Any intentional harm or mistreatment to a child under 18 years old is considered child abuse. Child abuse takes many forms, which often occur at the same time.

Physical abuse. Physical child abuse occurs when a child is purposely physically injured or put at risk of harm by another person.
Sexual abuse. Sexual child abuse is any sexual activity with a child, such as fondling, oral-genital contact, intercourse, exploitation or exposure to child pornography.
Emotional abuse. Emotional child abuse means injuring a child’s self-esteem or emotional well-being. It includes verbal and emotional assault — such as continually belittling or berating a child — as well as isolating, ignoring or rejecting a child.
Medical abuse. Medical child abuse occurs when someone gives false information about illness in a child that requires medical attention, putting the child at risk of injury and unnecessary medical care.
Neglect. Child neglect is failure to provide adequate food, shelter, affection, supervision, education, or dental or medical care.

Signs & Symptoms of child Abuse/Neglect

Behavioral clues:
infants excessive crying or developmental delay
fear, anxiety, clinging
phobias
nightmares, sleeping problems
bed wetting
social withdrawal
hyperactivity
poor concentration/distractibility
decreased school performance
chronic school absenteeism
speech disorders
regressive behavior for age
seems afraid of parent
eating issues
depression, passivity
increased verbal abuse or physically aggressive behavior with others
destroys or injures objects or pets
substance abuse
self-harm such as cutting
sexualized behavior
symptoms of PTSD
avoidance of undressing
withdrawal to touch, afraid of exam
overly compliant, especially with difficult or painful parts of the exam
Symptom clues:
headaches
abdominal pain, chronic
abdominal pain, acute – blunt trauma may not show external marks – look for distention, tenderness, absent bowel sounds
vague somatic complaints, often chronic
worsening medical problems, such as asthma
frequent, unexplained sore throat
abnormal weight gain or loss
reluctance to use an extremity
difficulty walking or sitting
genital discomfort or painful urination or defecation
unexplained symptoms – look for poisoning, forced ingestion of water, salt (Munchausen by proxy)
vomiting, irritability or abnormal respiration may represent head trauma
Physical clues (most common manifestations of abuse are found from skin, bone, or CNS):
poor hygiene
dressed inappropriately for weather
failure to thrive, poor weight gain, malnutrition
lack of care of medical needs; wound care, medication
see fractures
dislocations
see bruising
defensive injuries on forearms
bites – human bites are more superficial than animal, and show up better 2-3 days later
burns – (in 6-20% of abused children) cigarette, rope, immersion, or shape of hot object
is the severity of the burn consistent with length of contact by history?
cigarette burns circular, 8-10mm deep, heaped margin – may be confused with impetigo or moxibustion
stun gun burns occur in pairs, 0.5cm diameter and 5cm apart
immersion burns have sharp line of demarcation without drip or splash marks
signs of restraints on axilla or extremities
trauma to ear
lacerations
traumatic hair loss
facial injuries without good explanation
oral/dental injuries, such as torn or bruised frenulum, lips, teeth, palate, tongue or oral mucosa
injuries from non-ambulatory child may be “bottle jamming”
lacerations or tissue damage to oral structures may come from eating utensils, scalding or caustic liquids
scarring/bruising at corners of mouth from being gagged
oral injuries/STDs from forced oral sex
head injury, mental status change
retinal hemorrhage
subdural hematoma
intra-abdominal trauma, usually to multiple organs
bruising, tearing, bleeding, discharge from genital or rectal area
diagnosed STD or pregnancy

Children may be injured by domestic violence via:

being too small to get out of the way
trying to intervene
becoming an object of abuse
being neglected by the abused parent, who may be focused on their own fear or depression

Red flags with injuries:

explanation doesn’t fit the injury as to pattern, timing, or developmental ability of child
explanation keeps changing
child is consistently blamed as cause of repeated injuries
significant injuries attributed to a young sibling
delay in seeking medical care
history of multiple ED visits
frequent change of primary care provider

Parental risk factors:

rigid, severe discipline
strongly responds to negative behaviors, ignores child’s positive behaviors
ridicules child in public
isolates child socially or from other family members
seems overprotective or jealous
unrealistic expectations of child development or behavior for age
parent is caregiver for child with significant cognitive, physical or emotional disabilities
child unwanted, unplanned
lack of emotional interaction with child
inappropriate over or under concern about injury
partial confession
depression
difficulty controlling emotions, esp. anger
substance abuse
teen parenthood
family stress such as divorce, job loss

Warning!

Parents may seem evasive or inconsistent in their story due to language or cultural differences, or to being embarrassed or afraid relating to some other issue. Cultural/language difficulties may also lead to delayed care.

Conclusion

The signs of abuse aren’t always obvious and learning the warning signs of child sexual abuse could be lifesaving. You might notice behavioral or physical changes that could signal a child is being abused.

Some of these warning signs include:

Behavioral signs: Shrinking away from or seeming threatened by physical contact, regressive behaviors like thumb sucking, changing hygiene routines such as refusing to bathe or bathing excessively, age-inappropriate sexual behaviors, sleep disturbances, or nightmares
Physical signs: Bruising or swelling near the genital area, blood on sheets or undergarments, or broken bones
Verbal cues: Using words or phrases that are “too adult” for their age, unexplained silence, or suddenly being less talkative.

Warning Signs of Possible Sexual Abuse In A Child’s Behaviors

Any one sign doesn’t mean that a child was sexually abused, but the presence of several suggests that you begin asking questions and consider seeking help. Keep in mind that some of these signs can emerge at other times of stress such as:

During a divorce
Death of a family member or pet
Problems at school or with friends
Other anxiety-inducing or traumatic events

Behavior you may see in a child or adolescent
Has nightmares or other sleep problems without an explanation
Seems distracted or distant at odd times
Has a sudden change in eating habits
Refuses to eat
Loses or drastically increases appetite
Has trouble swallowing.
Sudden mood swings: rage, fear, insecurity or withdrawal
Leaves “clues” that seem likely to provoke a discussion about sexual issues
Writes, draws, plays or dreams of sexual or frightening images
Develops new or unusual fear of certain people or places
Refuses to talk about a secret shared with an adult or older child
Talks about a new older friend
Suddenly has money, toys or other gifts without reason
Thinks of self or body as repulsive, dirty or bad
Exhibits adult-like sexual behaviors, language and knowledge
Signs more typical of younger children
An older child behaving like a younger child (such as bed-wetting or thumb sucking)
Has new words for private body parts
Resists removing clothes when appropriate times (bath, bed, toileting, diapering)
Asks other children to behave sexually or play sexual games
Mimics adult-like sexual behaviors with toys or stuffed animal
Wetting and soiling accidents unrelated to toilet training
Signs more typical in adolescents
Self-injury (cutting, burning)
Inadequate personal hygiene
Drug and alcohol abuse
Sexual promiscuity
Running away from home
Depression, anxiety
Suicide attempts
Fear of intimacy or closeness
Compulsive eating or dieting

Physical warning signs

Physical signs of sexual abuse are rare. If you see these signs, bring your child to a doctor. Your doctor can help you understand what may be happening and test for sexually transmitted diseases.

Pain, discoloration, bleeding or discharges in genitals, anus or mouth
Persistent or recurring pain during urination and bowel movements
Wetting and soiling accidents unrelated to toilet training
What You Can Do If You See Warning Signs
Create a Safety Plan. Don’t wait for “proof” of child sexual abuse.
Look for patterns of behavior that make children less safe. Keep track of behaviors that concern you.