Key facts
- Six in 10 children – or 400 million children – under 5 years of age regularly suffer physical punishment and/or psychological violence at the hands of parents and caregivers (1).
- One in 5 women and 1 in 7 men report having been sexually abused as a child (2).
- Consequences of child maltreatment include impaired lifelong physical and mental health, and the social and occupational outcomes can ultimately slow a country's economic and social development.
- Child maltreatment is often hidden. Only a fraction of child victims of maltreatment ever get support from official support services.
- A child who is abused is more likely to abuse others as an adult, so that violence is passed down from one generation to the next.
- Preventing child maltreatment before it starts is possible. Effective prevention approaches include supporting parents, teaching positive parenting skills and enhancing laws to prohibit violent punishment.
Overview
Child maltreatment is the abuse and neglect that occurs to children under 18 years of age. It includes all types of physical and/or emotional ill-treatment, sexual abuse, neglect, negligence and commercial or other exploitation, which results in actual or potential harm to the child’s health, survival, development or dignity in the context of a relationship of responsibility, trust or power.
Scope of the problem
International studies reveal that 6 in 10 children under 5 years of age regularly suffer physical punishment and/or psychological violence at the hands of parents and caregivers, and 1 in 5 women and 1 in 7 men report having been sexually abused as a child.
Every year, there are an estimated 40 150 homicide deaths in children under 18 years of age, some of which are likely due to child maltreatment. This number almost certainly underestimates the true extent of the problem, since a significant proportion of deaths due to child maltreatment are incorrectly attributed to falls, burns, drowning and other causes.
In armed conflict and refugee settings, child maltreatment is often exacerbated.
Consequences of maltreatment
Child maltreatment has severe short- and long-term physical, sexual and mental health consequences. These include injuries, including head injuries and severe disability (particularly in young children), post-traumatic stress, anxiety, depression, and sexually transmitted infections (STIs) including HIV. Adolescent girls may face additional health issues, including gynaecological problems and unwanted pregnancy. Child maltreatment is strongly associated with alcohol and drug use and smoking – key risk factors for noncommunicable diseases (NCDs) such as cardiovascular diseases and cancer. Maltreatment exposes children to stress that can disrupt early brain development. Severe or prolonged stress can interfere with the healthy development of the nervous and immune systems. These effects extend into learning: child maltreatment is linked to poorer cognitive functioning and lower academic performance. Children who experience any form of violence in childhood have a 13% higher likelihood of not graduating from school. A child who experiences maltreatment is more at risk of perpetrating or being a victim of violence later in life.
Consequently, adults who experienced maltreatment during childhood, are at increased risk for behavioural, physical and mental health problems such as:
- perpetrating or being a victim of violence
- depression
- smoking
- obesity
- high-risk sexual behaviours
- unintended pregnancy
- alcohol and drug misuse.
Beyond the health, social and educational consequences of child maltreatment, there is an economic impact, including costs of hospitalization, mental health treatment, child welfare, and longer-term health costs.
Risk factors
Several risk factors for child maltreatment have been identified. Not all risk factors are present in all social and cultural contexts, and the list here provides an overview when attempting to understand the causes of child maltreatment.
Child
Characteristics of an individual child that may increase the likelihood of being maltreated include:
- being either under 4 years old or an adolescent
- being unwanted
- having special needs, crying persistently
- having an intellectual disability or neurological disorder
- identifying as or being identified as lesbian, gay, bisexual or transgender.
Parent or caregiver
Characteristics of a parent or caregiver that may increase the risk of child maltreatment include:
- difficulty bonding with a newborn
- not nurturing the child
- being a parent at a young age
- having been maltreated themselves as a child
- lacking awareness of child development or having unrealistic expectations
- using alcohol or drugs, including during pregnancy
- having low self-esteem
- suffering from poor impulse control
- having a mental or neurological disorder
- being involved in criminal activity
- experiencing financial difficulties.
Relationship
Characteristics of the relationships within families or among intimate partners, friends and peers that may increase the risk of child maltreatment include:
- family breakdown or violence between other family members
- larger family size
- being isolated in the community or lacking a support network
- a breakdown of support in child rearing from the extended family.
Community and societal factors
Characteristics of communities and societies that may increase the risk of child maltreatment include:
- gender and social inequality;
- high levels of unemployment or poverty;
- easy availability of alcohol and drugs;
- social and cultural norms that promote or glorify violence towards others, support the use of corporal punishment, demand rigid gender roles, or diminish the status of the child in parent-child relationships; and
- social, economic, health and education policies that lead to poor living standards, or to socioeconomic inequality or instability.
Prevention
Preventing and responding to child maltreatment requires a multisectoral approach.
The earlier such interventions occur in children's lives, the greater the benefits to the child (e.g. cognitive development, behavioural and social competence, educational attainment) and to society (e.g. reduced delinquency and crime).
Effective and promising interventions include:
- parent and caregiver support: information and skill-building sessions to support the development of nurturing, non-violent parenting delivered by nurses, social workers, or trained lay workers through a series of home visits or in a community setting;
- education and life skills approaches:
- increasing enrolment in quality education to allow children acquire knowledge, skills and experiences that build resilience and reduce risk factors for violence;
- programmes to prevent sexual abuse that build awareness and teach skills to help children and adolescents understand consent, avoid and prevent sexual abuse and exploitation, and to seek help and support; and
- interventions to build a positive school climate and violence-free environment, and strengthening relationships between students, teachers, and administrators.
- norms and values approaches: programmes to transform restrictive and harmful gender and social norms around child-rearing, child discipline and gender equality and promote the nurturing role of fathers;
- implementation and enforcement of laws: laws to prohibit violent punishment and to protect children from sexual abuse and exploitation; and
- response and support services: early case recognition coupled with ongoing care of child victims and families to help reduce reoccurrence of maltreatment and lessen its consequences.
To maximize the effects of prevention and care, WHO recommends that interventions are delivered as part of a four-step public health approach:
- defining the problem;
- identifying causes and risk factors;
- designing and testing interventions aimed at minimizing the risk factors; and
- disseminating information about the effectiveness of interventions and increasing the scale of proven effective interventions.
WHO response
WHO, in collaboration with partners:
- provides guidance for evidence-based child maltreatment prevention; see INSPIRE Seven strategies to end violence against children;
- provides evidence-based guidance to help frontline healthcare providers recognize children who have suffered from violence and neglect and provide evidence-based first line support; see Responding to child maltreatment: a clinical handbook for health professionals;
- advocates for increased international support for and investment in evidence-based child maltreatment prevention; and
- provides technical support for evidence-based child maltreatment prevention programmes in several low- and middle-income countries.
References
- Unicef. “Nearly 400 million young children worldwide regularly experience violent discipline at home.” 11 June 2024. https://www.unicef.org/press-releases/nearly-400-million-young-children-worldwide-regularly-experience-violent-discipline
- Unicef. Sexual violence. October 2024. https://data.unicef.org/topic/child-protection/violence/sexual-violence/#status