The 2023 Child Maltreatment Report explains that risk factors are characteristics of a child or caregiver that may increase the likelihood of child maltreatment. Drug abuse and domestic violence played large roles in child maltreatment reports, with 24% of victims suffering at the hands of caregivers who abused drugs and 25.1% whose caregivers were also involved in domestic violence. Caregiver alcohol abuse and inadequate housing, defined as substandard, overcrowded, or unsafe housing conditions including homelessness, were also designated as risk factors.

Maternal fatigue, which is often a predictor of depression, is often a factor when mothers shake their infants. First-time mothers, postpartum depression, unwanted pregnancy, and mothers under 19 or over 35 are also associated with shaking a baby. Fatherless households and domestic violence during pregnancy are further variables. Caregiver, family, and community-level factors should be taken into consideration as a physician embarks on a diagnosis (Krishnaprasadh, et al., 2025).

4.1 CDC: Types of Risk Factors

The CDC breaks down risk factors into individual, relationship/family, and community categories. Caregiver and family characteristics also contribute to AHT risk.

Individual risk factors include caregiver with (CDC, 2024):

• drug or alcohol issues
• mental health issues, including depression
• attitudes accepting of or justifying violence or aggression
• low education or income

Additionally, caregivers who (CDC, 2024):

• don't understand children's needs or development.
• were abused or neglected as children.
• are young or single parents or parents with many children
• have experienced high levels of parenting stress or economic stress
• use spanking and other forms of corporal punishment for discipline
• live in the home who are not a biological parent

Relationship / Family risk factors include families that (CDC, 2024):

• have household members in jail or prison
• are isolated from and not connected to other people
• experience other types of violence, including relationship violence
• have high conflict and negative communication styles

Community risk factors include communities with (CDC, 2024):

• high rates of violence and crime
• high rates of poverty and limited educational and economic opportunities
• high unemployment rates
• easy access to drugs and alcohol
• neighbors who don’t know or look out for each other
• communities where there is low community involvement among residents
• few community activities for young people
• unstable housing and where residents move frequently
• families that frequently experience food insecurity

The presence of these risk factors may increase vulnerability, but their absence does not rule out a diagnosis of AHT. Perpetrators vary; however, male caregivers, such as fathers, stepfathers, or the mother’s boyfriend, are most frequently involved, followed by female babysitters and biological mothers.

Healthcare providers should be alert to caregiver behavior, like providing an inconsistent back story for a child’s injury, delaying medical attention, or showing a lack of concern for the child’s injuries (Norton Children’s Hospital, 2020).

4.2 DHHS: Risk Factors for Victimization

The 2023 Child Maltreatment Report explains that risk factors are characteristics of a child or caregiver that may increase the likelihood of child maltreatment. States provide the data for this report via the National Child Abuse and Neglect Data System. Data has been collected every year since 1991 and is collected from child welfare agencies in the 50 states, Puerto Rico, and the District of Columbia (known as “52 states” in this report). During 2023, key findings include (US DHHS, 2025):

• more than 3 million children received either an investigation or alternative response
• over half a million victims of child abuse and neglect were reported. For FFY 2023, a nationally estimated 2,000 children died from abuse and neglect at a rate of 2.73 per 100,000 children in the population
• a unique count of 422,117 perpetrators
• recipients of prevention services numbered more than 1,700,000

More than a quarter of the victims ranged in age 0 to 2 years, with 14.2% of all victims being under a year. The victimization rate is highest for infant victims younger than 1 year at 21.0 per 1,000 children in the population of the same age, which is 2.2 times the rate of victims who are 1 year at 9.5 per 1,000 children. Victims who are 2 or 3 years old have victimization rates of 8.8 and 8.5 victims per 1,000 children of those respective ages in the population. In general, the rate of victimization decreases with the child’s age (US DHHS, 2025).

More than two-thirds of the perpetrators of child abuse were between 25 and 44 years old, with a concentration in the 25 to 34 age range. Based on data from 51 reporting states, more than one-half of perpetrators are female and 47.3 percent of perpetrators are male. The three largest percentages of perpetrators are White (46.6%), Black or African American (21.5%), and Hispanic (20.5%). (US DHHS, 2025).

Most perpetrators are a parent of their victim, 6.6 percent of perpetrators are a relative other than a parent, 4.1 percent have multiple relationships to their victims, and 4.0 percent are an unmarried partner of the parent. Nearly 4.0 percent of perpetrators have another relationship to their victims including foster sibling, nonrelative, or babysitter (US DHHS, 2025).

4.3 Family Risk Factors

Social isolation, family disorganization, dissolution, and violence—including domestic violence—are risk factors for a parent of caregiver committing child abuse. If a parent is stressed, has a poor relationship with the child, or engages in negative interactions with the child, they are at increased risk for committing child abuse.

Children themselves may be in a caretaker role—for example, as a babysitter—and may be responsible for abusing a child in their care. Any adult caretaker may be considered responsible if they delegate care responsibilities to an inappropriate minor. A mandatory reporter who suspects that abuse has occurred when one child is caring for another is required by law to make a child abuse report (Iowa HHS, 2024).

4.4 Community Risk Factors

Certain factors within the community can increase the risk of a parent or caregiver committing child abuse. Community violence, high community poverty rates, residential instability, high unemployment rates, high density of alcohol outlets, and poor social connections can increase the likelihood of a parent or caregiver abusing a child under their care (CDC, 2024).

4.5 The Protective Factors Approach

[The following information is from CWIG, 2025]

Some stakeholders in the child welfare community believe that focusing too much on family risks (mother’s mental health, history of violence) made families feel stigmatized and didn’t always lead to solutions. In response, the Child Welfare Information Gateway (CWIG)* has begun to promote a protective factors approach, in which they try to emphasize families’ strengths, engage families through collaboration with agencies, and encourage growth in safe and healthy ways.

*The Child Welfare Information Gateway is a service of the Children’s Bureau, US DHHS.

The protective factors approach aims to promote resilience among children, youth, and families, enabling them to develop skills, characteristics, knowledge, and relationships that mitigate risk and achieve both immediate and long-term positive outcomes.

Nurturing and Attachment. A child’s early experience of being nurtured and developing a bond with a caring adult affects all aspects of behavior and development. When parents and children have strong, warm feelings for one another, children develop trust that their parents will provide what they need to thrive, including love, acceptance, positive guidance, and protection.

Knowledge of Child Development. Discipline is both more effective and more nurturing when parents know how to set and enforce limits and encourage appropriate behaviors based on the child’s age and level of development. Parents who understand how children grow and develop can provide an environment where children are able to live up to their potential. Child abuse and neglect are often associated with a lack of understanding of basic child development or an inability to put that knowledge into action. Timely mentoring, coaching, advice, and practice may be more useful to parents than information alone.

Parental Resilience. Resilience is the ability to handle everyday stressors and recover from occasional crises. Parents who are emotionally resilient have a positive attitude, creatively solve problems, effectively address challenges, and are less likely to direct anger and frustration at their children. These parents are aware of their own challenges—for example, those arising from inappropriate parenting they received as children—and accept help and/or counseling when needed.

Social Connections. Evidence links social isolation and perceived lack of support to child maltreatment. Trusted and caring family and friends provide emotional support to parents by offering encouragement and assistance in facing the daily challenges of raising a family. Supportive adults in the family and the community can model alternative parenting styles and can serve as resources for parents when they need help.

Concrete Supports for Parents. Many factors beyond the parent-child relationship affect a family’s ability to care for their children. Parents need basic resources such as food, clothing, housing, transportation, and access to services that address specific needs (e.g., childcare, healthcare) to ensure the health and well-being of their children.

Some families may also need support connecting to social services such as alcohol and drug treatment, domestic violence counseling, or public benefits. Providing or connecting families to the concrete support that families need is critical. These combined efforts help families cope with stress and prevent situations where maltreatment could occur.

Child Social and Emotional Competence. Children need to learn how to identify and express emotions, just as they learn other skills. Healthy emotional expression helps parents meet their children's needs and strengthens relationships. If children are unable to express their needs due to age, disability, or other factors, it can lead to parental stress. Emotional self-regulation is vital for children’s interactions with family, peers, and others.

Child abuse and neglect is not a new phenomenon—it has been documented for more than two thousand years. For most of human history children had no rights in the eyes of the law and it was unthinkable that the law would intervene in the domain of the family. In the United States, the first known legal response to child abuse occurred in 1874.