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

Full review/revision Aug 2021 | Modified Sep 2022

Many children and adolescents occasionally have physical confrontations with others, but most children and adolescents do not continue violent behavior or engage in violent crime. However, children who become violent before puberty may be at higher risk of committing crimes.

There is little evidence that violent behavior is caused by genetic defects or chromosomal abnormalities. Known risk factors for violence include the following:

  • Intense corporal punishment (such as punching or beating) inflicted on the child

  • Alcohol and drug abuse by caregivers of the child

  • Gang involvement

  • Developmental issues

  • Poverty

  • Access to firearms

Violent video games may desensitize children to violence. Although experts do not think they actually cause children to become violent, children exposed to them are more used to violence being part of life.

Gang involvement

Participation in youth gangs Violence and Gang Membership Adolescence is a time for developing independence. Typically, adolescents exercise their independence by questioning or challenging, and sometimes breaking, rules. Parents and doctors must distinguish... read more has been linked with violent behavior, often involving firearms. Members are 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, particularly methamphetamines and heroin.


Bullying Bullying Bullying is a form of youth violence in which repeated verbal, emotional, physical, or psychologic attacks are done to dominate or humiliate. (See also Overview of Social Issues Affecting Children... read more is intentional infliction of psychologic or physical damage on less powerful children. Up to one third of children may be involved in bullying as bullies, victims, or both.

Bullying can take several forms, including

  • Repeated teasing

  • Threats or intimidation

  • Harassment

  • Violent assaults

  • Cyber-bullying (use of e-mail, texting, social media, and other digital communication tools to threaten and/or spread hurtful information)

Victims often tell no one about being bullied because they are ashamed, because they feel that nothing will be done, or because they fear the bully will retaliate. Children who are bullied may reach a breaking point, at which time they strike back with potentially dangerous or catastrophic results.

Both bullies and their victims are at risk of poor outcomes. Victims are at risk of physical injury, poor self-esteem, anxiety, depression, and school absence. Many victims of bullying become bullies themselves. Bullies are more likely to be imprisoned in later life. Bullies are less likely to remain in school, be employed, or have stable relationships as adults.


Violence prevention should begin in early childhood. Strategies include the following:

  • Not using violence to discipline young children

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

  • Creating and maintaining a safe school environment

  • Encouraging victims to report problems to their parents and school authorities

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

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