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Harvard Commentaries
Harvard Commentaries
Reviewed by the Faculty of Harvard Medical School

A Parent's Life A Parent's Life

Preventing Child Abuse

September 12, 2013

By Henry H. Bernstein D.O.

Child abuse is an enormous problem, affecting all socioeconomic, cultural, racial and religious groups. In the United States alone, there are more than 3 million reports of suspected child abuse each year, with one-third of these being confirmed cases. There may well be many more cases that are not even reported.

What Is Child Abuse?

Child abuse refers to the mistreatment of a child by another person. Legal definitions vary from state to state, but generally include:

  • Physical abuse: Deliberate (done on purpose) physical contact that causes significant pain, ends up in injury or jeopardizes the child's safety. It includes hitting, kicking, biting, shoving, shaking and burning.
  • Sexual abuse: Involvement of a child in any act meant to satisfy an adult's sexual needs. It includes both sexual assault (with physical contact) and sexual exploitation (using a child to help satisfy another adult's sexual needs).
  • Neglect: When a caretaker does not provide for a child's basic emotional or physical needs, such as food, shelter, clothing, health care and education. It includes poor supervision, not taking a child for medical care, not giving the right kind of affection, and abandonment.
  • Emotional abuse: Generally refers to behaviors that interfere with a child's emotional health or social development. Emotional abuse can occur with or without other forms of abuse, and includes verbal abuse, inattention, rejection and terrorization.

Where Does Child Abuse Happen?

Child abuse usually happens in the child's home. Usually, the abuser is someone the child knows, such as a parent, neighbor or relative. Children who are at the greatest risk of abuse have caregivers who feel isolated or inadequate, who are teenagers, or who have problems with depression, alcohol or drugs. Other things that may put a child at an increased risk of child abuse include being less than 1 year of age, being born prematurely or with low birth weight, having medical problems, living in a poorer community, or being a boy, a twin or a stepchild.

Detecting abuse can be difficult, because it is often hard to know when normal parenting ends and abuse begins. Caring for children of all ages can be stressful, and caregivers may lose their temper from time to time. However, parenting "styles" that appear include physical or emotional punishment, such as hitting or not recognizing the good things a child has done, deserve evaluation.

What Can You Do?

You can help to prevent child abuse, in your own home and your community.

In your home:

  • Nurture your child. Spend time talking with your child every day and let the child know that you love him or her.
  • Take care of yourself. Get enough sleep, eat right, and exercise regularly.
  • Take some time for yourself if you need it. Hire a sitter, exchange babysitting with another parent, or ask a trusted relative or friend to baby-sit occasionally, so you can take a break from your child.
  • Be prepared for stress, and find ways to manage it. Know that parenting can be frustrating, and you will feel angry with your child at times. If you start to feel overwhelmed, do not take it out on your child. Put your child in a safe place and go into another room to cool down: Play relaxing music, take a warm shower, or just sit quietly for a few minutes. Many people find exercise or their favorite hobby to be very helpful in managing their own stress.
  • Talk it through. It can be helpful to talk about parenting stresses with friends and relatives who also are parents, or to join a local parenting support group.
  • Teach your child. Encourage your child to share any concerns and problems with you. Explain to your child that his or her body belongs only to him or her, and that the child has the right to say no to anyone who might try to touch him or her.

In your community:

  • Help a parent. Offer to baby-sit, for even an hour or two, so the parent(s) can rest or spend a little time together.
  • Support local prevention efforts. Promote school, neighborhood and community programs that teach prevention to parents and children. Help to develop parenting resources at your local library. Volunteer at a local child-abuse prevention program.
  • Support social services. Community programs that improve housing, education, transportation and safety often help to increase self-esteem and reduce isolation and substance abuse within families.
  • Report suspected abuse. If you suspect that a child you know is being abused in any way, do something about it. Contact your local child protective services agency, emergency hotline, or police department.

Henry H. Bernstein, D.O., is a Senior Lecturer in Pediatrics at Harvard Medical School. In addition, he is chief of General Academic Pediatrics at Children's Hospital at Dartmouth and Professor of Pediatrics at Dartmouth Medical School. He is the former associate chief of General Pediatrics and director of Primary Care at Children's Hospital Boston.

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