How do I know if a child is being abused/neglected? In 2023, there were over 546,000 reported cases of child abuse and neglect across the U.S. That same year, approximately 2,000 children died from abuse and neglect – a 9.6% rise in child fatalities from 2019. ¹

The lifetime economic cost of child maltreatment was estimated at $218 billion in 2018, which is higher than chronic illnesses like heart disease and diabetes.²

Child abuse and neglect involve any mistreatment by a parent, caregiver, or another person in a custodial role that causes harm, risk of harm, or the threat of harm. This can include physical abuse, emotional abuse, sexual abuse, or neglect.^2,3

Recognizing the signs of child abuse and neglect are essential for ensuring a child’s safety and well-being.

Signs and symptoms that are present in the child can include:

• Physical abuse is the deliberate use of physical force that injures a child, such as hitting or shaking.^2,3
  Emotional abuse involves actions that damage a child’s self-esteem or emotional health, like shaming, name-calling, or withholding affection.2,3
• Sexual abuse refers to any attempted or completed sexual act or contact with a child by a caregiver, such as penetration, fondling, or exposing the child to sexual activity.^2,3
• Neglect is the failure to provide for a child’s basic emotional, medical, and physical needs, like housing, food, and clothing.^2,3
• Sudden changes in behavior – such as anger, hostility, constant exhaustion, or hyperactivity – or changes in academic performance.^3,4,5
• A child who exhibits poor hygiene, severe body odor, or consistently wearing soiled clothing or clothing that is significantly too large, too small or in need of repair.^3,5,6
• Frequently lacking necessary medical care or treatment, such as prescribed medications, assistive devices or other essential heath interventions.⁵
• Food hoarding and lack of adequate nutrition.³
• Unexplained injuries and may be accompanied by a child providing contradictory, questionable, or inconsistent explanations.^3,4
• Untreated physical or medical issues that parents are aware of.^3,4
• Struggles with learning or concentration without a clear physical or psychological cause.⁴
• Appears constantly alert, expecting something bad to happen.⁴
• Arrives early, leaves late, or reluctant to go home.⁴
• Lacking adequate adult supervision, which may lead to children taking on inappropriate responsibilities for their age.^3,4
• Hesitation to be near a specific individual.⁴Parental Substance UseParental substance misuse can lead to child abuse, neglect, and an increased likelihood of children witnessing intimate partner violence (IPV).^7,8 It disrupts secure parent-child attachment, diminishes the parent’s ability to nurture, and creates unsafe home environments, increasing the risk of maltreatment for the child.^8,9,10From 2015 to 2019, on average, over 21 million children in the United States lived with a parent who misused substances and more than 2 million lived with a parent with a substance use disorder (SUD). Marijuana was the most used substance.⁹

  Parental substance misuse was a leading factor in children entering foster care nationwide, accounting for 33% of all cases in 2022.¹¹ Parental opioid misuse was associated with over 200,000 reports of child abuse and neglect, over 95,000 children entering foster care, and almost $3 billion in child welfare system costs between 2011 and 2016.¹²

  In 2022, nearly 18% of child deaths in Florida (43 out of 237) were attributed to maltreatment, with 60.5% resulting from neglect and 39.5% from abuse. Among cases where caregiver impairment was documented, 31.2% of caregivers were found to be impaired.¹³ Additionally, in 2021, most caregivers of children who died had a history of substance misuse, with 67.4% reporting a history of marijuana use.¹⁴

  Parental marijuana use is associated with increased risk of marijuana, tobacco use, as well as opioid misuse, among both adolescents and young adult children, and is also associated with higher alcohol use among adolescent children.¹⁵

  Parental substance misuse can have a lasting effect on a child’s health, resulting in a higher risk of injuries, infectious diseases, hyperactivity, anxiety, depression, self-harm, suicidal behavior, and substance use in adolescence.^8,16

  Children of parents with an alcohol use disorder are nine times more likely to have poor school performance and twice as likely to repeat a grade. They are also more likely to need special classes, referrals to school psychologists, and report higher absenteeism, which in turn
  impacts school performance.¹⁶

  Engaging parents in appropriate evidence-based treatment can improve their quality of life, reduce negative health outcomes, and decrease child welfare involvement.^9,17

  Signs and symptoms that parents can exhibit:

• Denies or blames the child for their issues at school or home.³
• Requests teachers or caregivers to use physical punishment for misbehavior.⁴
• Views the child as completely bad, worthless or a burden.⁴
• Expects the child to meet unattainable physical and academic standards.^3,4
• Relies on the child to fulfill the parent’s emotional needs.⁴
• Shows minimal concern for the child’s wellbeing, such as constantly missing or canceling appointments.^3,4Barriers to Treatment
  Barriers to engaging in treatment services and recovery include waitlists, delays in appointment scheduling, mental health comorbidities, unemployment, economic challenges, homelessness, lack of childcare, and transportation.¹⁷Access to treatment is particularly difficult for parents, especially mothers, due to limited childcare options and strict program requirements, such as time-sensitive screenings and mandatory attendance. These barriers, along with penalties for missed appointments, can complicate their recovery process.¹⁹The financial burden of childcare further restricts access to treatment, as parents may be unable to afford both recovery services and the cost of childcare.^17,19Mothers often face stigma and fear judgement or custody loss if they seek treatment for substance use disorders.^10,18,19 This stigma, especially prevalent in the healthcare system, discourages many from seeking prenatal or postnatal care, further exacerbating health issues for both mother and child.¹⁹

  Healthcare providers’ negative perceptions of individuals with SUD often leads to discrimination.¹⁹ This stigma results in people being labeled as “untrustworthy” or “irresponsible,” contributing to fewer treatment-seeking behaviors and long-term negative outcomes for both parents and children.¹⁹

  Source: Copy of original file Sent to NDPA by Drug Free America Foundation  17 March 2025