Child maltreatment (child abuse) : Symptoms, Diagnosis and Management

Child maltreatment (child abuse) : Symptoms, Diagnosis and Management

Child maltreatment is abuse to children under 18 years of age by a parent, caregiver, or another person in a custodial role (e.g., clergy, coach, teacher). World Health Organization (WHO) defines child maltreatment as all types of physical and/or emotional ill-treatment, sexual abuse, neglect, negligence and commercial or other exploitation, which results in actual or potential harm to the child’s health, survival, development or dignity in the context of a relationship of responsibility, trust or power. Child maltreatment can be distinguished in to:

Physical abuse, that is intentional use of physical force against a child such as inflicting physical injury by hitting, beating, shaking, biting, scalding, burning, kicking, poisoning and suffocating.

Sexual abuse involves engaging a child in sexual acts. It includes fondling, rape, and exposing a child to other sexual activities.

Emotional and psychological abuse refers to behaviors that harm a child’s self-worth or emotional well-being such as name calling, shaming, rejection, withholding love, and threatening.

Neglect is the failure to meet a child’s basic needs. These needs include housing, food, clothing, education, and access to medical care.

Child maltreatment is a global problem with serious life-long consequences. International studies reveal that 20% of women and 5–10% of men report being sexually abused as children, while 25–50% of all children report being physically abused. Additionally, many children are subject to emotional abuse (sometimes referred to as psychological abuse) and to neglect. Every year, there are an estimated 41000 homicide deaths in children below 15 years of age (WHO).

In Asia due to high population density, poverty, illiteracy, caste system and landlessness, lack of economic opportunities, rural-urban migration, population growth, political instability and weak implementation of legal provisions the issues of child labour and child sexual exploitation are high.

Now that the scale and impact of all forms of violence against children is becoming better known, children must be provided with the effective prevention and protection to which they have an unqualified right.


Specific signs and symptoms depend on the type of abuse and can vary. Symptoms can be physical, psychological, or both.

Physical signs:

  • unexplained bruises on the face, throat, upper arms, buttocks, thighs or lower back in unusual patterns or shapes,
  • unexplained burns, cigarette burns, especially burns found on palms, soles of feet, abdomen, buttocks; immersion burns producing “stocking” or “glove” marks on hands and feet; “doughnut shaped” on buttocks or genital area,
  • infected burns indicating delay in treatment; burns in the shape of common household utensils or appliances.

Children who are sexually abused may:

  • stay away from certain people,
  • show sexual behaviour that’s inappropriate for their age,
  • have physical symptoms.

If a child looks or acts as older than their age or, a child develops more slowly than others of similar age with no physical or learning disability this could be cause of concern.

Along with physical signs certain general symptoms may be:

Withdrawn, behave differently, anxious, depressed, problem sleeping, eating disorders, wets the bed, soil the clothes, take risks, misses school, changing in eating habits, obsessive behavior, nightmares ,drug and alcohol misuse.


Some factors can increase the risk for abuse or neglect. The presence of these factors does not always mean that maltreatment will occur.

Risk factors for victimization: Child

  • Children younger than 4 years of age or an adolescent,
  • unwanted, or failing to fulfill the expectations of parents,
  • special needs that may increase caregiver burden (e.g., disabilities, mental retardation, and chronic physical illnesses).

Risk Factors for Perpetration:

Individual Risk Factors: Parent or caregiver

  • A number of characteristics of a parent or caregiver may increase the risk of child maltreatment. These include:
  • having been maltreated themselves as a child,
  • misusing alcohol or drugs, including during pregnancy,
  • physical/mental illness such as depression or post-traumatic disorder,
  • being involved in criminal activity,
  • parents’ lack of understanding of children’s needs, child development and parenting skills,
  • parental characteristics such as young age, low education, single parenthood, large number of dependent children, and low income,
  • non-biological, transient caregivers in the home (e.g., mother’s male partner).

Family environment: Relationship difficulties within families or among intimate partners, friends and peers may increase the risk of child maltreatment. These include:

  • physical, developmental or mental health problems of a family member,
  • family breakdown or violence between other family members,
  • being isolated in the community or lacking a support network,
  • a breakdown of support in child rearing from the extended family.

Community and societal factors: A number of characteristics of communities and societies may increase the risk of child maltreatment. These include:

  • gender and social inequality,
  • lack of adequate housing or services to support families and institutions,
  • high levels of unemployment or poverty,
  • the easy availability of alcohol and drugs,
  • on-going community violence, and weak social connections between neighbours,
  • social and cultural norms that promote or glorify violence towards others, support the use of corporal punishment, demand rigid gender roles, or diminish the status of the child in parent–child relationships.


If there is suspicion of child abuse a detailed account of the events leading to the injury should be obtained and documented. The child should be fully undressed, and the whole body should be examined thoroughly, including the anogenital region. The growth parameters should also be measured. Child abuse may be suspected when-

  • The injury is unusual or is not likely to be an accident, especially for the child’s age.
  • The parents or caregivers say no one saw the injury happen.
  • Similar injuries or patterns of neglect have occurred in the past also.
  • The parents or caregivers are reluctant to take medical advice.
  • The parents or caregivers don’t have a good explanation, or the explanation changes.
  • The doctor finds signs of sexual abuse.

 The following tests can reveal type of injuries-

  • Blood tests for detecting bleeding disorder or organ damage
  • Eye examination
  • Specialized test for samples taken such as skin, hair, fluid
  • Bone X-ray- all of the child bones, including the skull,
  • Ultrasonography
  • MRI (Magnetic Resonance Imaging) or CT scan(computerized tomography)



If child abuse is suspected, report it immediately to concerned person.

Early detection of child maltreatment and early intervention can help to minimize the likelihood of further violence and the long-term health and social consequences.

Medical management can range from inpatient care to outpatient treatment with close follow-up by a physician, a social worker, and child protective services.


Consequences of child maltreatment

Child maltreatment causes suffering to children and families and can have long-term consequences. As adults, maltreated children are at increased risk for behavioural, physical and mental health problems such as:

  • perpetrating or being a victim of violence
  • depression
  • smoking
  • obesity
  • high-risk sexual behaviours
  • unintended pregnancy
  • alcohol and drug misuse

Maltreatment through these behavioural and mental health consequences can contribute to heart disease, cancer, suicide and sexually transmitted infections along with an individual and social economic impact.


Child abuse and neglect is one of the nation’s most serious concerns. The ultimate goal is to stop child maltreatment before it starts. Strategies that promote safe, stable, and nurturing relationships (SSNRs) and environments for children and families are key factors to protecting against maltreatment and other harmful childhood experiences. However, community /schools/ institutions are also responsible for the care and protection of children. The prevention strategies for child abuse include multi-component interventions:

Protective factors for children

  • Sensitize the child about abuse/maltreatment. Families and schools can teach children about sexual abuse as:
  • body ownership
  • the difference between good and bad touch
  • how to recognize abusive situations
  • how to say “no”
  • how to disclose abuse to a trusted adult, do not keep it for yourself.
  • Awareness about Telephonic help lin


  • Stay safe on line-The internet and social media provide incredible opportunities for children to learn, participate and socialise but they also bring significant challenges for the protection of children from abuse and violence.
  • Provide outreach services to street children through bridge education, night shelters and vocational skills, so as to get them off the streets, reduce their vulnerability and enable them to sustain themselves.

Family protective factors

  • Good parent-child relationships by teaching positive parenting skills like good communication, appropriate discipline, and response to children’s physical and emotional needs.
  • Stable family relationships.
  • Parental employment.
  • Adequate housing.
  • Access to health care and social services- visits by nurses  to parents and children in their homes to provide support, education, and information.

Community protective factors-

  • Community should support parents and take responsibility for preventing abuse, gender equity, awareness on child rights and child protection issues.
  • Child protection mechanisms at village, block, district and state levels which involve parents, elected representatives of urban and rural local bodies, teachers, anganwadi workers, medical practitioners, police and social workers and responsible members of public.
  • Capacity enhancement and skill up-gradation of those who are already working in this sector;
  • Programmes to prevent child maltreatment such as programme to prevent corporal punishment in schools, child sexual abuse.