Diagnosis

Identifying abuse or neglect can be difficult. It requires careful evaluation of the situation, including checking for physical and behavioral signs. Agencies, such as appropriate county or state authorities, also may be involved in investigating cases of suspected abuse.

Factors that may be considered in determining child abuse include:

  • Physical exam, including evaluating injuries or signs and symptoms of suspected abuse or neglect
  • Lab tests, X-rays or other tests
  • Information about the child's medical and developmental history
  • Description or observation of the child's behavior
  • Observing interactions between parents or caregivers and the child
  • Discussions with parents or caregivers
  • Talking, when possible, with the child

Early identification of child abuse can keep children safe by stopping abuse and preventing future abuse from occurring.

Treatment

Treatment can help both children and parents in abuse situations. The first priority is ensuring the safety and protection for children who have been abused. Ongoing treatment focuses on preventing future abuse and reducing the long-term psychological and physical consequences of abuse.

Medical care

If necessary, help the child seek appropriate medical care. Seek immediate medical attention if a child has signs of an injury or a change in consciousness. Follow-up care with a doctor or other health care provider may be required.

Psychotherapy

Talking with a mental health professional can:

  • Help a child who has been abused learn to trust again
  • Teach a child about normal behavior and relationships
  • Teach a child conflict management and boost self-esteem

Several different types of therapy may be effective, such as:

  • Trauma-focused cognitive behavioral therapy. This type of therapy helps a child who has been abused to better manage distressing feelings and to deal with trauma-related memories. Eventually, the supportive parent who has not abused the child and the child are seen together so the child can tell the parent exactly what happened.
  • Child-parent psychotherapy. This treatment focuses on improving the parent-child relationship and on building a stronger attachment between the two.

Psychotherapy also can help parents:

  • Discover the roots of abuse
  • Learn effective ways to cope with life's inevitable frustrations
  • Learn healthy parenting strategies

If the child is still in the home, social services may schedule home visits and make sure essential needs, such as food, are available. Children who are placed in foster care because their home situation is too dangerous will often need mental health services and therapies.

Places to turn for help

If you need help because you're at risk of abusing a child or you think someone else has abused or neglected a child, there are organizations that can provide you with information and referrals, such as:

  • Childhelp National Child Abuse Hotline: 1-800-4-A-CHILD (1-800-422-4453)
  • Prevent Child Abuse America: 1-800-CHILDREN (1-800-244-5373)

Coping and support

If a child tells you he or she is being abused, take the situation seriously. The child's safety is most important. Here's what you can do:

  • Encourage the child to tell you what happened. Remain calm as you assure the child that it's OK to talk about the experience, even if someone has threatened him or her to keep silent. Focus on listening, not investigating. Don't ask leading questions — allow the child to explain what happened and leave detailed questioning to the professionals.
  • Remind the child that he or she isn't responsible for the abuse. The responsibility for child abuse belongs to the abuser. Say "It's not your fault" over and over again.
  • Offer comfort. You might say, "I'm so sorry you were hurt," "I'm glad that you told me," and "I'll do everything I can to help you." Let the child know you're available to talk or simply listen at any time.
  • Report the abuse. Contact a local child protective agency or the police department. Authorities will investigate the report and, if necessary, take steps to ensure the child's safety.
  • Help the child remain safe. Ensure the child's safety by separating the abuser and the child, and by providing supervision if the child is in the presence of the abuser. Help the child get medical attention if needed.
  • Consider additional support. You might help the child seek counseling or other mental health treatment. Age-appropriate support groups also can be helpful.
  • If the abuse has occurred at school, make sure the principal of the school is aware of the situation, in addition to reporting it to the local or state child protection agency.
Oct. 05, 2018
References
  1. The Childhelp National Child Abuse Hotline. Childhelp. https://www.childhelp.org/hotline/. Accessed Aug. 7, 2018.
  2. Contact us. Prevent Child Abuse America. http://preventchildabuse.org/contact-us/. Accessed Aug. 7, 2018.
  3. Other conditions that may be a focus of clinical attention: Abuse and neglect. In: Diagnostic and Statistical Manual of Mental Disorders DSM-5. 5th ed. Arlington, Va.: American Psychiatric Association; 2013. https://dsm.psychiatryonline.org. Accessed Aug. 7, 2018.
  4. The issue of child abuse. Childhelp. https://www.childhelp.org/child-abuse/. Accessed Aug. 7, 2018.
  5. Christian CW, et al. The evaluation of suspected child physical abuse. Pediatrics. 2015;135:e1337.
  6. Trauma and child abuse resource center. American Academy of Child and Adolescent Psychiatry. https://www.aacap.org/aacap/Families_and_Youth/Resource_Centers/Child_Abuse_Resource_Center/Home.aspx#factsforfamilies. Accessed Aug. 7, 2018.
  7. Factitious disorder. In: Diagnostic and Statistical Manual of Mental Disorders DSM-5. 5th ed. Arlington, Va.: American Psychiatric Association; 2013. https://dsm.psychiatryonline.org. Accessed Aug. 7, 2018.
  8. Dulcan MK, et al. Child abuse and neglect. In: Dulcan's Textbook of Child and Adolescent Psychiatry. 2nd ed. Arlington, Va.: American Psychiatric Publishing; 2016. https://psychiatryonline.org. Accessed Aug. 7, 2018.
  9. Child abuse and neglect: Risk and protective factors. Centers for Disease Control and Prevention. https://www.cdc.gov/violenceprevention/childabuseandneglect/riskprotectivefactors.html. Accessed Aug. 7, 2018.
  10. Child abuse and neglect: Consequences. Centers for Disease Control and Prevention. https://www.cdc.gov/violenceprevention/childabuseandneglect/consequences.html. Accessed Aug. 7, 2018.
  11. Child abuse and neglect: Prevention strategies. Centers for Disease Control and Prevention. https://www.cdc.gov/violenceprevention/childabuseandneglect/prevention.html. Accessed Aug. 7, 2018.
  12. Definitions of child abuse and neglect. Child Welfare Information Gateway. https://www.childwelfare.gov/topics/systemwide/laws-policies/statutes/define/. Accessed Aug. 7, 2018.
  13. Understanding and preventing child abuse and neglect. American Psychological Association. http://www.apa.org/pi/families/resources/understanding-child-abuse.aspx. Accessed Aug. 7, 2018.
  14. Assink M, et al. The intergenerational transmission of child maltreatment: A three-level meta-analysis. Child Abuse and Neglect. 2018;84:131.
  15. Children internet safety. U.S. Department of Justice. https://www.justice.gov/criminal-ceos/children-internet-safety. Accessed Aug. 8, 2018.
  16. Eniola K, et al. Diagnosis of child maltreatment: A family medicine physician's dilemma. Southern Medical Journal. 2017;110:330.
  17. Preventing and identifying child sexual abuse ― Tips from the American Academy of Pediatrics. American Academy of Pediatrics. https://www.aap.org/en-us/about-the-aap/aap-press-room/news-features-and-safety-tips/Pages/Parent-Tips-for-Preventing-and-Identifying-Child-Sexual-Abuse.aspx. Accessed Aug. 14, 2018.
  18. Overview of child maltreatment (child abuse). Merck Manual Professional Version. https://www.merckmanuals.com/professional/pediatrics/child-maltreatment/overview-of-child-maltreatment. Accessed Aug. 30, 2018.
  19. Caneira L, et al. Diagnosing child abuse: The role of the nurse practitioner. Journal for Nurse Practitioners. 2015;11:640.
  20. Boos SC. Physical child abuse: Diagnostic evaluation and management. https://www.uptodate.com/contents/search. Accessed Aug. 30, 2018.
  21. Graff AH (expert opinion). Mayo Clinic, Rochester, Minn. Sept. 10, 2018.