Signs of Abuse

There are a number of physical signs and behaviors that could indicate abuse or neglect. Most of these behaviors can also be found in children who are not being abused - very few are absolute proof of abuse or neglect. Children who are victims of abuse may show a few or many of the signs listed below and may also have other symptoms that are not listed here. This information was adapted from two guides by the Massachusetts Department of Social Services(1,2) as a general overview of some of the most common indicators of child abuse and neglect.

Signs of Physical Abuse
Signs of Sexual Abuse
Signs of Emotional Abuse
Signs of Neglect

Signs of Physical Abuse

Physical Signs:

Unexplained bruises, burns, cuts, broken bones, human bite marks, bald spots, or other physical injury
These wounds may:

- Be in a similar shape on different parts of the body
- Be shaped like the object used to inflict them (i.e. a belt buckle or cigarette)
- Be clustered together, forming a regular pattern
- Be in various stages of healing
- Appear on the child repeatedly after spending time with the abuser

Behavioral Signs:

Running away from home often
Going to school early and staying late
Fearful of adults
Fearful of going home (or to a caretaker’s house)
Irrational fears
Thumb sucking, nail biting, rocking, or uncontrollable crying
Constant anger or temper tantrums
Extremely aggressive, withdrawn, or overly compliant
Emotional neediness
Hurting him/herself or other children
Threatens or attempts suicide
Often absent from school or distracted while at school
Trouble in school
Low self-esteem, depression
Constant worrying and tenseness

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Signs of Sexual Abuse

Physical Signs:

Sexually transmitted disease
Pregnancy in a young non-sexually active child
Pregnancy in a non-sexually active adolescent
Frequent urinary tract or genital infections
Bruises or bleeding in the genitals or anal areas
Torn, stained, or bloody underwear

While there are no physical signs in most cases of sexual abuse, if a child reports sexual abuse, it is important to seriously consider that the child’s statements may be accurate. The following warrant follow-up:

Personalized statement that he/she was sexually abused
Knowledge of sexual matters inappropriate for the child’s age (especially in young children; older children could have acquired information from peers without a parent’s knowledge)
Sexual drawings
Sexual acting out with younger children, peers, or adults
Sexual acting out with animals or toys
Excessive or compulsive masturbation (i.e. in public or to the extent that the behavior interferes with the child participating in normal childhood activities)
Promiscuity (many sexual partners) or prostitution

The following symptoms and/or behaviors are only cause for concern of possible sexual abuse when they occur in association with a disclosure of sexual abuse or if the child has been exposed to a a known sexual offender. When observed in isolation, they are definitely cause for concern and require intervention, but may be indicative of some type of problem other than sexual abuse:

Sudden change in behavior
Trouble relating to peers
Trouble in school
Running away
Threatens or attempts suicide
Self harm (cutting or burning)
Eating disorders (anorexia, bulimia, or overeating)
Alcohol or drug abuse
Going to school early and staying late
Low self-esteem, depression
Emotional neediness
Trouble sleeping, nightmares, or bedwetting in an older child
Hurting animals
Setting fires
Extremely aggressive, withdrawn, or fearful
Criminal activity

If you have a question about a behavior, it is best to ask your child’s pediatrician whether that behavior is normal for your child’s age.

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Signs of Emotional Abuse

Behavioral Signs:

Suspicious, untrusting, anxious, distracted
Poor eye contact
Antisocial or withdrawn
Thumb sucking, nail biting, rocking, or uncontrollable crying
Low self-esteem, depression
Trouble in school
Running away
Trouble sleeping
Irrational fears or compulsiveness
Very worried about pleasing adults
Emotional neediness
Angry when not feeling in control
Suicide threats or attempts; self-harm
Alcohol or drug abuse

Physical Signs:

Appears withdrawn
Speech disorders, stuttering
Nervous tic
Hair missing because of pulling, nails bitten
Overweight
Self-inflicted injuries
Slow physical development
Ulcers, asthma, severe allergies

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Signs of Neglect

Physical Signs:

Always hungry, dirty, or inappropriately dressed
Often unsupervised for long periods of time
Medical problems that are not taken care of
Abandonment
Lice or skin infections
Starvation
Slow to grow and/or speak

Behavioral Signs:

Begging or stealing food
Often tired, weak, or listless
Often absent or late to school
Extremely aggressive, withdrawn, or fearful
Very shy or very demanding of attention
Emotional neediness

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References:
(1) Massachusetts Department of Social Services. 51-A Mandated Reporting: What Schools Need to Know. 1996.

(2) Massachusetts Department of Social Services. Investigation Training: Evidence and Indicators of Maltreatment. March 2002.


Last Updated: June 23, 2003
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