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Why This Topic Is Important
An estimated one in four U.S. children experience abuse or neglect (1). Child maltreatment can cause serious physical injury and even death (2). It also can cause lifelong physical, emotional, and behavioral problems, which can lead to multigenerational impacts (2). Children who are abused or neglected are at increased risk for anxiety, depression, delinquency, difficulty in school, and early sexual activity (2). Child maltreatment (along with other adverse childhood experiences) can cause toxic stress that disrupts brain and physical development, increasing the risk for numerous health problems in adulthood, such as heart disease, cancer, substance abuse, and mental illness (1, 2). While most survivors do not repeat the cycle of abuse later in life, they are more likely to mistreat their own children (2). The harmful effects of child maltreatment can be interrupted by stable and nurturing relationships and environments, and trauma-informed support services (1, 2).

Beyond the impact on individuals and families, child abuse and neglect have a significant impact on society. Between 2001 and 2016, the estimated average annual cost of hospitalizations due to child maltreatment in the U.S. was $116 million (3). The total lifetime economic burden of substantiated nonfatal child maltreatment cases in 2018 has been estimated at $563 billion for the U.S. and $53 billion for California (4).
While abuse and neglect occur in all types of families, certain factors place children at increased risk. For example, young children (especially infants) and those with special needs are at particularly high risk for maltreatment (5, 6). Examples of family and community risk factors include poverty, substance abuse or mental illness in the family, parental stress, social isolation, unintended pregnancy, and domestic or neighborhood violence (1, 7). Children of color, particularly American Indian/Alaska Native and African American/black children, are overrepresented in the child welfare system (1, 5). Increasingly, leaders are focused on prevention strategies that build on family strengths and promote protective factors at the individual, family, community, and system levels, which help parents provide safe, positive environments for their children (7).

For more information, see kidsdata.org’s Research & Links section.

Sources for this narrative:

1.  Centers for Disease Control and Prevention. (n.d.). Essentials for childhood: Creating safe, stable, nurturing relationships and environments for all children. Retrieved from: https://www.cdc.gov/violenceprevention/childabuseandneglect/essentials

2.  Child Welfare Information Gateway. (2019). Long-term consequences of child abuse and neglect. U.S. Department of Health and Human Services, Children's Bureau. Retrieved from: https://www.childwelfare.gov/pubs/factsheets/long-term-consequences

3.  Wojciak, A. S., et al. (2021). Trends, diagnoses, and hospitalization costs of child abuse and neglect in the United States of America. International Journal of Environmental Research and Public Health, 18(14), 7585. Retrieved from: https://www.mdpi.com/1660-4601/18/14/7585/htm

4.  Klika, J. B., et al. (2020). Economic burden of known cases of child maltreatment from 2018 in each state. Child and Adolescent Social Work Journal, 37, 227-234. Retrieved from: https://preventchildabuse.org/resources/economic-burden-of-known-cases-of-child-maltreatment-from-2018-in-each-state-2

5.  U.S. Department of Health and Human Services, Children's Bureau. (2022). Child maltreatment 2020. Retrieved from: https://www.acf.hhs.gov/cb/data-research/child-maltreatment

6.  Legano, L. A., et al. (2021). Maltreatment of children with disabilities. Pediatrics, 147(5), e2021050920. Retrieved from: https://publications.aap.org/pediatrics/article/147/5/e2021050920/180813/Maltreatment-of-Children-With-Disabilities

7.  Child Welfare Information Gateway. (n.d.). 2021/2022 prevention resource guide. U.S. Department of Health and Human Services, Children's Bureau. Retrieved from: https://www.childwelfare.gov/topics/preventing/preventionmonth/resources/resource-guide
Policy Implications
Child abuse and neglect are urgent public health problems with substantial consequences for both the individuals affected and society as a whole (1). Increasingly, experts view child maltreatment in the broader context of adverse childhood experiences (ACEs), which include abuse and neglect, exposure to violence, or other experiences that threaten a child's sense of stability and safety (1, 2). ACEs and their resulting toxic stress can disrupt healthy brain development and have negative, lasting effects on health, well being, and life opportunities (2). Child maltreatment and other ACEs can be prevented, however—and their effects reduced—by building child and family resilience, ensuring access to support services, and promoting policies that foster safe, stable homes and communities (2, 3, 4).

Children and youth at risk of maltreatment, and those already in the child welfare system, interact with a range of public and private systems that can help prevent abuse and neglect, mitigate its effects, strengthen families, and ensure that children have safe, nurturing, permanent home environments. Policymakers have a role in helping to prevent child maltreatment, as well as in ensuring early detection, reporting of maltreatment, effective child welfare system responses, and provision of appropriate services for survivors and families. While California has made major strides in these areas, inequities by race/ethnicity and socioeconomic status persist, and continued efforts are needed to ensure that all young people are safe and have the opportunity to thrive (2, 4, 5).

Policy and practice options to help prevent, interrupt, and mitigate the effects of child maltreatment include:
  • Supporting policies that help reduce family stress and promote stable environments for children, e.g., policies to improve the social safety net for families in need, strengthen financial security, improve community safety, support family-friendly business practices, and ensure quality child care is affordable and accessible (1, 2, 4)
  • Supporting public education campaigns to promote social norms around positive parenting behaviors and children's welfare as a shared community responsibility, as well as increasing awareness about the serious risks of ACEs and toxic stress (1, 2, 4)
  • Raising public awareness about the commercial sexual exploitation of children and youth in California, working collaboratively with survivors and across sectors to implement policy and practice solutions (6)
  • Supporting multi-sector coordination for California's statewide ACEs screening initiative, in which health care providers screen children for ACEs and toxic stress (2)
  • Standardizing and improving the detection of maltreatment among children treated in hospitals and emergency departments, advancing hospital-based prevention programs, and providing survivors high quality, trauma-informed treatment (7, 8)
  • Institutionalizing policies and practices designed to address the effects of trauma and facilitate resilience and healing in public and private systems and organizations; this should include workforce education to increase trauma-related knowledge and skills among professionals who have direct contact with children (2, 4, 9)
  • Continuing to build a coordinated and comprehensive system of accessible, trauma informed, and culturally appropriate prevention services for families at risk of child abuse and neglect, including strength-based parent education, family support, home visiting, mental health, and substance abuse services (2, 4, 9, 10)
  • Ensuring that Family First Prevention Services Act resources are integrated effectively into the continuum of prevention services and maximized to meet the needs of children of color and LGBTQ+ youth, in particular (4, 5, 11)
  • Supporting ongoing efforts to improve California's child welfare system, including strategies to reduce the overrepresentation of, and improve outcomes for, African American/black and American Indian/Alaska Native children; in addition, strengthening laws and practices to protect and support LGBTQ+ youth in the system or at risk of entering it (4, 5, 10, 11)
  • Promoting collaboration across organizations and sectors (e.g., local and state government, education, health care, juvenile justice, child welfare, nonprofits, etc.) to address systemic barriers to preventing or addressing child maltreatment, including improving service coordination and data sharing (1, 2, 4, 6)
For more information, see kidsdata.org’s Research & Links section or visit the Child Welfare Information Gateway and California Evidence-Based Clearinghouse for Child Welfare. Also see Foster Care and other topics related to Child and Youth Safety on kidsdata.org.

Sources for this narrative:

1.  Centers for Disease Control and Prevention. (n.d.). Essentials for childhood: Creating safe, stable, nurturing relationships and environments for all children. Retrieved from: https://www.cdc.gov/violenceprevention/childabuseandneglect/essentials

2.  Bhushan, D., et al. (2020). Roadmap for resilience: The California Surgeon General's report on adverse childhood experiences, toxic stress, and health. Office of the California Surgeon General. Retrieved from: https://osg.ca.gov/sg-report

3.  Child Welfare Information Gateway. (n.d.). 2021/2022 prevention resource guide. U.S. Department of Health and Human Services, Children's Bureau. Retrieved from: https://www.childwelfare.gov/topics/preventing/preventionmonth/resources/resource-guide

4.  California Department of Social Services. (n.d.). Office of Child Abuse Prevention strategic plan 2020-2025. Retrieved from: https://cdss.ca.gov/inforesources/ocap/about-ocap

5.  Short, A. (2022). The 2022-23 budget: Analysis of child welfare proposals and program implementation updates. Legislative Analyst's Office. Retrieved from: https://lao.ca.gov/Publications/Report/4558

6.  Walker Brown, K., et al. (2021). Strategies to end commercial sexual exploitation of youth: A toolkit for collaborative action. National Center for Youth Law. Retrieved from: https://youthlaw.org/resources/strategies-end-commercial-sexual-exploitation-youth-toolkit-collaborative-action

7.  Wojciak, A. S., et al. (2021). Trends, diagnoses, and hospitalization costs of child abuse and neglect in the United States of America. International Journal of Environmental Research and Public Health, 18(14), 7585. Retrieved from: https://www.mdpi.com/1660-4601/18/14/7585/htm

8.  Macaulay, J., et al. (2020). Pushing back: Balancing cost against the price of missing child physical abuse. Hospital Pediatrics, 10(4), 378–380. Retrieved from: https://publications.aap.org/hospitalpediatrics/article/10/4/378/26042/Pushing-Back-Balancing-Cost-Against-the-Price-of

9.  California Department of Social Services, & California Department of Health Care Services. (2018). The California integrated core practice model for children, youth, and families. Retrieved from: https://cdss.ca.gov/inforesources/the-integrated-core-practice-model

10.  California Department of Social Services. (2019). Child and family services plan 2020-2024. Retrieved from: https://www.cdss.ca.gov/inforesources/child-welfare-program-improvement/child-and-family-services-plan

11.  Raimon, M. L. (2021). The opportunity is now: Five ways to better serve adolescents and young adults through the Family First Prevention Services Act (FFPSA). Center for the Study of Social Policy. Retrieved from: https://cssp.org/resource/the-opportunity-is-now-five-ways-better-serve-adolescents-ffpsa
How Children Are Faring
In 2020, the first year of the COVID-19 pandemic, 391,546 California children ages 0-17 were reported to have been neglected or abused. For around half of these children (49%), the maltreatment alleged was general neglect, which occurs when a parent, guardian, or caregiver fails to provide adequate food, clothing, shelter, medical care, or supervision for the child but no physical injury occurs. Other common types of reported maltreatment included physical abuse (16%), emotional abuse (12%), and sexual abuse (10%).

 After 20 years of relatively stable rates between 50 and 55 children per 1,000, the statewide rate of children with allegations of maltreatment fell to 44 per 1,000 in 2020, a drop of more than 17% compared with 2019 (53 children per 1,000).

Among California children reported to have been neglected or abused in 2020, fewer than 1 in 6 (61,419) had one or more allegation substantiated by the state child welfare system. Overall, the statewide rate of substantiated maltreatment declined from 12 children per 1,000 in 2000 to 7 per 1,000 in 2020. Nearly half of California children with substantiated cases of maltreatment are ages 5 and younger—46% in 2020, up from 39% in 2000.

Child maltreatment allegations and substantiations disproportionately involve African American/black and American Indian/Alaska Native children. Statewide, more than 87 per 1,000 children in these groups had a report of neglect or abuse in 2020 and more than 16 per 1,000 had a substantiated case of maltreatment. These rates are more than double the rates for Hispanic/Latino children, more than 2.5 times the rates for white children, and more than 5 times the rates for Asian children.

Rates of emergency department (ED) and hospital use for injuries related to suspected or confirmed child maltreatment also fell in 2020, to 31 ED visits and 10 hospital discharges per 100,00 children. As in previous years, the rate of ED visits for child abuse and neglect among girls was more than double that for boys in 2020 (46 vs. 17 visits per 100,000), with girls accounting for 72% of all visits (up from 67% in 2019). A majority of maltreatment-related ED visits involve sexual abuse or exploitation (60% in 2020), whereas hospitalizations most frequently involve physical abuse (54% in 2020), followed by neglect or abandonment (26% in 2020). Infants under age 1 consistently experience the highest rate of hospitalization for abuse and neglect among age groups (81 discharges per 100,000 in 2020).