Child Maltreatment

Each year, hundreds of thousands of children in the United States are victims of one or more types of maltreatment, which include physical abuse, sexual abusepsychological maltreatment, and neglect. The Children’s Bureau has collected and analyzed data concerning child maltreatment for more than two decades, and revealed the following statistics in its 2010 annual report.

  • Child protective services (CPS) agencies received an estimated 3.3 million referrals (or reports) involving the alleged maltreatment of approximately 5.9 million children. 
  • Professionals made three-fifths of the reports, with the greatest number coming from teachers, law enforcement, legal personnel, and social services staff.
  • Of the 1.8 million reports that received an investigation, 24.2 percent (or 436,321 children) were substantiated, meaning CPS agencies found that those children experienced, or were likely to have experienced, abuse or neglect.
  • Victimization was split almost evenly between genders, and the highest rate of victimization was for children from birth to 1 year old.
  • African American children made up 21.9 percent of victims; Hispanic, 21.4 percent; and White, 44.8 percent.
  • 408,425 children were in foster care at the end of the fiscal year; the average age was 9.2 years, and the average stay in foster care was 14 months.
  • More than 80 percent of perpetrators (or abusers) were biological parents or stepparents, and another 6.1 percent were other relatives of the victim.

There are a variety of risk and protective factors in a child's life that can either contribute to or help decrease their risk of experiencing maltreatment. In addition to discussing those factors, this section looks at how individuals who suspect child abuse or neglect is taking place should handle reporting suspected maltreatment. Finally, it discusses the various consequences of child maltreatment that can happen to those children who experience it.

Types of Maltreatment

There are four commonly recognized forms of child maltreatment: neglect (including medical neglect), physical abusesexual abuse, and psychological maltreatment. These may be found separately or in any combination.  For fiscal year 2010, the breakdown of substantiated maltreatment for child victims is as follows.

  • 78.3 percent neglect
  • 17.6 percent physical abuse
  • 9.2 percent sexual abuse
  • 8.1 percent psychological maltreatment
  • 2.4 percent medical neglect
  • 10.3 percent other, such as abandonment or threats of harm to the child

Note that the sum of these percentages is more than 100 percent because children may have experienced more than one type of maltreatment.

There is no single, universally applied definition of child abuse and neglect.  While legal definitions describing the different forms of child maltreatment, as well as guidelines for reporting suspected maltreatment and criminal prosecutions, are found mainly in state statutes, the guidelines for accepting reports, conducting an investigation, and providing interventions may vary not only from state to state, but county to county.

Despite these differences, there are some commonalities.  The Child Abuse Prevention and Treatment Act (CAPTA) provides minimum federal standards for states to use when defining physical child abuse, child neglect, and sexual abuse if states choose to receive federal funds under the CAPTA state grant program.  Under CAPTA, child abuse and neglect means:

  • Any recent act or failure to act on the part of a parent or caretaker that results in death, serious physical or emotional harm, sexual abuse, or exploitation
  • An act or failure to act that presents an imminent risk of serious harm

This definition refers specifically to parents and other caregivers.  Under this definition, a child generally means someone under the age of 18 or someone who is not an emancipated minor.  In sexual abuse cases, a child is someone who is under 18 or the age specified by the state’s child protection law where he or she lives, whichever is younger.

While CAPTA provides definitions for sexual abuse and special cases related to withholding medical treatment, it does not provide specific definitions for physical abuse, neglect, or psychological maltreatment.  Each state provides the specific definitions for those and may expand upon the CAPTA definitions for sexual abuse and withholding of medical treatment.


Child neglect is the most common form of child maltreatment, comprising more than 75 percent of victims.  It is usually defined by omissions in care that may result in significant harm or the risk of significant harm and is characterized by the failure of a parent or caregiver to provide for the child’s basic needs.  Examples of neglect include:

  • Physical, such as the failure to provide necessary food, shelter, or supervision
  • Medical, such as the failure to provide necessary medical or mental health treatment
  • Educational, such as the failure to educate a child or attend to his or her special education needs
  • Emotional, such as inattention to a child’s emotional needs or psychological care or letting the child use alcohol or drugs

Sometimes cultural values, the standards of care in the community, and poverty may be contributing factors in what is considered neglect and how child protective service agencies respond.  State laws often exclude charges of neglect when a parent or caregiver cannot meet a child’s needs because of poverty or an inability to provide.  When a family fails to use information and resources, and the child's health or safety is at risk, child welfare intervention may be required.

The issue of medical neglect can sometimes be complicated.  The Child Abuse Prevention and Treatment Act (CAPTA), in part, defines the withholding of medically indicated treatment as the “failure to respond to the infant's life-threatening conditions by providing treatment…which, in the treating physician's reasonable medical judgment, will be most likely to be effective in ameliorating or correcting all such conditions.”  Many states, as allowed by CAPTA, provide an exception to this definition of neglect for parents who choose not to seek medical care for their children due to religious beliefs that may prohibit medical intervention.

Physical Abuse

Physical abuse is nonaccidental physical injury that is inflicted by a parent, caregiver, or other person who has responsibility for the child.  Such injury is considered abuse regardless of whether or not the caregiver intended to hurt the child and can result from severe discipline or physical punishment that is inappropriate to the child's age or condition.  Physical abuse may occur as the result of a single episode or of repeated episodes and can range in severity from minor marks and bruising to death. 

Sexual Abuse

Child sexual abuse generally refers to sexual acts, sexual exploitation, or sexually motivated behaviors involving children.  It includes both touching offenses, such as fondling or sexual intercourse, and nontouching offenses, such as exposing a child to pornographic materials.  It can also involve varying degrees of violence and emotional trauma. 

The Child Abuse Prevention and Treatment Act (CAPTA) defines sexual abuse as the “employment, use, persuasion, inducement, enticement, or coercion of any child to engage in, or assist any other person to engage in, any sexually explicit conduct or simulation of such conduct for the purpose of producing a visual depiction of such conduct” and the “rape, and in cases of caretaker or inter-familial relationships, statutory rape, molestation, prostitution, or other form of sexual exploitation of children, or incest with children.”

Note that the most commonly reported cases of child sexual abuse involve incest, which is sexual abuse occurring among family members.

Psychological Maltreatment

Psychological maltreatment (also called emotional abuse) is a repeated pattern of parental or caregiver behavior that communicates to the child that he or she is worthless, unloved, unwanted, or endangered.  This behavior can impair a child’s emotional development or sense of self-worth.  It may include constant criticism, threats, rejection, or the withholding of love, support, or guidance.

To warrant intervention, psychological maltreatment must be sustained and repetitive.  This type of maltreatment is often difficult to prove.  Therefore, child protective services agencies may not be able to intervene without evidence of harm to the child.  Psychological maltreatment, however, is almost always present when other forms of abuse and neglect are found.

Risk and Protective Factors

There is no single known cause of child abuse and neglect; it occurs across all socioeconomic, religious, cultural, racial, and ethnic groups.  However, researchers have identified several factors that may contribute to maltreatment (risk factors) or help prevent it (protective factors).  These include environmental supports, such as family income and community organization, as well as personal characteristics, such as temperament, identity development, and genetic and neurobiological influences. 

A greater understanding of risk factors can help those working with children and families to identify maltreatment and high-risk situations and to intervene appropriately.  Additionally, addressing both risk and protective factors can help to prevent child abuse and neglect or its recurrence.  Prevention programs may focus on increasing social supports for families (thereby reducing the risk of social isolation), for example, or on providing parent education to improve parents' expectations that are age-appropriate for their children.

Risk Factors

Children in families and environments with risk factors have a higher likelihood of experiencing maltreatment, but that does not mean that these factors will always result in child abuse and neglect.  The factors that contribute to maltreatment in one family may not do so in another.  While researchers have noted a relationship between poverty and maltreatment, for example, most people living in poverty do not harm their children.  It is important to recognize the multiple, complex causes of the problem and to tailor assessments and interventions for children and their families to their specific needs and circumstances.

Risk factors can be grouped into four domains:

  • Parent or caregiver, including personality characteristics and psychological well-being, substance abuse, history of maltreatment, and age
  • Family, such as marital conflict, domestic violence, single parenthood and/or boyfriends in the home, financial stress, and social isolation
  • Child, such as age, development, and special needs
  • Environmental, including poverty, unemployment, and community characteristics including, for example, violent neighborhoods

Protective Factors

Protective factors are those that may help protect families from vulnerabilities and help promote resilience.  These include:

  • Nurturing and attachment (developing a bond with a caring adult)
  • Knowledge of parenting and child development (understanding how children grow and develop)
  • Parental resilience (having the ability to handle everyday stressors and recover from occasional crises)
  • Social connections (having trusted and caring family and friends who provide emotional support)
  • Concrete support for parents (accessing basic resources, such as food, clothing, housing, transportation; services that address family-specific needs, such as child care and health care; and social services, such as for mental health and substance abuse treatment or domestic violence)
  • Social and emotional competence of children (having the right tools for healthy emotional expression)
For more information on these factors and how child welfare agencies and others can promote them in families, see the 2012 Resource Guide: Preventing Child Maltreatment and Promoting Well-Being: A Network for Action.

Reporting Suspected Maltreatment

The reporting of suspected abuse and neglect may be voluntary or mandatory.  Those who report alleged maltreatment are usually grouped into either the professional or nonprofessional category.  Professionals are people who encountered the child as part of their occupation, such as child daycare providers and medical personnel.  Nonprofessionals are people such as friends, relatives, and neighbors who did not have a relationship with the child based on their occupation. 

State statutes all include mandated reporting statutes that require certain individuals, called mandatory reporters, to identify maltreated children and to help protect them from harm.  Those designated as mandatory reporters are usually professionals who typically have frequent contact with children, including:

  • Social workers
  • Teachers and other school personnel
  • Physicians and other health-care workers
  • Mental health professionals
  • Child care providers
  • Medical examiners or coroners
  • Law enforcement officers

In about a third of the states, any person who suspects child abuse and neglect is required to report it.

The actual circumstances under which a mandatory reporter must make a report vary from state to state.  Typically, a report must be made when the reporter, in his or her official capacity, suspects or has reason to believe that a child has been abused or neglected, or when the reporter has knowledge of or observes a child being subjected to conditions that could reasonably result in harm to the child.  All states, the District of Columbia, and all U.S. territories have enacted statutes requiring that the maltreatment of children be reported to a designated agency or official. 

Of course, anyone who suspects child maltreatment can report it.  Most states maintain toll-free telephone numbers for receiving reports of abuse or neglect, which can be made anonymously by non-mandatory, or volunteer, reporters.  States do find it helpful to their investigations, however, to know the identity of reporters and will keep that information confidential if possible.  Approximately 18 states, the District of Columbia, American Samoa, Guam, and the Virgin Islands require mandatory reporters to provide their names and contact information, either at the time of the initial oral report or as part of a written report.

To receive federal grants under the Child Abuse Prevention and Treatment Act (CAPTA), states must establish provisions for immunity from liability for individuals making good-faith reports, which are reports that, to the best of the reporter's knowledge, are not deliberately false or made as an act of malice.  This protects reporters from civil or criminal liability that they might otherwise incur, even if the report is unsubstantiated.  A report of suspected maltreatment begins the case process by which child protective services agencies work to ensure the safety of children.

Consequences of Child Maltreatment

The consequences of child maltreatment can be profound and may last long after the abuse or neglect occurs.  The effects can appear in childhood, adolescence, or adulthood and may affect every aspect of an individual's development -- physical, cognitive, psychological, societal, and behavioral.  While the effects of child abuse and neglect are often discussed in terms of these specific categories, it is not truly possible to separate them completely.  Physical consequences, such as damage to a child's growing brain, for example, can have psychological implications as well, including cognitive delays, emotional difficulties, depression, or anxiety.  These might then manifest as high-risk or violent behaviors, such as an increased likelihood to smoke, abuse alcohol or illicit drugs, or overeat.

While research differs on the effects of trauma on a child's cognitive development, verbal abilities, and problem-solving skills, it has consistently found that maltreatment increases the risk of lower academic achievement and problematic school performance.  Physical abuse, sexual abuse, neglect, and psychological maltreatment can all affect a child's emotional and psychological well-being and lead to behavioral problems.  These emotional and psychological issues may appear immediately or years later and can involve behaviors that range from passive and withdrawn (internalizing) to active and aggressive (externalizing).  Maltreated children who developed insecure attachments to caregivers may become more mistrustful of others and experience difficulties in understanding the emotions of others, regulating their own emotions, and forming and maintaining relationships with peers.  Victims of child maltreatment are also more likely to engage in juvenile delinquency, adult criminality, and violent behavior.

Physically abused children, followed closely by neglected children, were the most likely to be arrested later for violent crime.  The health and physical effects of abuse include the immediate effects of bruises, burns, lacerations, and broken bones, as well as the longer-term effects of brain damage, hemorrhages, and permanent disabilities.  There can also be severe negative effects on a child's physical development resulting from physical trauma such as blows to the head or body, violent shaking, scalding with hot water, or asphyxiation, as well as from neglect such as inadequate nutrition, lack of adequate motor stimulation, or the withholding of medical treatments.

It is important to note that while maltreated children will have a higher risk of certain problems, not all of them will necessarily suffer severe or long-term consequences.  A number of factors may influence the effects of maltreatment, including the child's age and developmental status at the time of the maltreatment, as well as the type, frequency, duration, and severity of the maltreatment and co-occurring problems.  So, while the risk is higher, most abused and neglected children will not become delinquent, experience problem behaviors, or become involved in violent crime.