Recognizing Physical Abuse
Physical Indicators
Unexplained, chronic, or repeated bruising:
• On the face, throat, upper arms, buttocks, thighs, or lower back
• In unusual patterns or shapes which suggest the use of an instrument
• On an infant
• In the shape of bite or pinch marks
• In clusters
• In various stages of healing

Unexplained burns:
• Cigarette, immersion, rope burns
• Burns in the shape of common household utensils or appliances

Unexplained skeletal injuries:
• Any skeletal injury of an infant
• Injury to the facial structure, skull, and bones around the joints
• Fractures and dislocations caused by a severe blow or twisting/pulling
of the arm or leg

Other unexplained or repeated injuries:
• Lacerations, abrasions, welts, scars, and other unexplained marks
• Missing, chipped or loose teeth or other oral injury
• Loss of hair/bald patches
• Broken eardrum
• Abdominal injuries

Behavioral Indicators
• Behavioral extremes
• Inappropriate or excessive fear of parent or caretaker
• Unusual shyness, wariness of physical contact
• Substance abuse, truancy, running away
• Reluctance to return home
• Belief that punishment is deserved
• Suggestion that other children should be punished in a harsh manner
• Victim’s disclosure of abuse
• Depression, excessive crying
• Unbelievable or inconsistent explanation for injuries
• Attempt to hide injuries



Recognizing Sexual Abuse
Physical Indicators
• Somatic complaints, including pain and irritation of the genitals
• Sexually transmitted disease
• Pregnancy
• Bruises or bleeding from external genitalia, vagina, or anal region
• Genital discharge
• Torn, stained, or bloody underclothes
• Frequent, unexplained sore throats, yeast or urinary infections
• Bed wetting

Behavioral Indicators
• Victim’s disclosure of sexual abuse
• Poor peer relationships, inability to relate to children of same age
• Regressive behaviors (ex. Bedwetting, thumb sucking)
• Sudden changes in behavior
• Promiscuity or seductive behavior
• Aggression or delinquency
• Truancy or chronic running away
• Substance abuse
• Difficulty in walking or sitting
• Preoccupation with sexual organs (child’s own or others)
• Recurrent nightmares, disturbed sleep patterns or fear of the dark
• Sudden decline in school performance
• Unusual age-inappropriate interest in sexual matters
• Age-inappropriate ways of expressing affection
• Avoidance of undressing or wearing extra layers of clothes
• Self-injury



Recognizing Neglect
Physical Indicators
• Poor hygiene
• Unsuitable clothing; missing key articles of clothing such as underwear, socks,
shoes, or coat
• Untreated illness or injury
• Height and weight significantly below age level.

Behavioral Indicators
• Frequent or chronic school absence
• Chronic hunger, tiredness, or lethargy
• Begging or collecting leftovers
• Assuming adult responsibilities
• Reporting no caretaker at home