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Symptoms
By Mayo Clinic staffA child who's being abused may feel guilty, ashamed or confused. He or she may be afraid to tell anyone about the abuse, especially if the abuser is a parent, other relative or family friend. That's why it's vital to watch for red flags, such as:
- Changes in behavior or school performance
- Withdrawal from friends or usual activities
- An apparent lack of supervision
- Frequent absences from school
- Reluctance to leave school activities, as if he or she doesn't want to go home
- Attempts at running away
- Physical clues, such as bruising or blood in underwear
There also are specific signs and symptoms to look out for, depending on the type of abuse.
Physical abuse signs and symptoms
- Unexplained injuries, such as bruises, fractures or burns
- Untreated medical or dental problems
- Poisoning
- An apparent fear of parents or adult caregivers
- A discrepancy between the extent of the injuries and the explanation given for the injuries
Sexual abuse signs and symptoms
- Inappropriate sexual behavior for child's age
- Sexual knowledge that's inappropriate for the child's age
- Sleep problems, such as nightmares or night terrors
- Changes in behavior, such as aggression or hyperactivity
- Blood in the child's underwear
- Depression or anxiety
- Social withdrawal
- Abuse of other children sexually
- Statements that he or she was sexually abused
- Attempts to undress other people
- Trouble walking or sitting
Emotional abuse signs and symptoms
- Delayed or inappropriate emotional development
- Extremes in behavior, from very aggressive behavior to complete passivity
- Loss of self-confidence or self-esteem
- Sleep problems
- Headaches
- Stomachaches
- Avoidance of certain situations, such as refusing to go to school
- Seeks affection from other adults
- Depression
Neglect signs and symptoms
- Poor growth
- A lack of fat in cheeks, buttocks and extremities
- Indifference
- Poor hygiene
- Frequent absences from school
Sometimes a parent's demeanor or behavior also sends red flags about child abuse. Warning signs include a parent who:
- Shows little concern for the child
- May not offer comfort during a medical exam
- Denies that any problems exist at home or school, or blames the child for the problems
- Consistently blames, belittles or berates the child
- Describes the child with negative terms, such as "worthless"
- Uses harsh physical discipline or asks teachers to do so
- Demands an inappropriate level of physical or academic performance
- Severely limits the child's contact with others
- Offers conflicting or unconvincing explanations for a child's injuries, or no explanation at all
- Appears unable to recognize physical or emotional distress in children
- Seems jealous of other family members getting attention from the child
Keep in mind that warning signs are just that — warning signs. The presence of warning signs doesn't necessarily mean that a child is being abused.
Although most child health experts strongly advise against the use of violence in any form, some people still use corporal punishment (spanking etc.) as a way to discipline their children. Sometimes it can be difficult to tell if the line between discipline and abuse has been crossed. Corporal punishment that injures or leaves marks is excessive and considered abuse by child protection agencies in the United States. Any corporal punishment may leave emotional scars.
Certain parental behaviors — even when done in the name of discipline — are clearly child abuse, such as:
- Biting
- Kicking
- Burning
- Scalding
- Threatening extreme violence, such as using a knife or a gun
- Cutting
- Breaking bones
- Bruising
- Spanking multiple times a day
- Spanking an infant
When to see a doctor
If you're concerned that your child or another child has been abused, seek help immediately. Contact the child's doctor, a local child protective agency or the local police department. Keep in mind that health care professionals are legally required to report all suspected cases of child abuse to state authorities.
If you're worried that you might abuse your own child, stop what you're doing and put some distance between you and your child. If there's someone who can watch your child, leave the house and go for a walk. Call your own primary care doctor or your child's pediatrician for advice and a treatment referral. If you don't think you can control your temper, call 911 or take your child to the nearest emergency room for help.
- Sirotnak AP, et al. Child abuse and neglect. In: Hay WW Jr, et al. Current Diagnosis and Treatment: Pediatrics. 19th ed. New York, N.Y.: McGraw Hill; 2009. http://www.accessmedicine.com/content.aspx?aID=3399277. Accessed May 18, 2010.
- Child maltreatment 2008. U.S. Department of Health and Human Services. http://www.acf.hhs.gov/programs/cb/pubs/cm08/cm08.pdf. Accessed May 19, 2010.
- What do I need to know about child abuse? American Academy of Pediatrics. http://www.healthychildren.org/English/safety-prevention/at-home/Pages/What-to-Know-about-Child-Abuse.aspx. Accessed May 18, 2010.
- Bernet W. Child maltreatment. In: Ebert MH, et al. Current Diagnosis and Treatment: Psychiatry. 2nd ed. New York, N.Y.: McGraw Hill; 2008. http://www.accessmedicine.com/content.aspx?aID=3291295. Accessed May 18, 2010.
- Recognizing child abuse and neglect: Signs and symptoms. Child Information Gateway. http://www.childwelfare.gov/pubs/factsheets/signs.cfm. Accessed May 18, 2010.
- Milosavljevic N, et al. Abuse and neglect. In: Stern TA, et al. Massachusetts General Hospital Comprehensive Clinical Psychiatry. Philadelphia, Pa.: Mosby Elsevier; 2008. http://www.mdconsult.com/das/book/body/201664618-3/0/1657/764.html. Accessed May 18, 2010.
- Berkowitz CD. Child abuse and neglect. In: Tintinalli JE, et al. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. 6th ed. New York, N.Y.: McGraw Hill; 2004. http://www.accessmedicine.com/content.aspx?aID=614652. Accessed May 18, 2010.
- Whipple EE, et al. Crossing the line from physical discipline to child abuse: How much is too much? Child Abuse and Neglect. 1997;21:431.
- Chung EK, et al. Parenting attitudes and infant spanking: The influence of childhood experiences. Pediatrics. 2009;124:e278.
- Asnes AG. Managing child abuse: General principles. Pediatrics in Review. 2010;31:47.
- Long-term consequences of child abuse and neglect. Child Welfare Information Gateway. http://www.childwelfare.gov/pubs/factsheets/long_term_consequences.pdf. Accessed May 18, 2010.
- Shipman K, et al. Mental health treatment of child abuse and neglect: The promise of evidence-based practice. Pediatric Clinics of North America. 2009;56:417.
- Hoecker J (expert opinion). Mayo Clinic, Rochester, Minn. May 20, 2010.
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