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Section 7
Recognition of Child Abuse i.e. Indicators

Question 7 | Test | Table of Contents

As has been stated in previous sections, there are different types of child abuse and neglect that individuals who work with children on a frequent basis may see. Within these different types of child abuse and neglect (physical abuse, sexual abuse/exploitation, emotional abuse, and abandonment). There are many signs and indicators that a child may show being abuse by either relatives or others who they come into contact with on either a frequent or even an occasional basis. There are also indicators that a parent may show if they may be abusing their child.

For those individuals who work in fields that put them in contact with children on a frequent basis, such as those in healthcare fields or those employed at schools, it is very important that they know and are familiar with the different signs and indicators that they may see in children who are the victims of some type of child abuse or neglect. It is also important to remember that these indicators do not necessarily conclude that the child is being abused, but should warrant further investigation into what may be going on.

Some indicators that a child may be at risk of being physically abused include, but are not limited to [25]:

• Unexplained bruises, welts, human bite marks, bald spots
• Numerous bruises in various stages of healing
• Marks on many surfaces of the body
• Unexplained burns, especially cigarette or immersion burns
• Bruises located on faces, ears, necks, buttocks, backs, chests, thighs, back of legs, and genitalia
• Bruises that resemble objects such as a hand, fist, belt buckle, or rope
• Injuries that are inconsistent with a child’s age/developmental level
• Withdrawal or aggression – behavioral extremes
• Uncomfortable with physical contact
• Afraid to go home
• Extreme apprehensiveness/vigilance
• Pronounced aggression or passivity
• Flinches easily or avoids being touched
• Play includes abusive behavior or talk
• Unable to recall how injuries occurred or account of injuries is inconsistent with the nature of the injuries
• Fear of parent or caregiver
• Dressed inappropriately for the weather
• Cringes when approached by an adult
• Overreacts to accidents
• Does not want to talk about home life
• Extreme attachment to parents
• Extreme attentiveness to needs of parents

Indicators that a child may be sexually abused include [25]:

• Sleep disturbances
• Pain or itching in genital area
• Difficulty walking or sitting
• Difficultly urinating
• Pregnancy
• Positive testing for sexually transmitted disease or HIV
• Excessive or injurious masturbation
• Bruises or bleeding in external genitalia
• Frequent urinary or yeast infections
• Torn, stained, or bloody underclothing
• Venereal disease
• A child’s report or self-disclosure
• Sexual knowledge beyond what is natural for a child
• Preoccupation with their body
• Acting out sexual behavior
• Withdrawal, chronic depression
• Self-devaluation and lack of confidence
• Problems with bedtime or afraid to go to bed
• Bedwetting – especially if it begins in a child who has been dry
• Sexually promiscuous
• Developmental age-inappropriate sexual play and/or drawings
• Cruelty to others
• Cruelty to animals
• Fire setting
• Anxious
• Withdrawn

Some indicators that a child may be mentally abuse include:

• Frequent psychosomatic complaints (nausea, stomachache, headache, etc.)
• Bed-wetting
• Self-harm
• Speech disorders
• Expressing feelings of inadequacy
• Fearful of trying new things
• Overly compliant
• Poor peer relationships
• Excessive dependence on adults
• Habit disorders (sucking, rocking, etc.)
• Eating disorders

Some indicators that a child may be neglected include:

• Lack of adequate medical and dental care
• Often hungry
• Lack of shelter
• Child’s weight is significantly lower than what is normal for his/her age and gender
• Developmental delays
• Persistent (untreated) conditions (e.g. head lice, diaper rash)
• Exposure to hazards (e.g., illegal drugs, rodent/insect infestation, mold)
• Clothing that is dirty, inappropriate for the weather, too small or too large
• Not registered in school
• Inadequate or inappropriate supervision
• Poor impulse control
• Frequently fatigued
• Parentified behaviors

Some indicators that a child may be emotionally abused or physically neglected include [25]:

• Unattended medical needs
• Consistent lack of supervision
• Persistent hunger, poor hygiene, or inappropriate dress
• Distended stomach or emaciated body
• Delayed physical development
• Substance abuse
• Regularly displays fatigue or listlessness
• Steals food or begs
• Habit disorders
• Passive or aggressive behavior extremes
• Neurotic traits such as sleep disorders or inhibition of play

As with indicators that a child may show if they are being abused, there are indicators that a parent may show if they are abusing their child. Some indicators that a parent may show if they are physically abusing their child include [25]:

• Contradictory statements about child’s injury
• Excessive anxiety about child’s behavior
• Labels child as a "problem"
• Says child makes up stories and that the child should not be believed
• Verbally aggressive toward child

Indicators that a parent may show if they are sexually abusing or exploiting their child include [25]:

• Poor sexual relationship between parents
• Frequent changes of adults in household
• Lack of supervision of child
• Parent related to child on adult level
• Parent is jealous of child’s relationship with others
• Parent is overly possessive of child

A parent may show indicators that they are physically neglecting or emotionally abusing their child, these include [25]:

• Disinterest in or rejection of child
• Deserting or avoiding child
• Threatening child, yelling, and/or screaming at child
• Ignoring medical problems of child
• Constant criticism of child, making negative comparison with other children
• Embarrassing children in public or making child feel ashamed or guilty
• Isolating child from society or normal friendships
• Placing child in dangerous situations
• Blaming child for situations not within child’s control
• Failing to meet child’s physical and/or emotional needs

In addition to the indicators that may be seen in either children or their parents, there are also some risk factors that could potentially increase the likelihood that some children will become a victim of child abuse and neglect. These risk factors can either be a particular characteristic of a caregiver of a child or a characteristic of a child. It is important that these risk factors are understood and those individuals who come into contact with children frequently should continuously be on the lookout for them to help a child who may be a victim of child abuse [46].

Some risk factors that may be seen in a caregiver include [46]:

• A parents’ lack of understanding of children’s needs, child development, and parenting skills
• A parents’ history of child maltreatment in family of origin
• Substance abuse and/or mental health issues, including depression in other members of the family
• Parental characteristics such as young age, low education, single parenthood, large number of dependent children, and low income
• Nonbiological, transient caregivers in the home
• Parental thoughts and emotions that tend to support or justify maltreatment behaviors

There are also some characteristics of children that can be considered risk factors for child abuse or neglect. These include [46]:

• Children under 4 years of age
• Special needs children that may increase a caregiver’s burden
• Physical disability
• Intellectual disability
• Mental health issues
• Chronic physical illnesses

Additional risk factors could include [46]:

• Social isolation
• Family disorganization, dissolution, and violence, including intimate partner violence
• Parenting stress, poor parent-child relationships, and negative interactions
• Community violence
• Concentrated neighborhood disadvantages (for example, high poverty, residential instability, high unemployment rates, and a high density of alcohol stores)
• Poor social connections

On the other hand, just as there are risk factors that can increase the chance that a child may become the victim of child abuse and neglect, there are protective factors that can help protect children from becoming a victim of child abuse and neglect. It is equally important to understand these protective factors as it is to be able to understand the risk factors that were listed above.

Even though most of these protective factors have not been studied as extensively or rigorously as the previously listed risk factors, these are still important to understand. Some protective factors include [46]:

• Supportive family environment and social networks
• Nurturing parenting skills
• Stable family relationships
• Household rules and child monitoring
• Parental employment
• Adequate housing
• Access to health care and social services
• Caring adults outside the family who can service as role models or mentors
• Communities that support parents and take responsibility for preventing abuse

Case Study 3

Lucy is a very shy, sensitive 7-year-old who has trouble getting along with the other children in her class. You ask her mother to come talk to you about the situation. Her mother claims that Lucy is a "prima-donna" and "stuck-up" and it is no wonder the other children don't like her.

You overhear her mother ridiculing her in the parking lot, telling her she is worthless and stupid.

During the next week, a new girl starts in the same class and Lucy begins to taunt her and pinch her at every opportunity. [30]

Thoughtful Considerations:

-What type of abuse could you suspect Lucy to be experiencing?
-What risk factors covered in this section, or prior sections, have led you to this determination?
-What would your responsiblities be in this situation?

Peer-Reviewed Journal Article References:
Babcock Fenerci, R. L., & DePrince, A. P. (2018). Shame and alienation related to child maltreatment: Links to symptoms across generations. Psychological Trauma: Theory, Research, Practice, and Policy, 10(4), 419–426.

Meeker, E. C., O'Connor, B. C., Kelly, L. M., Hodgeman, D. D., Scheel-Jones, A. H., & Berbary, C. (2021). The impact of adverse childhood experiences on adolescent health risk indicators in a community sample. Psychological Trauma: Theory, Research, Practice, and Policy, 13(3), 302–312.

Sousa, C., Mason, W. A., Herrenkohl, T. I., Prince, D., Herrenkohl, R. C., & Russo, M. J. (2018). Direct and indirect effects of child abuse and environmental stress: A lifecourse perspective on adversity and depressive symptoms. American Journal of Orthopsychiatry, 88(2), 180–188.

Wagner, M. F., Milner, J. S., McCarthy, R. J., Crouch, J. L., McCanne, T. R., & Skowronski, J. J. (2015). Facial emotion recognition accuracy and child physical abuse: An experiment and a meta-analysis. Psychology of Violence, 5(2), 154–162.

QUESTION 7
What are some risk factors that may be seen in a caregiver? To select and enter your answer go to Test.