Child Abuse: A Hidden Violence that Goes Unrecognized for Far Too Long

Beth Hawkes MSN, RN-BC - 03/21/19

Horrifyingly, violence against children happens everywhere, everyday. UNICEF termed its 2014 global report on violence against children “Hidden in Plain Sight”. Child abuse is not rare and it is not limited by society or location.

It is undocumented and underreported. There are many reasons why, and one of them is that it’s simply too painful to contemplate abuse of a vulnerable, dependent child or infant. Denial is in effect.  While most of us cannot tolerate seeing a dog or pet mistreated or abused, in many cases, violence against children is tacitly condoned, excused, and overlooked.

It’s hard to wrap our heads around two seemingly opposing thoughts - for example, that Michael Jackson was one of the greatest musical talents of all time, and that he was also a perverted child molester who systematically groomed and preyed upon young boys for his own satisfaction.

Violence against children goes unrecognized because of social acceptance, because of fear, and because of shame.

Children Suffer in Silence

Children themselves typically do not report abuse but instead tend to suffer shame and fear in isolation. Often even siblings in the same household experiencing the same abuse do not talk with each other about it. Even while feeling guilty and confused, children may deny the abuse and protect the abuser.

Depending on their age, children may not be able to understand the concept of abuse or realize that anything out of the ordinary is occurring to them. Young children being groomed and manipulated by a child predator, for example, do not understand that they are being used. Children who are routinely beaten or emotionally abused may believe that it’s a normal part of childhood.

Because of these reasons, children do not self-report but they will often demonstrate it through play and acting out. Anxiety and nightmares are signs of abuse.

Physical Abuse

Physical abuse is the infliction of physical harm, bodily injury, or corporal punishment. It can take the place of hitting, pinching, whipping, punching, biting, burning, shaking or poisoning. Abusers may use belts, cigarettes, or any object they can easily grab to beat a child. Shaking a baby and causing harm is also considered abuse. The most severe form of physical abuse is hitting a child about the face, head and ears, as in pediatric abusive head trauma. Still today, there are cultures that believe physical punishment is necessary to raise children properly. This is based on a belief that physical punishment, as a planned action to correct children’s behavior is not only acceptable but a sign of good parenting.

Sexual Abuse

Sexual abuse is when a child is coerced or seduced to participate in sexual activity for which they cannot give consent. It includes inducing or coercing a child to participate in sexual acts such as fondling, penetration, and exposure to pornographic activities. Indecent exposure and exploitation through pornographic activities are also considered to be sexual abuse.

Casting blame on the victim, such as blaming a girl for the way she dresses, is still prevalent in some societies. In the case of a sexual assault, victims can be helped by clinicians who collect forensic evidence.

Emotional Abuse 

Emotional abuse may be the least understood and most damaging form of abuse. Behaviors that characterize emotional abuse include: withdrawal of love or approval, emotional manipulation, psychological aggression, such as humiliation and threatening. It can include forcing a child to assume an adult role in the family.

  • Rejecting
  • Belittling
  • Withholding love
  • Shaming
  • Isolating the child is not allowed normal social contacts
  • Terrorizing Bullying and punishing
  • Ignoring the child is deprived of parental responsiveness
  • Verbally assaulting blaming, threatening, name-calling
  • Over pressuring- the child is pressured to achieve and perform
  • Denying emotional responsiveness

Emotional abuse reduces a child's self-worth and emotional well being without physically harming them. Children who have been emotionally abused feel unloved or unwanted, which can damage the child's emotional development and lead to lifelong problems.


Neglect is failure to meet a child's basic needs, including physical and emotional needs, housing, food, clothing, education, and medical care. Failure to adequately supervise children can be considered neglect, especially in children younger than age 12.

Whether or not failure to seek medical care for a child due to religious beliefs is considered child abuse varies from state to state.


Polyvictimization is when children suffer more than one kind of abuse, such as a young girl who is sexually violated by physical force and then threatened not to tell anyone.  Many children experience a combination of violent disciplinary methods.

Children who suffer violence at the hands of a trusted caregiver may have trouble forming attachments later on in life. Building healthy relationships may not be possible without intense therapy.

Violence reduces their sense of self-worth, hinders normal development and is an affront to their dignity. Witnessing violence in a household is also detrimental, as in the case of a sibling watching a sister or brother being abused by a parent. Both children will suffer distress and effects of the violence.

Barriers to Reporting

There are many reasons child abuse is underreported. Often the extent of the harm of abuse is under-recognized, as children will not readily reveal the frequency and severity of the abuse. There can also be: 

  • Failure to recognize emotional abuse and neglect.
  • Belief that Child Protective Services (CPS) will not do anything
  • Lack of knowledge about reporting requirements
  • Self doubt (usually as a result of lack of knowledge)
  • Denial when victim is from a higher income family or location
  • Lack of emotional support for the reporting nurse

Signs of physical abuse may include skin lesions, multiple bruises, fractures, and dislocations. Bruises may be in the shape of handprints.

Signs of emotional abuse include social withdrawal, and lack of emotional development.

Signs of sexual abuse can be sexual knowledge inappropriate to their age, inappropriate sexual play with others and blood in the underwear.


 We all have a responsibility to help end child abuse. Nurses are key reporters and reporting is a fundamental responsibility. In some states, such as Pennsylvania, mandated reporter education is required.

Educational training should emphasize the importance of recognizing and reporting child abuse. While nursing schools touch on child abuse, much more knowledge is needed to competently recognize and report. To increase your skills on assessing and reporting child abuse in your practice, read Child Abuse and Maltreatment. You can also review Domestic and Community Violence


Unicef. (2014). Hidden in plain sight: A statistical analysis of violence against children.