Merck Manual

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Violence in Children and Adolescents


Stephen Brian Sulkes

, MD, Golisano Children’s Hospital at Strong, University of Rochester School of Medicine and Dentistry

Reviewed/Revised Apr 2023

Children and adolescents may engage in occasional physical confrontations, but most do not develop a sustained pattern of violent behavior or engage in violent crime. Children and adolescents who become violent before puberty may be at higher risk of committing crimes.

Violent behavior is increasingly common among children and adolescents.

Despite ongoing interest in the possibility of a relationship between violent behavior and genetic defects or chromosomal anomalies, there is minimal evidence for such a relationship. However, several risk factors have been associated with violent behavior, including

  • Intense corporal punishment

  • Alcohol and drug use

  • Gang involvement

  • Developmental issues

  • Poverty

  • Access to firearms

In 2019, 19.5% of male high school students in the United States reported carrying a weapon at least once during the month before they were surveyed as part of a study on youth risks (1 Reference Children and adolescents may engage in occasional physical confrontations, but most do not develop a sustained pattern of violent behavior or engage in violent crime. Children and adolescents... read more ).



Bullying is intentional infliction of psychologic or physical damage on less powerful children. Bullying can take several forms, including

  • Persistent teasing

  • Threats

  • Intimidation

  • Harassment

  • Violent assaults

  • Cyberbullying

Cyberbullying is the use of e-mail, texting, social media, and other digital communication tools to convey threats and/or spread hurtful information to purposely embarrass or communicate false or hostile information about another child. "Sexting," which is the act of sharing sexually charged messages or photographs (usually via cell phone), can be a form of cyberbullying if the messages or photographs are purposefully shared with other people to embarrass or harm the child who originated or appeared in the message or photograph.

Up to one third of children may be involved in bullying as bullies, victims, or both. Social stresses (eg, low family income, low parental education levels) are risk factors for bullying.

Bullies act to inflate their sense of self-worth. Bullies often report that bullying creates feelings of power and control.

Both bullies and their victims are at risk of poor outcomes. Victims often tell no one about being bullied because of feelings of helplessness and shame and fear of retaliation. Victims are at risk of physical injury, poor self-esteem, anxiety, depression, and school absence. Children who are bullied may reach a breaking point, at which time they strike back with potentially dangerous or catastrophic results. Many victims of bullying become bullies themselves. Bullies are more likely to be incarcerated in later life; they are less likely to remain in school, be employed, or have stable relationships as adults.

Gang involvement

Participation in gangs has been linked with violent behavior. Youth gangs are self-formed associations of 3 members, typically ages 13 to 24.

Gangs usually adopt a name and identifying symbols, such as a particular style of clothing, the use of certain hand signs, tattoos, or graffiti. Some gangs require prospective members to perform random acts of violence before membership is granted.

Increasing youth gang violence has been blamed at least in part on gang involvement in drug distribution and drug use. Use of firearms is a frequent feature of gang violence.

Prevention of Violence in Children and Adolescents

Violence prevention should begin in early childhood. Strategies include

  • Violence-free discipline in young children

  • Limiting access to weapons and exposure to violence through media and video games

  • Creating and maintaining a safe school environment for school-age children

  • Encouraging victims to discuss problems with parents, school authorities, and their doctor

  • Teaching older children and adolescents strategies for avoiding high-risk situations (eg, places or settings where others have weapons or are using alcohol or drugs) and for reacting to or defusing tense situations

NOTE: This is the Professional Version. CONSUMERS: View Consumer Version
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