failing to provide psychological care.
• Medical Neglect: Not providing necessary medical or dental care.
• Educational Neglect: Failing to ensure a child receives an education or attends to special education needs.
• Technological Neglect: Allowing excessive use of technology that hinders a child’s social or academic development.
• Environmental Neglect: Allowing a child to live in unhealthy or unsafe conditions.
• Nutritional Neglect: Not providing a balanced diet, leading to malnutrition or obesity.
• Supervisory Neglect: Leaving a child unsupervised or with an incapable caregiver.
• Abandonment: Leaving a child without adequate care or contact for a prolonged period.

Warning Signs of Neglect

• Poor personal hygiene, such as severe body odor
• A pattern of untreated illnesses or injuries
• Frequent lack of supervision, being left alone, or playing in unsafe situations
• Chronic lateness or absences from school
• Signs of under-nutrition
• Fatigue
• Begging or stealing food or money
• Substance abuse
• Statements indicating no one at home to provide care
• Appears to be indifferent to the child
• Seems apathetic or depressed
• Behaves irrationally or behaves irrationally

The profound and lasting effects of child neglect can extend far beyond the initial incidents, impacting future generations. These effects can manifest in various stages of life, affecting physical, psychological, and behavioral development. Children who experience neglect may face cognitive and language delays, socio-emotional difficulties, and mental health issues such as depression, anxiety, eating disorders, and suicidal tendencies. They are also at higher risk for substance abuse and inappropriate sexual behaviors in adulthood, as well as issues like delinquency, teenage pregnancy, poor academic performance, and school dropout. Furthermore, neglected children often struggle with forming and maintaining relationships due to a lack of early attachment.

Sexual Abuse

Sexual abuse involves any sexual activity that an adult forces upon a child. This can include direct physical contact, such as intentional sexual touching, oral-genital contact, or intercourse. Non-contact forms of abuse are also prevalent and can include exposing a child to sexual activity or pornography, observing or filming a child in a sexual manner, sexual harassment, and child prostitution, including sex trafficking. In 36 states, the definition of sexual abuse explicitly includes human trafficking, sex trafficking, and trafficking of children for sexual exploitation.

Sexual abuse is marked by actions that a child cannot fully comprehend, cannot consent to, or is not developmentally prepared for. The crime of sexual abuse often brings more shame and guilt to the victim than the offender, which can make it difficult for children to disclose the abuse. Tragically, about one in every four girls in the United States will experience some form of sexual abuse during childhood. This includes acts such as fondling, penetration, and indecent exposure. The emotional, physical, and psychological scars caused by such abuse can be profound and long-lasting.

In approximately 90% of child sexual abuse cases, the victim knows their abuser. This familiarity often makes the abuse more difficult to detect, as the abuser may be someone in a position of trust, such as a family member, teacher, coach, or caretaker. Abusers frequently use manipulation, intimidation, or threats to silence the child, making it even harder for the victim to come forward.

A critical step in protecting children from sexual abuse is fostering open communication. Engage in ongoing conversations with your child about their safety, boundaries, and what makes them feel uncomfortable. Encourage them to speak up about anything troubling, and educate both yourself and your child on the signs of abuse.

Indicators and Warning Signs

Recognizing child sexual abuse (CSA) can be challenging, as it may not always present obvious signs. However, there are several physical, behavioral, and emotional indicators that may suggest abuse:

Physical Signs

• Difficulty walking or sitting
• Torn, stained, or bloody underclothes
• Frequent urinary or yeast infections
• Unexplained bleeding, bruises, or swelling in the genital area
• Pain, itching, or burning in the genital area

Behavioral Signs

• Sudden changes in behavior or academic performance
• Nightmares or bed-wetting
• Development of phobias
• Depression or PTSD symptoms
• Suicidal thoughts or behaviors, particularly in adolescents
• Running away from home or school
• Inappropriate sexual knowledge or behaviors
• Overprotective behavior towards siblings or assuming a caretaker role

Signs in Parents or Caregivers

• Excessive protectiveness or severe limitation of the child’s contact with peers
• Secretive and isolated behavior
• Jealousy or controlling behavior towards family members

Consequences of Child Sexual Abuse (CSA)

Child sexual abuse can have profound and lasting impacts on a survivor’s physical, mental, and behavioral health.

Physical Health Consequences

• Increased risk of sexually transmitted infections (STIs)
• Chronic health conditions, such as heart disease, obesity, and cancer
• Physical injuries

Mental Health Consequences

• Depression
• Post-traumatic stress disorder (PTSD)
• Anxiety and other mental health disorders

Behavioral Consequences

• Substance use and misuse
• Risky sexual behaviors
• Increased risk of suicide

Survivors of CSA are at a significantly higher risk of re-victimization and intimate partner violence in adulthood. Females who have experienced CSA face a 2-13 times higher risk of sexual victimization as adults. The psychological impact of CSA often includes complex feelings of guilt and shame, which may result in delayed reporting or non-reporting of the abuse altogether.

Common Indicators of Child Abuse

The warning signs of child abuse and neglect aren't always obvious. The presence of a single sign does not necessarily confirm maltreatment, but a closer look may be warranted when signs appear repeatedly or in combination. Children who are being abused often feel guilty, ashamed, or confused, especially when the abuser is a parent, relative, or family friend. This fear may prevent them from disclosing the abuse, making it essential to be aware of the potential red flags, such as:

• Withdrawal from friends or usual activities
• Sudden behavioral changes, such as aggression, anger, hostility, hyperactivity, or changes in school performance
• Depression, anxiety, unusual fears, or a sudden loss of self-confidence
• Sleep problems or nightmares
• A lack of supervision
• Frequent absences from school
• Rebellious or defiant behavior
• Self-harm or suicide attempts
• Avoiding specific people or situations

The presence of these warning signs doesn't necessarily mean abuse is occurring, but they may indicate a need for further investigation. Specific symptoms depend on the type of abuse and may vary.

Physical Abuse Signs and Symptoms

• Unexplained injuries, such as bruises, fractures, or burns
• Injuries that do not match the explanation provided
• Injuries that are inconsistent with the child's developmental abilities

Sexual Abuse Signs and Symptoms

• Sexual behavior or knowledge that's inappropriate for the child's age
• Pregnancy or a sexually transmitted infection
• Genital or anal pain, bleeding, or injury
• Statements by the child that he or she was sexually abused
• Inappropriate sexual behavior with other children

Emotional Abuse Signs and Symptoms

• Delayed or inappropriate emotional development
• Loss of self-confidence or self-esteem
• Social withdrawal or loss of interest in activities
• Depression
• Avoiding certain situations, such as refusing to go to school
• Desperate seeking of affection
• Decline in school performance
• Regression in previously acquired developmental skills

Neglect Signs and Symptoms

• Poor growth or weight issues with unaddressed medical complications
• Poor personal hygiene
• Inadequate clothing or supplies for physical needs
• Hoarding or stealing food
• Frequent school absences
• Lack of attention to medical, dental, or psychological issues
• Lack of necessary follow-up care

Parental Behavior

Sometimes, the behavior or demeanor of a parent or caregiver can raise red flags for potential child abuse. Warning signs may include parents who:

• Show little concern for the child
• Fail to recognize physical or emotional distress in the child
• Blame the child for problems within the family
• Constantly belittle or berate the child, using negative terms like "worthless" or "evil"
• Expect the child to provide care and attention to them, sometimes displaying jealousy towards other family members
• Use harsh physical discipline
• Demand unrealistic levels of physical or academic performance
• Severely limit the child’s contact with others
• Offer inconsistent, conflicting, or implausible explanations for the child’s injuries
• Repeatedly seek medical evaluations or tests without supporting evidence of illness or injury

Factors Contributing to Child Abuse and Neglect

Child abuse and neglect arise from a complex interplay of individual, relational, community, and societal factors. Although these factors do not directly cause abuse or neglect, they increase the risk and help to contextualize the environment in which maltreatment occurs. It is critical to remember that children are never to blame for the abuse or neglect they endure.

Individual Risk Factors for Victimization

Child-Related Factors

• Age: Children under four years old and adolescents are particularly vulnerable.
• Unwanted or Unmet Expectations: Being unwanted or not meeting parental expectations.
• Special Needs: Children with special needs, persistent crying, or abnormal physical features that add caregiver stress.
• Disabilities: Intellectual or neurological disabilities.

Parental or Caregiver Factors

• Upbringing: Parents with a history of receiving little affection or emotional support may have unrealistic expectations of their children.
• Nurturing Skills: Lack of nurturing and an understanding of child development.
• Bonding: Difficulties bonding with a child, particularly in cases involving premature infants, sick children, or stepchildren.
• History of Maltreatment: Parents who were abused or neglected as children may lack emotional maturity and have unrealistic expectations.
• Mental Health: Mental health conditions like depression, anxiety, or poor impulse control can increase the risk of maltreatment, especially when coupled with high-stress levels from caring for irritable or disabled children.
• Substance Abuse: Drug or alcohol use, especially during pregnancy, can exacerbate the risk of neglect and abuse.
• Criminal Activity and Financial Stress: Involvement in criminal activity, combined with financial difficulties, can contribute to an abusive environment.
• Demographics: Risk factors include young parental age, low education levels, single parenthood, many dependent children, and low income.
• Transient Caregivers: The presence of non-biological caregivers (e.g., a mother’s male partner) can increase risk.
• Family Stress: Family breakdowns, separation, or intimate partner violence often lead to child maltreatment.

Relational Factors

Relationships within the family and with peers can also influence the risk of child maltreatment:

• Health Problems: Physical, developmental, or mental health problems of a family member.
• Family Breakdown: Family breakdown or violence between other family members.
• Social Isolation: Lack of a support network.
• Support Breakdown: Breakdown of child-rearing support from the extended family.
• Incarceration: Families with members in jail or prison.
• Isolation: Families isolated from extended family, friends, and neighbors.
• Family Conflict: High conflict and negative communication styles within the family.

Community and Societal Factors

Certain community and societal characteristics may increase the risk of child abuse and neglect:

• Housing and Services: Lack of adequate housing or family support services.
• Unemployment and Poverty: High levels of unemployment or poverty.
• Substance Availability: Easy availability of alcohol and drugs.
• Policy Gaps: Inadequate policies and programs to prevent child maltreatment, child pornography, child prostitution, and child labor.
• Cultural Norms: Social and cultural norms that glorify violence, support corporal punishment, or diminish the status of children in parent-child relationships.
• Economic Policies: Policies leading to poor living standards, socioeconomic inequality, or instability.