Child abuse takes many forms:

• Physical abuse: Physical child abuse occurs when a child is purposefully injured. Physical abuse can be an act of direct physical harm or an act of omission that leads to injury.
• Sexual abuse: Sexual child abuse is any sexual activity with a child, including fondling, oral-genital contact, intercourse and exposure to child pornography.
• Emotional abuse. Emotional child abuse includes verbal and emotional assault — such as continually belittling or berating a child — as well as isolating, ignoring or rejecting a child.
• Neglect: Child neglect is failure to provide a child adequate food, shelter, affection, supervision or medical care.
• A child who's being abused may feel guilty, ashamed or confused. He or she may be afraid to tell anyone about the abuse, especially if the abuser is a parent or other loved one.
  

That's why it's vital to watch for red flags, such as:

• Sudden changes in behavior or school performance.
• Untreated medical or dental problems.
• Unexplained bruises, cuts, burns or other injuries.
• Blood in the child's underwear.
• Inappropriate sexual behavior for the child's age.
• Behavior extremes, from overly aggressive to unusually passive.
• Nightmares or unusual fears.
• Withdrawal from friends or usual activities.
• Low self-esteem.
• Poor hygiene.
• Frequent absences from school.

Sometimes a parent's demeanor or behavior also sends red flags about child abuse. Warning signs include a parent who:

• Shows little concern for the child.
• Denies the existence of problems at home or school, or blames the child for the problems.
• Refuses offers of help to resolve problems at school.
• Consistently blames, belittles or berates the child.
• Describes the child with negative terms.
• Uses harsh physical discipline or asks teachers to do so.
• Demands an inappropriate level of physical or academic performance.
• Severely limits the child's contact with other children.
• Offers conflicting or unconvincing explanations for a child's injuries, or no explanation at all.

Risk factors:

Child abuse occurs across all socioeconomic levels and ethnic groups. For parents and other caregivers, factors that may increase the risk of becoming abusive include:

• Low self-esteem
• Poor impulse control
• Depression
• Anxiety
• Marital conflict
• Domestic violence
• Financial stress
• Social isolation

Complications:

Some children overcome the physical and psychological effects of child abuse, particularly those who have high self-esteem, an optimistic attitude and strong social support. For others, however, child abuse has lifelong consequences. For example, child abuse may lead to:

• Physical disabilities.
• Learning disabilities.
• Low self-esteem.
• Depression.
• Difficulty establishing or maintaining relationships.
• Challenges with intimacy and trust.
• An unhealthy view of parenthood.
• Anxiety.
• Substance abuse.
• Eating disorders.
• Post-traumatic stress disorder.
• Personality disorders.
• Delinquent or violent behavior.
• Alcoholism or other forms of substance abuse.
• A history of mistreatment as a child.