Child Maltreatment Studies: Physical, Sexual, Emotional Abuse and Neglect

The Journal of Adolescent Health released a special supplement investigating the role of safe, stable, nurturing relationships (SSNRs) and social contexts in the cycle of child maltreatment across generations. Efforts focused on enhancing nurturing relationships between parents and children, as well as between parents and other adults, may be a helpful prevention strategy for breaking the cycle of child maltreatment and promoting life-long health.


Child maltreatment is a signi?cant public health problem that requires a multifaceted approach to prevention. It is estimated that one out of every ten children in the United States experiences one or more forms of physical, sexual, or emotional abuse or neglect by a parent or other caregiver at some point during their lifetime. In 2011, social service workers identi?ed 681,000 children in the United States as substantiated victims of maltreatment. This equates to an overall victimization rate of 9.1 per 1,000 children in the U.S. population.


A combination of individual, relational, community, and societal factors contribute to the risk of child maltreatment. Although children are not responsible for the harm inflicted upon them, certain characteristics have been found to increase their risk of being maltreated. Individual risks include being younger than 4 years of age and having special needs that may increase caregiver burden (e.g., disabilities, mental retardation, mental health issues and chronic physical illnesses). Risk factors for committing abuse include parents’ lack of understanding of children’s needs; child development and parenting skills; history of child maltreatment in family of origin; substance abuse; non-biological, transient caregivers in the home (e.g., mother’s male partner); and young age, low income, and single parenthood. Family risks are social isolation; disorganization; violence, including intimate partner violence; and parenting stress. Community risks include violence, high poverty, residential instability, high unemployment rates, and poor social connections.


There is scientific evidence to support the following protective factor to buffer children from maltreatment: a supportive family environment and social networks. Other family protective factors are household rules and child monitoring, stable family relationships, parental employment, access to health care and social services, and caring adults outside the family who can serve as role models.


 It is well-established that experiencing child maltreatment is associated with a variety of negative physical, emotional, and psychological outcomes, including subsequent harsh and/or neglectful parenting in adulthood. Yet, it is also clear that not all maltreated children grow up to become maltreating parents. Thus, identifying factors that distinguish families in which the cycle of violence is maintained from families in which it is interrupted is critical for violence prevention and optimal child development.


The CDC has identi?ed the promotion of safe, stable, nurturing relationships (SSNRs) as a key strategy for the public health approach to child maltreatment prevention. The three dimensions of SSNRs (i.e., safety, stability, and nurturance) each represent signi?cant aspects of the social and physical environments that protect children and promote development. Each can be thought of as being on a relational and environmental continuum. In extreme cases, SSNRs may be regarded as being on the positive end of the continuum while the opposing negative end represents risk. One can think of safety being transposed with neglect and violence, while stability counters chaos and unpredictability, and nurturing opposes hostility and rejection. In less extreme cases, SSNRs may buffer the impact of negative relational and environmental contexts. These dimensions overlap, but each represents central and distinct aspects of a child’s relationships and environments that are crucial to their healthy development.


From a public health perspective, the promotion of SSNRs is strategic, in that it can have synergistic effects on a broad range of health outcomes as well as contribute to the development of skills that will enhance the attainment of healthy habits and lifestyles. Because young children experience their world through their relationships with parents and caregivers, these relationships are fundamental to the healthy development of the brain and, consequently, the development of physical, emotional, social, behavioral, and intellectual capacities.


SSNRs can also be found in social environments that children encounter outside of the home and, thus, can be extended to relationships between children and other caregivers, between children and peers, and also between caregivers and other adults. For example, studies of intergenerational transmission of child physical abuse have suggested that even the perception of support from signi?cant adults may itself reduce the risk of subsequently maltreating one’s child. As such, it is critically important to empirically test whether different types of SSNRs (e.g., between children and caregivers, between caregivers and other adults) have the potential to interrupt the intergenerational continuity of maltreatment.


Child abuse and neglect are a costly public health burden. Recent estimates place the daily cost of child maltreatment in the United States at $220 million, with the total lifetime burden of new cases of child maltreatment placing, at a minimum, a $124 billion impact on society.

As such, programs that may have the greatest likelihood of breaking the cycle of child maltreatment are those that are implemented prior to childrearing and enhance relationship skills and promote healthy and safe dating and romantic relationships. Nurturing behaviors by a romantic partner reduce the likelihood that a parent raised in a harsh manner will use this same parenting style with children. Thus, the ?ndings identify an important social mechanism that holds promise for helping to break the intergenerational cycle of child maltreatment.


Studies suggest that promoting supportive relationships and increasing relationship satisfaction among caregivers who have experienced childhood maltreatment may have the greatest bene?ts in fostering safe, stable, nurturing, and child maltreatment-free environments. Signi?cant work is still needed to fully understand the myriad factors that in?uence disruption of violence perpetration between generations.


See the CDC Announcement


Also see the CDC’s Child Maltreatment Prevention Site


Also see the CDC’s Steps to Create Safe, Stable, and Nurturing Relationships


Also see the CDC’s Adverse Childhood Experiences Study


CDC’s Public Health Leadership Initiative: Preventing Child Maltreatment