Symptoms

Abused or neglected children often show both physical and behavioral symptoms. Older children may not talk about the problem, because they fear or want to protect the offender or they do not believe they will be taken seriously. Sometimes children report abuse to an adult they trust. These conversations should be taken seriously and acted upon.

Some symptoms are specific to certain forms of maltreatment. There are also general symptoms that can occur with all types.

General symptoms

Certain general symptoms that may suggest that a child is experiencing some type of abuse or neglect include:

• Developmental delays, which means a child does not reach developmental milestones as expected, such as starting to talk or socialize with others.
• Regression, which is losing skills already mastered and moving back to a earlier state of development.
• Failure to thrive, which is when a child's growth pattern is not in a healthy range. Both weight and height can be affected, but low weight for height and head circumference is the most common symptom. Most cases of failure to thrive are the result of problems with the immediate care of the child, the interaction between the child and the caregiver (usually the mother), or the social and emotional health of the caregiver.
• Unusual parent/child interaction. The parent may be uninterested in the child, or a child may be especially sensitive to the parent's moods and may attempt to smooth over any potential conflict. Often this appears as a type of role reversal, with the child closely monitoring and responding to the parent. Abused or neglected children may also fear their parents.
• Poor mental health, such as exhibiting low self-esteem, anxiety, depression, or suicidal tendencies.
• Sudden decline in academic performance.
• Inappropriate or problem behavior. In some cases, especially for a young child, unusual fussiness, fear, or lack of interest in activities may be noticed. Other behaviors may be disruptive. Children often act out what they have seen or experienced, such as violence or sexual activity. Older children may act out by being promiscuous or running away.

Symptoms of physical abuse

Physical abuse often results in cuts, bruises, burns, broken bones, head injuries, and abdominal injuries. These types of injuries may point to physical abuse when:

• They are unlikely to have been caused by an accident, especially for the child's developmental stage. Geometric patterns or mirror (symmetrical) injuries are suspicious, as are those located on areas of the body that usually are protected, such as the inside of the legs and arms, the back, the genitalia, and the buttocks.
• Explanations change or do not adequately account for how an injury occurred. The history of the injury does not match the actual type of injury, its location, or how long ago it occurred.
• Evidence shows that injuries have occurred previously.
• Medical care for the injury is delayed.

Symptoms of psychological abuse

A child who experiences psychological abuse has a parent or caregiver who uses tactics to hurt a child psychologically, such as by saying demeaning words or by failing to be supportive. The emotional pain caused by this type of abuse can devastate a child. An emotionally abused child may:

• Have little interest in what is going on around him or her and not be eager to try new activities.
• Have inappropriate responses to pain, other people, or changes in his or her environment.
• Avoid a parent or caregiver.
• Act overly fearful, angry, depressed, or anxious.
• Perform poorly in school.
• Inflict self-injury or be self-destructive.

Symptoms of sexual abuse

A child with symptoms of recent sexual abuse may be reluctant to go to the bathroom; may show signs of discomfort or pain while sitting, urinating, or passing stools; may have discharge from the vagina or penis; or may bleed through his or her pants.

Certain behaviors may also point to sexual abuse. These include:¹

• Age-inappropriate awareness and knowledge of sex or sexual behavior.
• Running away from home.
• Suicide attempts.
• Involvement with drugs or prostitution.

Note: Sexual abuse is very different from normal sexual play between children. Sexual abuse is a criminal activity. It includes any sexual activity that the child is not able to understand or consent to. This may include, but is not limited to, obvious sexual acts (such as intercourse), fondling, exhibitionism, voyeurism, and exposure to pornography.

Normal sexual play involves preteen children within 4 years of age of each other, who have similar developmental levels. No force, power, or coercion is used, and the play-primarily touching and looking at genitalia-is driven by an innocent curiosity.

Symptoms of neglect

A child is neglected when he or she does not have appropriate care. A child's general appearance, home environment, and behavior patterns can show signs of neglect.

A child who is neglected may be:

• Significantly underweight or overweight.
• Developmentally delayed.
• Obviously unhealthy, such as being sick or tired most of the time.
• Dirty or have poor personal hygiene.
• Inadequately clothed.