The following are some signs often associated with particular types of child abuse and neglect:
physical abuse, neglect, sexual abuse, and emotional abuse.
It is important to note, however, that these types of abuse are more typically found in combination than alone. A physically abused child, for example, is often emotionally abused as well, and a sexually abused child also may be neglected.
Signs of Physical Abuse
In more than half of the cases of child abuse treated in
America, children sustain head, face and neck injuries. In a
10-year study of our nation's emergency rooms, child abuse
accounted for more than 10 percent of all blunt trauma to
patients younger than 5 years old. It was also found that
abused children were mainly injured by battering (53%) and
by shaking (10.3%). "The injuries most commonly are
inflicted with blunt trauma with an instrument, eating
utensils, hands, or fingers or by scalding liquids or
caustic substances." Common dental injuries include cuts on
the tongue, damaged soft and hard palate, fractured teeth,
facial bone and jaw fractures, and burns. "Multiple
injuries, injuries in different stages of healing, injuries
inappropriate for the child's stage of development, or a
discrepant history should arouse suspicion of abuse."
In an 10-year study of America's emergency departments, it
was found that children injured by abuse sustain more severe
injuries, utilize more medical services, and have worse
outcomes than children with accidental injuries. "Children
injured by child abuse were more likely to have retinal
hemorrhages (27.8% vs 0.06%) than children with
unintentional injuries... Abused children were more likely
than unintentionally injured children to sustain
intracranial injury (42.2% vs 14.1%) and thoracic (12.5% vs
4.5%) and abdominal (11.4% vs 6.8%) injuries; to sustain
very severe injuries (22.6% vs 6.3%); and to be admitted to
the intensive care unit (42.5% vs 26.9%). The mean length of
stay for children who were abused was significantly longer
(9.3 vs 3.8 days) and the survival to discharge from the
hospital was significantly worse (87.3% vs 97.4%) than for
those unintentionally injured. Among the survivors, children
who were abused developed extensive functional limitations
more frequently than those unintentionally injured (8.7% vs
2.7%)."
Consider the possibility of physical abuse when the
child:
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Has unexplained burns, bites, bruises, broken bones, or black eyes
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Has fading bruises or other marks noticeable after an absence from school
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Seems frightened of the parents and protests or cries when it is time to go home
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Shrinks at the approach of adults
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Reports injury by a parent or another adult caregiver
Consider the possibility of physical abuse when the
parent or other adult caregiver:
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Offers conflicting, unconvincing, or no explanation for the child's injury
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Describes the child as "evil," or in some other very negative way
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Uses harsh physical discipline with the child
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Has a history of abuse as a child
Signs of Neglect
Consider the possibility of neglect when the
child:
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Is frequently absent from school
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Begs or steals food or money
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Lacks needed medical or dental care, immunizations, or glasses
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Is consistently dirty and has severe body odor
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Lacks sufficient clothing for the weather
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Abuses alcohol or other drugs
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States that there is no one at home to provide care
Consider the possibility of neglect when the
parent or other adult caregiver:
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Appears to be indifferent to the child
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Seems apathetic or depressed
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Behaves irrationally or in a bizarre manner
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Is abusing alcohol or other drugs
Signs of Sexual Abuse
There are no medical signs in the vast majority of sexual
abuse cases.
Several physical injuries are strong signs of sexual abuse.
The oral cavity is a frequent site of sexual abuse in
children. The presence of oral and perioral gonorrhea or
syphilis in prepubescent children is a strong sign of sexual
abuse. When gonorrhea or syphilis is diagnosed in a child,
the case must be reported to public health authorities for
investigation of the source and other contacts. Bite marks
are lesions that may indicate sexual abuse. Gags applied to
the mouth may leave bruises, scratching, or scarring at the
corners of the mouth.
Consider the possibility of sexual abuse when the
child:
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Has difficulty walking or sitting
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Suddenly refuses to change for gym or to participate in physical activities
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Reports nightmares or bedwetting
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Experiences a sudden change in appetite
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Demonstrates bizarre, sophisticated, or unusual sexual knowledge or behavior
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Becomes pregnant or contracts a venereal disease, particularly if under age 14
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Runs away
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Reports sexual abuse by a parent or another adult caregiver
Consider the possibility of sexual abuse when the
parent or other adult caregiver:
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Is unduly protective of the child or severely limits the child's contact with other children, especially of the opposite sex
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Is secretive and isolated
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Is jealous or controlling with family members
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Misuses alcohol or other drugs
Signs of Emotional
Maltreatment
Consider the possibility of emotional maltreatment when the
