April marks the start of another child abuse prevention month. Blue ribbons serve to raise awareness that as I type this and everyone goes about their day, a child is being abused, maybe even killed. We have all heard the terrifying statistics and see the horror stories that roll past us on our news feeds. But, how many of us even care? Who among us cares enough to do anything to change the status quo? It is, after all, someone else’s problem, so why should we put ourselves out there to try to do anything about it? I’ll tell you why.

As physicians, we’ve been trained to know what bruises look suspicious. However, child abuse is so much more. Most scars are not visible. Child abuse can be physical, sexual, emotional, or mental. What is child abuse, really? It is not a spanking or even a horrific beating. Rather, it is fear, terror set deep in the bones. An important part of it is mind control. It is the unpredictability of the coming explosion that keeps kids always on edge, never able to relax. It is a forever fright of ever speaking up, or even speaking at all. It is not the color blue to remind us that it exists, and pithy sayings or dramatic pictures do nothing to chase it away. It is a paralyzing horror of what may come, of having met the monster under the bed up close and personal. And knowing that nothing will ever calm it down. That no one will ever help or even care. That you are all alone in the world to fight the beast. That you are too scared to scream, or even whisper, and often to even care.

How do I know? Because I lived that life. While other kids were learning to ride bikes or tie their shoes, I was being educated in abject humiliation and how to take blows from a leather belt, sometimes with the metal end if my father was in a particularly bad mood. The worst part of it was never knowing what exactly would set him off. Sometimes, it would happen while we slept and we would be woken by the start of a beating. I slept with my shoes on for most of my childhood, just in case I had to escape out of my bedroom window in the middle of the night. How many kids of 6 or 7 years of age know to leave the screen up because it is easier to jump out of the window if you only have to slide up the glass panel?

When other kids were playing outside, I was often hiding under my bed or in the closest. Or locked in the basement. You know that feeling when you’re watching a horror movie and you know the murderer is just around the corner and about to catch the main character? That is how I felt when hiding. He was out there and if he found me, that might be my end. I could hear other kids outside laughing and playing while I struggled to stay alive. I often wondered if they knew I was there, hiding. Didn’t they hear him screaming? Or did they just not care?

I often dreamed of being rescued, of a superhero in disguise. I wondered what my life would be like if I could be like other kids, allowed to have friends and just be me. That was not permitted by my psychopathetic father: he owned us, our thoughts, and our opinions. Disagreement was not allowed.

My rescue never came, no one ever stood up and tried to save me. I just outgrew the abuse and left home when I was 18 years old. The abuse never left my dreams, and I still have many quirks from growing up in isolation and fear. Many people suffer greatly their whole lives because of it. The statistics are indeed frightening.


                   The Ugly Truth About Child Abuse & Neglect in the US:

                     – Last year, nearly 6.6 million children were involved in reported child abuse and neglect cases.

                                 – Physical abuse was involved in 17% of cases last year.

                                 – 8% were sexually abused.

                                 – More than 27% were abused starting before 1 year of age.

                    – In the US, about 4 children die of abuse or neglect every day, representing one of the worst records among developed countries 

                      in the world.

                    – Last year, more than 1,500 children died as a direct result of abuse or neglect.

                    – Of those who die from child abuse, 44% are younger than 1.

                    – More than 90% of sexually abused children know the perpetrator.

                    – Child abuse occurs across all socioeconomic classes, religions, and educational levels.

                    – More than 50% of children who died as a result of abuse do not have this recorded on their death certificates.

                   – Of those in prison as adults, 13% of men and 36% of women were abused as children.


Survivors of child abuse have complications lasting into adulthood. These adults tend to suffer from higher rates of mental health disorders. These include, but are not limited to, depression, personality disorders, anxiety disorders, PTSD, eating disorders, increased risk of suicide, dissociation, and sexual difficulties. It has been estimated that 50% of those abused as children have three or more psychiatric disorders. Many survivors’ lives are defined by frequent crises leading to job dissatisfaction, failed relationships, frequent relocations, and financial setbacks. Many of these adults live in “crisis mode,” which can be quite disheartening and exhausting. It has recently been shown that many chronic physical ailments, such as diabetes, are more common in survivors of childhood abuse as well.

Approximately 30% of abused children go on to be abusers themselves. What is the difference between a child who was abused who goes on to perpetuate the cycle of abuse or one who breaks free? Is it the unbreakable spirit of a child who refuses to give up their dreams? A child who is wished dead but refuses to quit living? A child who was thrown away like trash but refuses to stay in the gutter? Yes, it is, but wouldn’t it have been much better for that child to be saved and loved with support along that journey?

Rescue is not up to child abuse organizations and superheroes. It is up to each one of us. While we sit here and do our work and sip our coffee, a child somewhere is being beaten, told they are ugly and stupid, being sexually abused, or hiding in fear feeling no one cares if they live or die. Yet, most of us rather look the other way. Will you be one who steps up and makes a difference in the life of a child? Or will you be one of many who ignore its existence?

How to Help

The problem is that great efforts are made to keep child abuse hidden. A good list of some signs is available at https://www.brightfutures4kids.org/programs/signs-of-abuse/.

Anyone who suspects abuse should call child protective services (or even the police). Call even if it’s just a suspicion. CPS will investigate and find the truth. Better to embarrass someone than to let a child stay in an abusive situation. If they find no abuse, they close the case, and that’s it. If there is abuse, that one phone call may save a child’s life!