Child Abuse, Child Neglect, and Health

Both child abuse and child neglect are worldwide problems that impair the health and welfare of children and adolescents. Consequences often impede children's growth and development, and effects can be chronic, sometimes affecting individuals throughout their lifetime. The World Health Organization first recognized child abuse as a major public health problem in 1997, indicating that its elimination is a relatively recent but vital addition to their agenda of improving human health and well-being across the globe.

Perpetration of child abuse and neglect is thought to result from a complex combination of individual, family, community, and societal factors. At the individual level, some characteristics of caregivers who abuse or neglect children include mental health problems, including substance abuse, and a caregiver's own history of witnessing violence or being a victim of child abuse or neglect in the past. At the family level, violence between adult caregivers is a risk for child abuse and neglect. High levels of stress from financial or employment problems are other family risk factors. At the community level, cultural norms[Page 168] about treatment and nurturing of children may affect the prevalence of child abuse and neglect. For example, widespread acceptance of high levels of community violence and/or use of severe physical punishment has been associated with higher prevalence of child abuse. However, social networks may protect children from abuse and neglect in that they help caregivers provide safer, healthier environments for children. At the societal level, countries engaging in wars or ongoing conflicts have rates of child abuse and neglect that escalate as the conflict grows and mass displacement occurs.

There is ongoing debate over how to define different types of child abuse and neglect in reliable, valid, and useful ways. Four general categories are currently recognized: (1) physical abuse, (2) sexual abuse, (3) neglect, and (4) emotional abuse. The most tragic consequence of child abuse and neglect is death of a child; in 1999, it was estimated that 1,100 children died from abuse and neglect in the United States, reflecting a rate of 1.62 children out of every 100,000 children in the population. This rate has remained stable since 1995.