ATrain Education


Continuing Education for Health Professionals

IA: Child Abuse, A Guide for Mandatory Reporters

Module 4

Indicators of Possible Child Abuse

The following physical and behavioral indicators are listed as signs of possible child abuse for you to consider in making your report. These indicators need to be evaluated in the context of the child’s environment. The presence of one or more of these symptoms does not necessarily prove abuse. These lists are examples and are not all-inclusive.

Physical indicators

  • Bruises and welts on the face, lips, mouth, torso, back, buttocks, or thighs in various stages of healing
  • Bruises and welts in unusual patterns reflecting the shape of the article used (eg, electric cord, belt buckle) or in clusters indicating repeated contact
  • Bruises on infant, especially facial bruises
  • Subdural hematomas, retinal hemorrhages, internal injuries
  • Cigarette burns, especially on the soles, palms, back, or buttocks
  • Immersion burns (sock-like, glove-like, doughnut-shaped) on buttocks or genitalia
  • Burns patterned like an electric element, iron, or utensil
  • Rope burns on arms, legs, neck, or torso
  • Fractures of the skull, nose, ribs, or facial structure in various stages of healing
  • Multiple or spiral fractures
  • Unexplained (or multiple history for) bruises, burns, or fractures
  • Lacerations or abrasions to the mouth, frenulum, lips, gums, eyes, or external genitalia
  • Bite marks or loss of hair
  • Speech disorders, lags in physical development, ulcers
  • Asthma, severe allergies, or failure to thrive
  • Consistent hunger, poor hygiene, inappropriate dress
  • Consistent lack of supervision, abandonment
  • Unattended physical or emotional problems or medical needs
  • Difficulty in walking or sitting
  • Pain or itching in the genital area
  • Bruises, bleeding or infection in the external genitalia, vaginal, or anal areas
  • Torn, stained, or bloody underclothing
  • Frequent urinary or yeast infections
  • Venereal disease, especially in pre-teens
  • Pregnancy
  • Substance abuse—alcohol or drugs
  • Positive test for presence of illegal drugs in the child’s body

Behavior indicators

  • Afraid to go home; frightened of parents
  • Alcohol or drug abuse
  • Apprehensive when children cry, overly concerned for siblings
  • Begging, stealing, or hoarding food
  • Behavioral extremes, such as aggressiveness or withdrawal
  • Complaints of soreness, uncomfortable movement
  • Constant fatigue, listlessness, or falling asleep in class
  • Delay in securing or failure to secure medical care
  • Delinquent, runaway, or truant behaviors
  • Destructive, antisocial, or neurotic traits, habit disorders
  • Developmental or language delays
  • Excessive seductiveness or promiscuity
  • Extended stays at school (early arrival and late departure)
  • Extreme aggression, rage, or hyperactivity
  • Fear of a person or an intense dislike of being left with someone
  • Frequently absent or tardy from school or drops out of school or sudden school difficulties
  • History of abuse or neglect provided by the child
  • Inappropriate clothing for the weather
  • Massive weight change
  • Indirect allusions to problems at home such as “I want to live with you”
  • Lack of emotional control, withdrawal, chronic depression, hysteria, fantasy, or infantile behavior
  • Lags in growth or development
  • Multiple or inconsistent histories for a given injury
  • Overly compliant, passive, undemanding behavior; apathy
  • Poor peer relationships; shunned by peers
  • Poor self-esteem, self-devaluation, lack of confidence, or self-destructive behavior
  • Role-reversal behavior or overly dependent behavior; states there is no caretaker
  • Suicide attempts
  • Unusual interest in or knowledge of sexual matters, expressing affection in inappropriate ways
  • Wary of adult contacts, lack of trust, uncomfortable with or threatened by physical contact or closeness
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