Parents sacrifice for their children - giving up their time, money and sometimes their own dreams - in order for their children to have the best life possible. Children, too, sacrifice for their parents. Consider this: A child grows up in a family with parental conflict or divorce, or with mental illness, or with a sibling off the derech, or with a parent who yells and hits. Children absorb the tensions in the family, taking on the role of protector, caretaker, appeaser, surrogate parent and/or surrogate spouse. Children instinctively begin to learn the art of sacrificing for the sake of their parent in the face of turmoil. Adapting to family problems helps maintain a status quo within the family and maintenance the family's appearance of functioning well.

But at what cost to the child? Children, sensing that things are not right, even if they are unable to articulate it, will likely feel scared and confused. What will happen to their parents? What will happen to them and maybe to their younger siblings? They are worried, fearing the worst, ambivalent, and confused. They suffer these thoughts in silence. And they silence their own feelings with shame and doubt.

When consumed by their own problems or those of the family, parents cannot give unconditional protection and nurturing to their children. The child's sense of safety and security erodes, and the child becomes overly vigilant, ever alert to little changes in the precarious family balance, anticipating signs of trouble and fighting, figuring out how to stay safe and protect others. The sense of danger is heightened. The child may feel guilty for not rescuing the family.

When children, albeit unconsciously, lay themselves down to serve as the sacrificial lambs, they are prone to fear, confusion, ambivalence, shame, doubt, hypervigilance and guilt. Soon they will begin to act differently as well.

In suppressing their needs, not daring to rock an already shaky foundation, children might become anxious, depressed, and withdrawn. They may develop fears or rituals, or have difficulty concentrating in school. They may cut themselves off from their family or friends. They shut down, adopting an "I don't care attitude," partly because they care so much and partly because they learn to numb themselves. Helplessness and hopelessness may set in. Such children do not make trouble. They simply accept their self sacrifice or suffer in silence.

Alternatively, some children will act out. They may show irritability, anger and disrespect in the home and/or in school. It would not be surprising to find involvement in drugs or prohibited relationships. These children may escape or even leave the family, not necessarily from a desire to be bad, as is often thought, but in an attempt to find support in the world or to assert their own selves apart from the problems that surround them. Such responses to family problems serve an ulterior purpose: by drawing attention to themselves, these children take the focus off the real problems in the home.

The acting out mode entails self-sacrifice in that children end up hurting themselves. They are not willing to remain passive but do not know another way to survive what they see as an impossible situation at home. Unlike those children who sacrifice for the benefit of parents (as they believe), these acting-out children are sacrificed because of the parents.

In families where the problems are more severe, where abuse - - psychological, physical or sexual -- dominates, the child's reactions will be most impaired. Trust is broken, and there is no refuge in the home. Fear turns into terror. Confusion turns into losing sight of what is real. Self-blame turns into self mutilation. Any sense of security is shattered. The self is crushed, and it is not unusual for such children to cut themselves, turn to drugs or even attempt suicide. Future relationships will equate violence and aggression with love, and so the hurt will only continue. The person feels damaged, and survival becomes the only goal.

Ultimately, by keeping the family secrets and playing the role of appeaser or protector of the parents, the child is left to carry an unspeakable burden that wears away at the self. What gets sacrificed is the child's well-being, sense of security and trust. And without these, a child cannot grow into a healthy adult.

It is incumbent on those coming in contact with children -- family members, educators and medical professionals -- to recognize the signs of distress and to take action. Getting these children to licensed mental health professionals is critical. The cost of covering up family problems is too great for any child to bear without professional help.

Dr. Levine is on staff at Maimonides Medical Center, in the Child and Adolescent Outpatient Clinic, where she works with children and their families. She also has a private practice in Boro Park and in Manhattan.