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. Sexual child abuse is any sexual activity with a child, such as fondling, oral-genital contact, intercourse, exploitation or exposure to child pornography.
• 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, shelter, 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. He or she 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
• An apparent lack of supervision
• Frequent absences from school
• Reluctance to leave school activities, as if he or she doesn't want to go home
• Attempts at running away
• 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.

Physical abuse signs and symptoms

• Unexplained injuries, such as bruises, fractures or burns
• Injuries that don't match the given explanation

Sexual abuse signs and symptoms

• Sexual behavior or knowledge that's inappropriate for the child's age
• Pregnancy or a sexually transmitted infection
• Blood in the child's underwear
• Statements that he or she was sexually abused
• Inappropriate sexual contact with other children

Emotional abuse signs and symptoms

• Delayed or inappropriate emotional development
• Loss of self-confidence or self-esteem
• Social withdrawal or a loss of interest or enthusiasm
• Depression
• Avoidance of certain situations, such as refusing to go to school or ride the bus
• Desperately seeks affection
• A decrease in school performance or loss of interest in school
• Loss of previously acquired developmental skills

Neglect signs and symptoms

• Poor growth or weight gain or being overweight
• Poor hygiene
• Lack of clothing or supplies to meet physical needs
• Taking food or money without permission
• Hiding food for later
• Poor record of school attendance
• Lack of appropriate attention for medical, dental or psychological problems or lack of necessary follow-up care

Parental behavior

Sometimes a parent's demeanor or behavior sends red flags about child abuse. Warning signs include a parent who:

• Shows little concern for the child
• Appears unable to recognize physical or emotional distress in the child
• Blames the child for the problems
• Consistently belittles or berates the child, and describes the child with negative terms, such as "worthless" or "evil"
• Expects the child to provide him or her with attention and care and seems jealous of other family members getting attention from the child
• Uses harsh physical discipline
• Demands an inappropriate level of physical or academic performance
• Severely limits the child's contact with others
• Offers conflicting or unconvincing explanations for a child's injuries or no explanation at all

Child health experts condemn the use of violence in any form, but some people still use corporal punishment, such as spanking, as a way to discipline their children. Any corporal punishment may leave emotional scars. Parental behaviors that cause pain, physical injury or emotional trauma — even when done in the name of discipline — could be child abuse.

When to see a doctor

If you're concerned that your child or another child has been abused, seek help immediately. Depending on the situation, contact the child's doctor or health care provider, a local child protective agency, the police department, or a 24-hour hotline such as Childhelp National Child Abuse Hotline (1-800-422-4453).

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

Keep in mind that health care professionals are legally required to report all suspected cases of child abuse to the appropriate county authorities or the police.

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. Below are some examples.

Physical issues

• Premature death
• Physical disabilities
• Learning disabilities
• Substance abuse
• Health problems, such as heart disease, immune disorders, chronic lung disease and cancer

Behavioral issues

• Delinquent or violent behavior
• Abuse of others
• Withdrawal
• Suicide attempts or self-injury
• High-risk sexual behaviors or teen pregnancy
• Problems in school or not finishing high school
• Limited social and relationship skills
• Problems with work or staying employed

Emotional issues

• Low self-esteem
• Difficulty establishing or maintaining relationships
• Challenges with intimacy and trust
• An unhealthy view of parenthood
• Inability to cope with stress and frustrations
• An acceptance that violence is a normal part of relationships

Mental health disorders

• Eating disorders
• Personality disorders
• Behavior disorders
• Depression
• Anxiety disorders
• Post-traumatic stress disorder (PTSD)
• Sleep disturbances
• Attachment disorders

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. For example:

• Offer your child love and attention. Nurture your child, listen and be involved in his or her 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 foster your child's self-esteem and sense of 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 doctor or 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 — and to tell 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 the episode. 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, and check your child's privacy settings on social networking sites. Consider it a red flag if your child is secretive about online activities. Cover 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. Consider joining a parent support group so that you have an appropriate place to vent your frustrations. 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.

If you worry that you might abuse your child

If you're concerned that you might abuse your child, seek help immediately. These organizations can provide information and referrals:

• 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)

Or you can start by talking with your family doctor or health care provider. He or she may offer a referral to a parent education class, counseling or a support group for parents to help you learn appropriate ways to deal with your anger. If you're abusing alcohol or drugs, ask your doctor about treatment options.

If you were abused as a child, get counseling to ensure you don't continue the abuse cycle or teach those destructive behaviors to your child.

Remember, child abuse is preventable — and often a symptom of a problem that may be treatable. Ask for help today.

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 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)

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.