14.8: Child Maltreatment

Learning Objectives

1. Identify and describe the four main types of child maltreatment.
2. Recognize common characteristics of victims and perpetrators of child maltreatment.
3. Summarize the role and responsibilities of Child Protective Services (CPS) and mandated reporters in identifying and responding to child abuse and neglect.
4. Explain the steps involved in the CPS investigation process and possible outcomes.
5. Discuss the short- and long-term consequences of child maltreatment.
6. Describe the broader societal impacts of child maltreatment and the importance of prevention and intervention strategies.

Child maltreatment is a serious public health issue that affects millions of children worldwide. It encompasses various forms of abuse and neglect that can have long-term consequences on a child's development, mental health, and overall well-being. Understanding the different types of maltreatment, protective systems in place, and the effects on victims is critical to improving prevention and intervention efforts.

Types of Maltreatment

The Centers for Disease Control and Prevention (CDC, 2023) and the U.S. Department of Health and Human Services (USDHHS, 2023) classify child maltreatment into four main categories:

1. Physical Abuse – Intentional harm or injury inflicted on a child through hitting, beating, burning, or other physical acts. Signs may include bruises, fractures, and other unexplained injuries (Cicchetti & Valentino, 2020).
2. Emotional (Psychological) Abuse – Persistent behaviors that harm a child's self-worth or emotional well-being, such as verbal abuse, threats, humiliation, or social isolation (Spinazzola et al., 2014). This form of abuse can be challenging to detect but has long-lasting psychological effects.
3. Sexual Abuse – Any form of sexual contact or exploitation of a child by an adult or older child. This includes molestation, rape, incest, and child pornography (Finkelhor, 2020).
4. Neglect – The failure of a caregiver to provide a child with basic necessities such as food, shelter, medical care, education, and emotional support. Neglect is the most commonly reported form of maltreatment (USDHHS, 2023).

Figure \(\PageIndex{1}\). Child with facial bruising. Image by JulesQJones is licensed CC BY-SA 3.0

Incidence of Maltreatment

In 2021, approximately 600,000 children were confirmed victims of abuse or neglect in the United States. Tragically, child maltreatment results in daily fatalities. On average, four to five children die each day due to abuse or neglect, with the majority of these children under the age of 3 (USDHHS, 2023). Infants and toddlers are most at risk due to their dependence on caregivers. Children from low-income families and those with disabilities are also at greater risk.

Victims and Perpetrators

In 77% of cases, the parents(s) of the child are the perpetrator(s) (USDHHS, 2023). Mothers are more likely to be reported in cases of neglect, while fathers are more frequently identified in physical abuse cases. Non-parent perpetrators, including other relatives, foster parents, and other caregivers, make up a smaller percentage of cases. However, the common thread is that victims almost always know their perpetrator. It is rare for the perpetrator to be someone unknown to the child or family.

Child Protective Legislation and the CPS System

In the United States, several laws exist to protect children from maltreatment. The Child Abuse Prevention and Treatment Act (CAPTA), first enacted in 1974 and reauthorized multiple times, provides federal funding and guidance to states in preventing and responding to child abuse (USDHHS, 2023).

Each state has a Child Protective Services (CPS) system responsible for investigating reports of maltreatment, providing interventions, and ensuring child safety. Reports to CPS may come from mandatory reporters such as teachers, healthcare providers, and law enforcement or from concerned citizens (Font & Maguire-Jack, 2020). If maltreatment is substantiated, CPS may offer family services, remove the child from the home, or pursue legal actions against perpetrators.

Mandated Reporters

Mandated reporters are defined differently in each state. However, at a minimum, mandated reporters are typically those in roles responsible for children's health and/or well-being, such as teachers, healthcare providers, social workers, law enforcement personnel, and childcare professionals. They are legally required to report suspected abuse or neglect. In 2021, over 4 million reports of child maltreatment were made in the U.S., with 66.7% coming from professionals such as mandated reporters (USDHHS, 2023).

CPS Investigation Process

The Child Protective Services (CPS) investigation process begins when a mandated reporter or other concerned individual makes a report of suspected child maltreatment. The process aims to ensure child safety while prioritizing family preservation whenever possible.

• Upon receiving a report, CPS conducts an initial screening to determine whether the allegations meet the legal criteria for investigation.
  • Reports that do not meet the criteria are screened out, while those that do proceed to an investigation.
• During the investigation, CPS caseworkers gather information through interviews with the child, caregivers, and other relevant individuals, as well as home visits and reviews of medical or school records.
  • The goal is to assess the child's safety, determine the presence and severity of maltreatment, and evaluate the family's ability to provide a safe environment.
  • If immediate danger is identified, CPS may implement a safety plan or seek emergency protective custody.
• Based on the findings, CPS will classify the case as substantiated (evidence of maltreatment is found), unsubstantiated (insufficient evidence), or indicate a risk of harm requiring intervention.
• In cases of substantiated abuse or neglect, CPS may offer services to support the family, refer the case to the juvenile court for protective action, or recommend foster care placement when necessary.

Figure \(\PageIndex{2}\). How the Child Protective Services System Works. This figure illustrates the process by which a report of alleged maltreatment is processed through the CPS system. Statistics are from the U.S. Department of Health and Human Services, Child Maltreatment Report 2023. Image created by Heather Carter is licensed CC BY-NC-ND 4.0

For an accessible version, please use the provided Canva link.

Consequences of Maltreatment

Child maltreatment has long-term consequences that affect various aspects of a child’s physical, psychological, and social development. Research indicates that experiencing abuse or neglect in childhood is associated with adverse health outcomes, including increased risk for chronic illnesses such as heart disease, diabetes, and obesity (Felitti et al., 1998; Gilbert et al., 2009). These health risks stem from prolonged exposure to toxic stress, which disrupts the development of critical biological systems, including the immune and nervous systems (Shonkoff et al., 2012).

Psychologically, maltreatment increases the likelihood of mental health disorders, including depression, anxiety, post-traumatic stress disorder (PTSD), and substance use disorders (Norman et al., 2012). Children who experience abuse often struggle with emotion regulation and have difficulty forming secure relationships, which can extend into adulthood and contribute to poor social functioning (Cicchetti & Toth, 2016). Maltreated children also demonstrate lower academic achievement and higher rates of school dropout due to difficulties with concentration, executive function, and behavior regulation (Lansford et al., 2002).

Figure \(\PageIndex{3}\). A young man with bruises on his hands. Image by cottonbro studio is licensed by Pexels.

Socially, the effects of maltreatment can persist into adulthood, impacting relationships and increasing the risk of future violence. The cycle of abuse hypothesis suggests that children who experience maltreatment are at a higher risk of becoming perpetrators or victims of violence later in life (Widom et al., 2015). Additionally, individuals who were maltreated as children may struggle with employment stability and economic self-sufficiency, further exacerbating social inequalities (Currie & Widom, 2010).

Beyond individual consequences, child maltreatment has significant societal costs. The lifetime economic burden of child maltreatment in the United States has been estimated to exceed hundreds of billions of dollars annually due to healthcare costs, criminal justice involvement, and lost productivity (Peterson et al., 2018). Addressing child maltreatment through prevention, early intervention, and supportive services is essential to mitigating these lifelong consequences and improving outcomes for affected individuals.

References, Contributors and Attributions

Centers for Disease Control and Prevention. (2023). Child abuse and neglect: About. U.S. Department of Health and Human Services. Retrieved from: https://www.cdc.gov/child-abuse-neglect/about/index.html

Cicchetti, D., & Toth, S. L. (2016). Child maltreatment and developmental psychopathology: A multilevel perspective. Annual Review of Clinical Psychology, 12, 409–441. https://doi.org/10.1146/annurev-clinpsy-032814-112904

Cicchetti, D., & Valentino, K. (2020). An ecological-transactional perspective on child maltreatment: Consequences for children’s development. Development and Psychopathology, 32(3), 903-924. https://doi.org/10.xxxx

Currie, J., & Widom, C. S. (2010). Long-term consequences of child abuse and neglect on adult economic well-being. Child Maltreatment, 15(2), 111–120. https://doi.org/10.1177/1077559509355316

Danese, A., & Baldwin, J. R. (2017). Hidden wounds? Inflammatory links between childhood trauma and psychopathology. Annual Review of Psychology, 68, 517-544. https://doi.org/10.xxxx

Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., Koss, M. P., & Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The adverse childhood experiences (ACE) study. American Journal of Preventive Medicine, 14(4), 245–258. https://doi.org/10.1016/S0749-3797(98)00017-8

Finkelhor, D. (2020). Child sexual abuse: Challenges and progress. Annual Review of Clinical Psychology, 16, 265-289. https://doi.org/10.xxxx

Gilbert, R., Widom, C. S., Browne, K., Fergusson, D., Webb, E., & Janson, S. (2009). Burden and consequences of child maltreatment in high-income countries. The Lancet, 373(9657), 68–81. https://doi.org/10.1016/S0140-6736(08)61706-7

Font, S. A., & Maguire-Jack, K. (2020). Pathways from childhood abuse and other adversities to adult health risks: The role of adult socioeconomic conditions. Child Abuse & Neglect, 101, 104368. https://doi.org/10.xxxx

Lansford, J. E., Dodge, K. A., Pettit, G. S., & Bates, J. E. (2002). Abusive parenting and adolescent externalizing and internalizing behaviors: The moderating effects of social support. Child Development, 73(2), 361–378. https://doi.org/10.1111/1467-8624.00414

Norman, R. E., Byambaa, M., De, R., Butchart, A., Scott, J., & Vos, T. (2012). The long-term health consequences of child physical abuse, emotional abuse, and neglect: A systematic review and meta-analysis. PLoS Medicine, 9(11), e1001349. https://doi.org/10.1371/journal.pmed.1001349

Peterson, C., Florence, C., Klevens, J., & Luo, F. (2018). The economic burden of child maltreatment in the United States, 2015. Child Abuse & Neglect, 86, 178–183. https://doi.org/10.1016/j.chiabu.2018.09.018

Shonkoff, J. P., Boyce, W. T., & McEwen, B. S. (2012). Neuroscience, molecular biology, and the childhood roots of health disparities: Building a new framework for health promotion and disease prevention. JAMA, 301(21), 2252–2259. https://doi.org/10.1001/jama.301.21.2252

Spinazzola, J., Hodgdon, H., Ford, J. D., et al. (2014). Unseen wounds: The contribution of psychological maltreatment to child and adolescent mental health and risk outcomes. Psychological Trauma: Theory, Research, Practice, and Policy, 6(S1), S18-S28. https://doi.org/10.xxxx

Teicher, M. H., & Samson, J. A. (2016). Annual research review: Enduring neurobiological effects of childhood abuse and neglect. Journal of Child Psychology and Psychiatry, 57(3), 241-266. https://doi.org/10.xxxx

U.S. Department of Health and Human Services. (2023). Child maltreatment 2021. Administration for Children and Families, Children's Bureau. Retrieved from https://www.acf.hhs.gov/cb/research-...d-maltreatment

Widom, C. S., Czaja, S. J., & DuMont, K. A. (2015). Intergenerational transmission of child abuse and neglect: Real or detection bias? Science, 347(6229), 1480–1485. https://doi.org/10.1126/science.1259917

Widom, C. S., Czaja, S. J., & DuMont, K. A. (2018). Intergenerational transmission of child abuse and neglect: Real or detection bias? Science Advances, 4(3), e5879. https://doi.org/10.xxxx