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The rate of substantiated child maltreatment, as of 2014, has shown little change over the past five years, though it is significantly lower than in 1990. The rates of physical, sexual, and psychological or emotional abuse have declined the most since 2000, while rates of neglect have declined the least.

Importance

Child maltreatment (a term that encompasses both abuse and neglect) is associated with physical injuries, delayed physical growth, and neurological damage.[1] Child maltreatment is also associated with psychological and emotional problems, such as aggression, depression, and post-traumatic stress disorder.[2] In extreme cases, child abuse and neglect can lead to death. In 2014, approximately 1,546 children died as the result of abuse or neglect.[3]

In addition, child abuse is linked to an increased risk of alcoholism, depression, drug abuse, eating disorders, obesity, high-risk sexual behaviors, smoking, suicide, and certain chronic diseases later in life.[4] Women who were victims of physical assault as children are twice as likely to be victims of physical assault as adults.[5],[6] Also, some evidence suggests that victims of child maltreatment may be more likely than others to engage in deviant or criminal behavior as juveniles and adults.[7]

Child maltreatment is influenced by a number of factors, including poor knowledge of child development, substance abuse, other forms of domestic violence, and mental illness. Although maltreatment occurs in families at all economic levels, abuse, and especially neglect are more common in poor and extremely poor families than in families with higher incomes.[8],[9]

In the national statistical system that tracks child maltreatment, children are counted as victims if an investigation by a state child welfare agency classifies their case as either “substantiated” or “indicated” child maltreatment. Substantiated cases are those in which an allegation of maltreatment or risk of maltreatment was supported or founded according to state law or policy. Indicated cases are those in which an allegation of maltreatment or risk of maltreatment could not be substantiated, but there was reason to suspect maltreatment or the risk of maltreatment.[10]

Beginning in 2009, data for children was based on “unique” counts – that is, each victim was counted only once, even if there were multiple substantiated or indicated cases of child maltreatment for that child over the course of the year.

Trends

Between 1990 and 1994, the number of cases of child abuse or neglect that were either substantiated or indicated rose from 861,000 to 1,032,000—representing a rate of 15.2 per thousand children under age 18 in 1994. Between 1994 and 1999, the trend reversed, and the number of cases dropped to 829,000—a rate of 11.8 per thousand. Cases increased slightly between 1999 and 2001, then leveled off until 2006, although the rate stayed fairly constant throughout that time period. After a sharp drop in both rate and number of maltreated children (duplicate cases removed) between 2006 and 2007, the number and rate of maltreated children continued to decline until 2012, when they began to rise again. In 2014, there were approximately 702,000 maltreated children in the United States, a rate of 9.4 per thousand. (Figure 1) Note that these data reflect states’ definitions of what constitutes maltreatment; these definitions vary across states, and may change over time.

Differences by Age

Young children are more likely than older children to be victims of child maltreatment. In 2014, children three and younger had a child maltreatment rate of 14.8 per thousand, compared with 10.6 per thousand for children ages four to seven, 7.9 per thousand for children ages eight to 11, 6.9 per thousand for children ages 12 to 15, and 4.6 per thousand for children ages 16 to 17. (Figure 2)

Differences by Race and Hispanic Origin[11]

Black, American Indian or Alaskan Native, and multiple-race children have higher rates of reported child maltreatment than do other children. In 2014, black children had a reported maltreatment rate of 15.3 per thousand children, American Indian and Alaskan Native children had a reported maltreatment rate of 13.4, and children of multiple races had a rate of 10.6 per thousand. This compares with 8.8 for Hispanic children, 8.6 for Pacific Islander children, 8.4 for white children, and 1.7 for Asian children. (Figure 3)

Differences by Type of Maltreatment

Reported rates of neglect are higher than those for other types of child maltreatment. In 2014, 7.1 per thousand children were reported victims of neglect, compared with 1.6 for physical abuse, 0.8 for sexual abuse, and 0.6 for psychological or emotional abuse. (Appendix 2)

Among maltreated children, the proportion reported as neglected increased from 49 percent in 1990 to 75 percent in 2014, while those reported as sexually abused declined from 17 to 8 percent, and the share reported as physically abused declined from 27 to 17 percent. Less frequent types of maltreatment, including those classed as “unknown,” accounted for the balance. (Appendix 1)

Rates of physical abuse and sexual abuse have declined over the past two decades while rates of neglect have fluctuated. Between 1990 and 2014, rates of substantiated physical abuse declined by 55 percent, and sexual abuse rates by 64 percent; in contrast, rates of substantiated neglect fell by 8 percent over this period.[12]

State and Local Estimates

State estimates for 2014 are available from the US Department of Health and Human Services. (See Tables 3-1, through 3-6, and 3-8 through 3-15).

The KIDS COUNT Data Center also has state-level data, including the percent of victims who received post-investigation services.

International Estimates

Estimates of child maltreatment in European countries are available from the World Health Organization (See chapter 2).

National Goals

The Healthy People 2020 initiative has set a goal to reduce rates of non-fatal child maltreatment (from 9.4 per thousand in 2008, to 8.5 per thousand by 2020) and maltreatment fatalities in children (from 2.3 per 1,000 in 2008, to 2.1 per 1,000 by 2020).

Additional information is available here. (Objectives IVP-37 and IVP-38)

What Works to Make Progress on This Indicator

Several recent reviews summarize the knowledge base on effective, evidence-based practices to prevent or reduce the harm from child maltreatment:

The Future of Children. (2009). Preventing child maltreatment. The Future of Children, 19(2).

Lee, S., Aos, S, and Miller, M. (2008). Evidence-based programs to prevent children from entering and remaining in the child welfare system: Benefits and costs for Washington. Washington State Institute for Public Policy.

MacMillan, H. L., Wathen, C. N., Barlow, J., Ferguson, D. M., Leventhal, J. M., and Taussig, H. N. (2009). Interventions to prevent child maltreatment and associated impairment. The Lancet, 373, 250-266. Available at: www.thelancet.com/journals/lancet/issue/current?tab=past

Also, see Child Trends’ LINKS database (“Lifecourse Interventions to Nurture Kids Successfully”), for reviews of many rigorously evaluated programs, including the following which have been shown to be effective:

• Early Start
• Parent-Child Interaction Therapy
• Nurse-Family Partnership
• Healthy Families New York
• Triple-P Positive Parenting Program

Related Indicators

• Foster care
• Attitudes toward spanking
• Infant Homicide
• Children’s Exposure to Violence
• Violent crime victimization
• Adverse Experiences

Definition

Child maltreatment can be defined as “behavior towards [a child] . . . which (a) is outside the norms of conduct, and (b) entails a substantial risk of causing physical or emotional harm. Behaviors included will consist of actions and omissions, ones that are intentional and ones that are unintentional.”[13] Four types of maltreatment are generally recognized, including physical abuse, sexual abuse, neglect (including educational neglect, medical neglect, and other forms), and emotional maltreatment. Before 2009, all data included in this report represent all substantiated or indicated cases from reporting states in a given year. For 2009 and subsequent years, duplicate victims are removed, and data represent the number of children who had at least one substantiated or indicated case in that year. Not all states report duplicate victims, so the total number of unique victims is an estimate based on available numbers. Legal definitions of maltreatment vary by state.

Data Sources

Data for 2000-2014: U.S. Department of Health and Human Services, Administration on Children, Youth and Families. Child maltreatment {various years}. Washington, DC: US Government Printing Office. Available at: www.acf.hhs.gov/programs/cb/stats_research/index.htm#can

Additional data for 2000-2001: National Center for Health Statistics, Centers for Disease Control and Prevention (2003). 2000 and 2001 Population Estimates for Calculating Vital Rates. Author. Available at: http://www.cdc.gov/nchs/about/major/dvs/popbridge/popbridge.htm

Data for 1990-1999 (except rate per thousand): Department of Health and Human Services. Office of the Assistant Secretary for Planning and Evaluation. Trends in the well-being of America’s children and youth 2001. Table HC 2.10 U.S. (See Table HC 2.10)

Data on rate per thousand for 1990-1999: U.S. Department of Health and Human Services, Administration on Children, Youth, and Families. (2000).Child maltreatment 1999. Available at: http://www.acf.hhs.gov/programs/cb/pubs/cm99/index.htm

Raw Data Source

U.S. Department of Health and Human Services, Children’s Bureau, National Child Abuse and Neglect Data System (NCANDS).

http://www.acf.hhs.gov/programs/cb/resource/about-ncands

Appendix 1 – Number of Cases/Victims of Child Maltreatment, Rate per Thousand Population, and Percent Distribution by Various Characteristics: Selected Years, 1990-2014