Physical Abuse

Physical abuse occurs when a parent or other person legally responsible for the child’s care inflicts or knowingly allows the child to be subjected to non-accidental physical injury which causes or creates substantial risk or impairment of physical well-being.


Some physical indicators of physical abuse include:
  • Unexplained bruises or welts, injuries in various stages of healing, or on vital areas such as torso, kidney, and chest

  • Unexplained burns from cigars or cigarettes, in patterns such as an iron or electrical burner, or infected burns indicating a delay in treatment

  • Unexplained fractures/dislocations in multiples or various stages of healing

  • Unexplained lacerations or abrasions, especially in various stages of healing or to genitalia

  • Head injuries including, an absence of hair due to hair pulling, subdural hematomas, retinal hemorrhages, or jaw and nasal fractures


Other factors to consider when assessing physical injuries:
  • Are injuries inconsistent with medical history?

  • Are injuries inconsistent with explanation for injury?

  • Are injuries inconsistent with developmental abilities of the child to injure itself?


An important point is that documented behavioral/psychological manifestations of abuse may be just as important as the physical evidence during a medical exam.


Some behavioral and emotional indicators of physical abuse include:
  • Obvious attempts to hide bruises or injuries such as excessive school absenteeism and wearing long-sleeve shirts during summer time

  • Fearful of parents or adults and/or appears frightened or apprehensive of caretaker

  • Attempts to avoid abusive situations, such as running away from home or leaving school late

  • Behavioral extremes, such as being extremely aggressive or overly compliant

  • Academic and behavioral difficulties at school

  • Cognitive and intellectual impairment

  • Deficits in speech and language

  • Hyperactivity, impulsivity, low frustration tolerance

  • Lack of basic trust in others

  • Depression, low self-esteem, destructive behavior, and/or suicidal tendencies

  • Consistently tired and unable to stay awake

  • Missing PE or complaining that physical activity causes pain or discomfort

Sexual Abuse

Sexual abuse is any sexual behavior with a child or the use of a child for the sexual gratification of someone else. Sexual abuse usually occurs with someone known to the child and begins gradually with the offender “testing the limits” to determine what the child will accept. The sexual abuse progresses through stages and may include exhibitionism, fondling, oral sex, or attempts to enter and/or actual penetration of the vagina or anus. The majority of cases involving sexually abused children will not have physical indicators of sexual abuse.

Physical indicators of sexual abuse include:
  • Difficulty walking or sitting

  • Torn, stained, or bloody undergarments

  • Bruises, bleeding, lacerations, or pain in external genitalia, vaginal, or anal areas

  • Painful urination

  • Vaginal/penile discharge or swelling

  • Venereal disease

  • Poor sphincter tone

  • Pregnancy

  • Semen around genitals or on undergarments

  • Swollen or red cervix, vulva, perineum, or anus


An important point is that documented behavioral/psychological manifestations of abuse may be just as important as the physical evidence during a medical exam.


Behavioral/Emotional indicators and effects of sexual abuse include:
  • Excessive masturbation

  • Seductive behavior and sexual acting out towards adults, promiscuity, prostitution

  • Knowledge of sexual matters inappropriate to child’s age or developmental level

  • Lack of trust

  • Poor peer relationships, social withdrawal

  • Extreme fear of particular person or place

  • Sudden drop in academic performance and/or inability to concentrate in school

  • Non-participation in school & social activities

  • Unwillingness to undress for physical education class at school

  • Feelings of depression, guilt, shame, withdrawal, suicidal feelings and gestures

  • Overly compliant behavior or acting out, aggressive behavior

  • Behavioral regression or infantile behavior

  • In extreme cases, psychosis, dissociative states or flat affect

  • Physical symptoms with no organic basis

  • Nightmares, will not sleep alone

  • Food – over or under eating


Emotional Abuse

Emotional abuse includes excessive, aggressive, or unreasonable demands that place expectations on a child beyond his or her capacity. Constant criticizing, belittling, insulting, rejecting and teasing are some of the forms these verbal attacks can take. Emotional abuse also includes failure to provide the psychological nurturance necessary for a child’s emotional growth and development – providing no love, support, or guidance.


Physical indicators of emotional abuse include:
  • Speech disorders

  • Lags in physical development

  • Failure to thrive

  • Hyperactive/disruptive behavior

  • Sickly, unhealthy or empty facial appearance


Behavioral/Emotional indicators and effects of emotional abuse include:
  • Anxiety and unrealistic fears

  • Sleep problems, nightmares

  • Consistent conduct and academic problems at school

  • Poor relationships with peers

  • Behavioral extremes

  • Depressed and withdrawn and/or apathetic and indifferent

  • Habit disorder such as biting, rocking, head banging, or thumb sucking in an older child


Physical Neglect

A neglected child is one who’s physical, mental, or emotional development is impaired as a result of the failure of the child’s parent, legal guardian, or caretaker to provide the child with adequate food, clothing, shelter, education, or medical care. Failure to provide proper supervision, which puts the child at risk, is also neglect.


Physical indicators of physical neglect include:
  • Underweight, poor growth pattern (i.e. small in stature, failure to thrive)

  • Consistent hunger, poor hygiene, inappropriate dress

  • Consistent lack of supervision, especially in dangerous activities or for long periods

  • Loss of fat under the skin, ex. in the cheeks, buttocks

  • Unattended physical problems or medical needs

  • Bald patches on the scalp

  • Appearance is consistently dirty or unbathed

  • Filthy living conditions


Behavioral/Emotional indicators and effects of physical neglect include:
  • Serious height and weight abnormalities

  • Developmental lags

  • Nonorganic failure to thrive: delayed developmentally, apathetic, depressed, nonresponsive, fatigued

  • Frequent absences from school

  • Reports of being left alone, unsupervised, or abandoned

  • Antisocial tendencies, delinquency, alcohol or drug abuse, streetwise

  • Hoarding food or extreme hunger

  • Frequent inappropriate dress for the weather conditions

  • Brings only candy, sweets, chips, soda for lunch


Presence of one or more indicators should prompt a closer look at the child and the child’s environment. It is important to keep in mind that many of the indicators may be observed in children or families where abuse is not occurring. A history of suspicious injuries, patterns of behavior, and verbal reports of abuse are all key elements in recognizing possible abuse or neglect.

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