Child abuse

Any intentional harm or mistreatment to a child under 18 years old is considered child abuse. Child abuse takes many forms, which often occur at the same time.

• Physical abuse. Physical child abuse occurs when a child is purposely physically injured or put at risk of harm by another person.
• Sexual abuse. Child sexual abuse is any sexual activity with a child. This can involve sexual contact, such as intentional sexual touching, oral-genital contact or intercourse. This can also involve noncontact sexual abuse of a child, such as exposing a child to sexual activity or pornography; observing or filming a child in a sexual manner; sexual harassment of a child; or prostitution of a child, including sex trafficking.
• Emotional abuse. Emotional child abuse means injuring a child's self-esteem or emotional well-being. It includes verbal and emotional assault — such as continually belittling or berating a child — as well as isolating, ignoring or rejecting a child.
• Medical abuse. Medical child abuse occurs when someone gives false information about illness in a child that requires medical attention, putting the child at risk of injury and unnecessary medical care.
• Neglect. Child neglect is failure to provide adequate food, clothing, shelter, clean living conditions, affection, supervision, education, or dental or medical care.

In many cases, child abuse is done by someone the child knows and trusts — often a parent or other relative. If you suspect child abuse, report the abuse to the proper authorities.

A child who's being abused may feel guilty, ashamed or confused. The child may be afraid to tell anyone about the abuse, especially if the abuser is a parent, other relative or family friend. That's why it's vital to watch for red flags, such as:

• Withdrawal from friends or usual activities
• Changes in behavior — such as aggression, anger, hostility or hyperactivity — or changes in school performance
• Depression, anxiety or unusual fears, or a sudden loss of self-confidence
• Sleep problems and nightmares
• An apparent lack of supervision
• Frequent absences from school
• Rebellious or defiant behavior
• Self-harm or attempts at suicide

Specific signs and symptoms depend on the type of abuse and can vary. Keep in mind that warning signs are just that — warning signs. The presence of warning signs doesn't necessarily mean that a child is being abused.

If you're concerned that your child or another child has been abused, seek help immediately. Depending on the situation, contact the child's health care provider, a local child welfare agency, the police department or a 24-hour hotline for advice. In the United States, you can get information and assistance by calling or texting the Childhelp National Child Abuse Hotline at 1-800-422-4453.

If the child needs immediate medical attention, call 911 or your local emergency number.

In the United States, keep in mind that health care professionals and many other people, such as teachers and social workers, are legally required to report all suspected cases of child abuse to the appropriate local child welfare agency.

Factors that may increase a person's risk of becoming abusive include:

• A history of being abused or neglected as a child
• Physical or mental illness, such as depression or post-traumatic stress disorder (PTSD)
• Family crisis or stress, including domestic violence and other marital conflicts, or single parenting
• A child in the family who is developmentally or physically disabled
• Financial stress, unemployment or poverty
• Social or extended family isolation
• Poor understanding of child development and parenting skills
• Alcohol, drugs or other substance abuse

Some children overcome the physical and psychological effects of child abuse, particularly those with strong social support and resiliency skills who can adapt and cope with bad experiences. For many others, however, child abuse may result in physical, behavioral, emotional or mental health issues — even years later.

Here are some examples.

You can take important steps to protect your child from exploitation and child abuse, as well as prevent child abuse in your neighborhood or community. The goal is to provide safe, stable, nurturing relationships for children.

Here's how you can help keep children safe:

• Offer your child love and attention. Nurture and listen to your child and be involved in your child's life to develop trust and good communication. Encourage your child to tell you if there's a problem. A supportive family environment and social networks can help improve your child's feelings of self-esteem and self-worth.
• Don't respond in anger. If you feel overwhelmed or out of control, take a break. Don't take out your anger on your child. Talk with your health care provider or a therapist about ways you can learn to cope with stress and better interact with your child.
• Think supervision. Don't leave a young child home alone. In public, keep a close eye on your child. Volunteer at school and for activities to get to know the adults who spend time with your child. When old enough to go out without supervision, encourage your child to stay away from strangers and to hang out with friends rather than be alone. Make it a rule that your child tells you where he or she is at all times. Find out who's supervising your child — for example, at a sleepover.
• Know your child's caregivers. Check references for babysitters and other caregivers. Make irregular, but frequent, unannounced visits to observe what's happening. Don't allow substitutes for your usual child care provider if you don't know the substitute.
• Emphasize when to say no. Make sure your child understands that he or she doesn't have to do anything that seems scary or uncomfortable. Encourage your child to leave a threatening or frightening situation immediately and seek help from a trusted adult. If something happens, encourage your child to talk to you or another trusted adult about what happened. Assure your child that it's OK to talk and that he or she won't get in trouble.

• Teach your child how to stay safe online. Put the computer in a common area of your home, not the child's bedroom. Use the parental controls to restrict the types of websites your child can visit. Check your child's privacy settings on social networking sites. Consider it a red flag if your child is secretive about online activities.

  Cover online ground rules, such as not sharing personal information; not responding to inappropriate, hurtful or frightening messages; and not arranging to meet an online contact in person without your permission. Tell your child to let you know if an unknown person makes contact through a social networking site. Report online harassment or inappropriate senders to your service provider and local authorities, if necessary.

• Reach out. Meet the families in your neighborhood, including parents and children. Develop a network of supportive family and friends. If a friend or neighbor seems to be struggling, offer to babysit or help in another way. Consider joining a parent support group so that you have an appropriate place to vent your frustrations.