►Difficulty walking or sitting

►Bloody, torn, or stained underclothes

►Bleeding, bruises, or swelling in genital area

►Pain, itching, or burning in genital area

►Frequent urinary or yeast infections

►Sexually Transmitted Infections, especially if under 14 years old

►Pregnancy, especially if under 14 years old

Many adults tend to overlook, to minimize, to explain away, or to disbelieve allegations of abuse. This may be particularly true if the perpetrator is a family member. Children often show us rather than tell us that something is upsetting them. There may be many reasons for changes in their behavior, but if we notice a combination of worrying signs it may be time to call for help or advice.


If you need professional help...

Do you feel angry and frustrated and don’t know where to turn? In the U.S., call 1-800-4-A-CHILD to find support and resources in your community that can help you break the cycle of abuse.

►You can’t stop the anger. What starts as a swat on the backside may turn into multiple hits getting harder and harder. You may shake your child harder and harder and finally throw him or her down. You find yourself screaming louder and louder and can’t stop yourself.

►You feel emotionally disconnected from your child. You may feel so overwhelmed that you don’t want anything to do with your child. Day after day, you just want to be left alone and for your child to be quiet.

►Meeting the daily needs of your child seems impossible. While everyone struggles with balancing dressing, feeding, and getting kids to school or other activities, if you continually can’t manage to do it, it’s a sign that something might be wrong.

►Other people have expressed concern. It may be easy to bristle at other people expressing concern. However, consider carefully what they have to say. Are the words coming from someone you normally respect and trust? Denial is not an uncommon reaction.


Recognizing that you have a problem is the biggest step to getting help. If you yourself were raised in an abusive situation, that can be extremely difficult. Children experience their world as normal. It may have been normal in your family to be slapped or pushed for little to no reason, or that mother was too drunk to cook dinner. It may have been normal for your parents to call you stupid, clumsy, or worthless. Or it may have been normal to watch your mother get beaten up by your father.


Are you experiencing any of the risk factors, painful as it may be? Do you feel angry and frustrated and don’t know where to turn? Raising children is one of life’s greatest challenges and can trigger anger and frustration in the most even tempered. If you grew up in a household where screaming and shouting or violence was the norm, you may not know any other way to raise your kids.

​Townsend, C., & Rheingold, A.A., (2013). Estimating a child sexual abuse prevalence rate for practitioners: studies. Charleston, S.C., Darkness to Light. Retrieved from
National Clearinghouse on Child Abuse and Neglect Information. Administration for Children and Families. National Center on Child Abuse and Neglect. National Institutes of Health & The National Library of Medicine. U.S. Department of Health and Human Services


•Sexual abuse can cause long-lasting problems well into adulthood. It is important to get your child into counseling after abuse has been disclosed. It is also often necessary and healthy for adult survivors of child sexual abuse to re-enter counseling at various periods of their life to assist in working through issues that resurface.

•Both males and females sexually offend; however, males represent a higher percentage of known sex offenders.

•When sexual abuse occurs within a family, it is likely to continue for a period of time, even years, until it is discovered and stopped.

•80-90% percent of offenders are family members or someone close to the family.

•One in ten children will be sexually abused by age 18.

►Engaging a child or soliciting a child for the purposes of prostitution; and
►Using a child to film, photograph or model pornography.

These definitions are broad. In most states, the legal definition of child molestation is an act of a person—adult or child—who forces, coerces or threatens a child to have any form of sexual contact or to engage in any type of sexual activity at the perpetrator’s direction.



►Engaging in indecent exposure or exhibitionism;
►Exposing children to pornographic material;
►Deliberately exposing a child to the act of sexual intercourse; and
►Masturbating in front of a child.



Making a child touch an adult’s sexual organs; and

Penetrating a child’s vagina or anus no matter how slight with a penis or any object that doesn’t have a valid medical purpose..

sexual abuse
  • Suspect sexual abuse When You See :

►Malnutrition or failure to thrive measure height, weight and use growth charts

►Excessive crying, tiredness, hunger or scavenging.

►Poor hygiene and clothing; severe and persistent infestations - e.g., scabies or head lice.

►Developmental delay - may be due to lack of stimulation - e.g., being kept in a cot or pram much of the time.

►The child often left alone or left in unsafe situations - accidental injuries may indicate lack of appropriate supervision.

►Frequent school absence.

►Untreated medical problems, including untreated dental decay (where NHS treatment is available).

►Persistent failure to attend important child health programs or follow-up appointments.

►No social relationships.

►Emotional or behavioral symptoms (see under 'Behavior', above).

►Often show catch-up growth and improved emotional response in a new environment.

  • Suspect neglect When You See :

It is important to keep in mind, however, that isolated incidents do not necessarily indicate abuse. These behaviors can be attributed to traumatic events in the child's life or something that upsets the child. The key factor in determining if the behavior indicates abuse is if there is a pattern of behavior. In that case, the tell tale signs should not be ignored and action should be taken.

►Indifference Toward the Child's Welfare or Problems

►Is Cold Toward the Child

►Rejects the Child

►Blames the Child

►Puts the Child Down

►Call the Child Cruel, Damaging or Inappropriate Names

►Withholds Affection

►Shows Preferential Treatment to Siblings

Family behaviors can also indicate emotional abuse. If you are in a position to observe the family, some red flags to look for are::

A child's behavior can also be a strong indicator of abuse. Some telling behaviors include:

►Self Destructive
►Makes Negative Statements about Himself or Herself
►Overly Aggressive
►Shy or Passive
►Cruel to Animals
►Overly Demanding
►Overly Compliant
►Delay in Physical, Mental and Emotional Development
►Cruel to Others

►Sucking (thumb, fingers, etc.) or Biting His or Her Self
►Inappropriate Aggression
►Destructive to Other People or to Property
►Sleep Disorders
►Speech Disorders
►Restricts Play Activities Experiences ►Compulsive
►Excessive Anger
►Has Phobias
►Hysterical Outbursts

While emotional abuse does not carry the bruises and scars that are hallmark indicators of typical abuse, there are ways to detect it. The indicators usually depend upon the age of the child, but one of the primary red flags is a child whose behavior is not consistent with his or her age. Some observable indicators of child emotional abuse include:

  • Suspect emotional Abuse When You See :
emotional abuse


►Deliberate contact burns tend to be: multiple; have a clearly demarcated edge and involve unusual areas of the body such as the back, shoulders or buttocks, backs of hands, soles of feet; may show the shape of an implement - e.g., cigarette, iron.
►Accidental burns tend to be: on palm of the hand; often a single burn or at most two burn areas; not well demarcated (as the skin may have had only glancing contact with the hot object); hair straighteners may leave a burn on each side of the hand or ankle. If doing a home visit, look at the environment to see if the burn could have occurred in this environment.
►Deliberate scalds tend to have clear demarcation and a symmetrical pattern. (This contrasts with accidental scalds where the child will quickly try to withdraw and the burn pattern will probably be irregular.)
►Suspicious patterns are a glove or sock pattern, or a 'doughnut' pattern (where a child's buttocks are pressed against the hot water container, so the central area is spared).



Cold injuries (for example, swollen, red hands or feet


Human bite marks (if unlikely to be from young child).

►Lash marks.

►Red lines around the neck, wrist or ankles, from tying up.

►Oral injury, including torn frenulum of the upper lip.

►Lacerations, abrasions or scars in sites where accidental injuries are unusual (as for 'Bruising', above).


These may occur from a blow to the head or from shaking. Brain injuries of all types can occur in child abuse -  most commonly subdural hemorrhages (SDHs), with or without subarachnoid hemorrhages (SAHs).

►Multiple SAH or SDH.

►Combination of brain injury, retinal hemorrhage and rib fractures (due to the child being squeezed and shaken).

►Retinal hemorrhages or eye injury without any major accident.

►Accidental skull fractures being rare in children <5 years, even after a fall of 90 cm. A history of a fall from a bed or sofa should be questioned.


►Intra-abdominal or intrathoracic injury without confirmed major accidental trauma


Two patterns of non-accidental injury are described:  neck injuries and chest or lower back injuries.

Neck injury: usually with co-existing inflicted brain injury and/or retinal hemorrhages; mainly in infants aged <4 months; may not be obvious, as the child is often unconscious and difficult to assess; if conscious, the baby may be reluctant or distressed when its neck is moved.

Chest or lower back injuries: in toddlers, showing EITHER signs of spinal injury OR an obvious deformity, such as spinal curvature or swelling of the lower back. These injuries are often severe - fatal or causing permanent paralysis.



The age of a bruise cannot be exactly determined from its color, but bruises show a progression of color change over time (red/purple/blue initially, followed by green/yellow/brown).

NB - accidental bruises tend to be on bony prominences. Accidental bruises in children are most commonly found on knees, shins, elbows, palms, chin, nose, forehead, occiput or parietal bone.

►Bruising in the shape of an object  - fingertips, hand, ligature, stick, teeth mark or implement such as belt buckle. Note that beating from rod-shaped instruments such as a stick can leave 'tramline bruising' (parallel lines of bruising due to blood being pushed sideways, away from the impact of the rod).
►Petechiae (tiny red or purple spots) not caused by a medical condition - may be due to shaking or suffocation.
►Bruises at sites where accidental bruising is unusual: face, eyes, ears (bruising around the pinna may be subtle), the 'safe triangle' of the neck (the neck and top of the shoulder), inner arms, anterior chest, abdomen, groins. 
►Multiple or symmetrical bruises.

physical abuse
  • Suspect Physical Abuse When You See :





1.800.4.A.CHILD (422-4453)






TO report child abuse or maltreatment, call


  • Rarely touch or look at each other

  • Consider their relationship entirely negative

  • State that they do not like each other


  • Shows little concern for the child

  • Denies the existence of—or blames the child for—the child's problems in school or at home

  • Asks teachers or other caregivers to use harsh physical discipline if the child misbehaves

  • Sees the child as entirely bad, worthless, or burdensome

  • Demands a level of physical or academic performance the child cannot achieve

  • Looks primarily to the child for care, attention, and satisfaction of emotional needs


  • Shows sudden changes in behavior or school performance

  • Has not received help for physical or medical problems brought to the parents' attention

  • Has learning problems (or difficulty concentrating) that cannot be attributed to physical or psychological causes

  • Is always watchful, as though preparing for something bad to happen

  • Lacks adult supervision

  • Is overly compliant, passive, or withdrawn

  • Comes to school or other activities early, stays late, and does not want to go home

The first step in helping abused or neglected children is learning to recognize the signs of child abuse and neglect. The presence of a single sign does not prove child abuse is occurring in a family, but a closer look at the situation may be warranted when these signs appear repeatedly or in combination.

If you do suspect a child is being harmed, reporting your suspicions may protect the child and get help for the family. Any concerned person can report suspicions of child abuse and neglect.

The following signs may signal the presence of child abuse or neglect.


Reports sexual abuse

►Sexual behavior or knowledge inappropriate to age; sexually explicit play (with self, other children, pets, toys)

►Excessive masturbation

►Overly compliant behavior

►Unexplained fear of a known adult - e.g., a relative or babysitter

►Emotional or behavioral changes - e.g., depression, low self-esteem, running away 

►Interruptions in sleep patterns and more frequent nightmares 

►Afraid of getting undressed for bathing, or abnormally uncomfortable with doctor visits. Toddlers may show signs of regression,  e.g. a potty-trained child going back to wetting his pants; thumb sucking; decrease in verbal skills.

►Large weight changes/major changes in appetite

►Suicide attempts or self-harming, especially in adolescents

►Shrinks away or seems threatened by physical contact

►Psychosomatic symptoms - e.g., stomachaches, headaches

►School problems - e.g., absences, drops in grades

►Runs away

►Overly protective and concerned for siblings, assumes a caretaker role

Post-Traumatic Stress Disorder or Rape Trauma Syndrome symptoms

•Child sexual abuse usually begins with a sex offender gaining both the parent’s and the child’s trust and friendship. Once a relationship has been established, the offender will begin to test the child’s knowledge and ability to protect themselves. Sexual jokes, back rubs, “accidental” sexual touching, and hugging, often done in the presence of the parent, are utilized to “test the waters”. If the offender isn’t given the message that these behaviors are inappropriate he/she will increase the amount and type of sexual exposure. To adjust the child to sexual activity, offenders commonly utilize casual or “accidental” exposure to pornography. This entire process is known as grooming.

•The media reports information on the highest risk offenders; however the majority of sex offenders are unknown to the general public either because information isn’t publicized or because they haven’t been caught yet


There are four major types of child maltreatment:

physical abuse, neglect, sexual abuse, and

emotional abuse

Dear Mr. Jesus....please don't let them hurt your children...we need love and shelter from the storm...please don't let them hurt your children...won't you keep us safe and warm.

At the extreme end of the spectrum, sexual abuse includes sexual intercourse or its deviations. Yet all offences that involve sexually touching a child, as well as non-touching offenses and sexual exploitation, are just as harmful and devastating to a child’s well-being.

Children who are well informed and empowered to act, and who have someone who will listen to them can, in many cases, prevent or stop sexual abuse. Offenders do not usually choose victims who are likely to resist or tell.

•While most other criminals decrease their criminal activity as they age, sex offenders typically do not. Most sex offenders continue to offend until they are physically incapable. Successful completion of sex offender treatment can interrupt this behavior; however extreme caution around children will continue to be necessary.