The Federal Child Abuse Prevention and Treatment Act provides this definition of child abuse: Child abuse and neglect means the physical or mental injury, sexual abuse or exploitation, negligent treatment, or maltreatment of a child under the age of eighteen.

Some incidences of child abuse and neglect are easily recognized: an infant left alone in a hot car, a three-year-old with multiple facial bruises, a child who is repeatedly locked out of the house for long periods of time.

What about the more subtle forms of abuse or neglect such as verbal abuse, poor supervision, overly strict discipline? And what about the physical abuse that occurs behind closed doors, is obscured by clothing, is attributed to "accidents," is denied or concealed by the victim? The key to early identification is education.

Child abuse is usually not an isolated event but a pattern of behavior that an adult uses in interacting with a child. This behavior generally increases in severity and frequency and may be exhibited on a regular or sporadic basis.

Maltreatment of children usually falls into one or more of four general areas:

• Neglect

• Physical abuse

• Emotional abuse

• Sexual abuse.

Three Basic Types of Maltreatment Indicators:

1. Physical indicators, such as the child's appearance (including the presence of physical injury).

2. Behavioral indicators, such as behavior which the child exhibits as a result of maltreatment.

3. Environmental/circumstantial indicators, including social, cultural or familial factors which are known to correlate with various kinds of abuse or neglect.

In being alert to the signs of abuse and neglect, it is important to keep in mind that the indicators presented here are not all-inclusive. These indicators are clues. They may help you be tuned in to a child's possible need.

Physical and behavioral indicators are often specific to the types of maltreatment. However, some environmental/circumstantial indicators of all types of maltreatment are:

• Family crises of unemployment, death, desertion, ill health.

• Severe personal problems, such as drug addiction, alcoholism,
  mental illness.

• Geographic and/or social isolation of a family.

• Child viewed as different or difficult to manage.

• Parent unaware of appropriate behavior for child at given age.

• Parental characteristics stemming from own childhood abuse.

Most persons are capable of abuse under conditions of excessive stress. Most abusers have been abuse victims.

Abusers' personal characteristics may include:

• Poor self-concept.

• Passive marital relationship or marital difficulty.

• Fear of authority.

• Lack skills to meet own emotional needs.

• Belief of necessity for harsh physical discipline.

• Undue fear of spoiling child.

• Rigidity or compulsiveness.

• Acceptance of violence as a means of communication.

• Poor emotional control, impulsive.

• Emotional dependency on (non-abusive) spouse to the point that he/she will not intervene and will protect abusive spouse.

• Unreasonable expectations for child.

NEGLECT

Neglect is the consistent failure by a parent or caretaker to provide a child under 18 with appropriate support, attention and affection. Most reported neglect cases involve lack of proper food, shelter, clothing, medical care, educational opportunities, protection and supervision. Some neglect is a result of ignorance. Other forms of neglect involve deliberate maltreatment of the minor.

General Physical Indicators of Neglect

• Inadequate supervision; abandonment.

• Inadequate clothing for weather; otherwise inappropriately dressed.

• Poor hygiene; frequently dirty; scaly skin.

• Lack of necessary medical or dental care; untreated illness or injury.

• Inadequate nutrition; hungry.

• Lack of safe, warm, sanitary shelter.

• Engages in dangerous situations due to lack of supervision.

• Abnormal height/weight.

• Chronically tired and listless.

• Appears to be overworked or exploited.
  

General Behavioral Indicators of Neglect

• Failure to thrive among infants.
• Poor attendance, chronic lateness, poor learning.
• Begs for, collects or steals food.
• Coming early and staying late.
• Lethargic behavior; squinting.
• Use of drugs or alcohol.
• Engages in sexual misconduct.
• Runs away from home; attempts suicide.
• Extremely dependent or detached.
• Delinquent behavior, such as prostitution, vandalism or stealing.
• States frequent absence of parent or guardian.
• Assumes adult responsibilities at home.

Possible Environmental Circumstances of Neglect

• A large family with marital disruption.
• Long term parental illness.
• Indifferent parental attitude.
• Situational stress, such as unemployment.
• Lack of material resources.

Neglectful parents frequently were victims of the same type of parenting
that they now provide for their children.

Personal Characteristics or Behaviors of Neglectful Parents

• Apathetic; frequently unkempt.
• Craving for excitement, change.
• Desire to be rid of the demands of the child.
• Lack of interest in the child's activities.
• Low acceptance of child's dependency needs.
• Unskilled as parents.
• Little planning or organization.
  

PHYSICAL ABUSE

Physical abuse is any non-accidental injury to a child under 18 caused by a parent or caretaker. It is the most commonly identified form of abuse. It occurs when someone inflicts bodily harm that leaves a physical injury. As most children participate in normal activities, they accumulate their share of cuts, scrapes and bruises. The outward signs of physical abuse are not typical of the normal "wear and tear" of childhood.

Physical Indicators of Physical Abuse

Bruises, Welts or Lacerations

• On the face, buttocks, back or thighs.
• In unusual patterns or distinctive shapes.
• In clusters.
• On an infant, especially on the face.
•  In various stages of healing.
•  Of gum tissue, caused by forced feeding.
• On external genitals.

Human bite marks, especially when recurrent and appear to be adult size.

Burns

• Immersion burns, such as "stocking burns" or "glove burns" or doughnut-shaped burns on the buttocks.
• Cigarette-type burns, especially on the palms of hands, soles of feet or genitals.
• Friction or tether burns on the wrist, ankles or neck; possible rope burns from confinement.

Dry burns, such as those caused by an iron, radiator grates or stove burners.
 

Fractures, Dislocations, Injuries

• Spiral fractures.
• Stiff, swollen, enlarged joints.
• Multiple fractures.
• Unexplained fractures or dislocations.
• Fractures in various stages of healing.
• Absence of hair.
• Hemorrhaging beneath scalp caused by pulling hair.
• Nasal or jaw fractures.
• Abdominal injuries.

Behavioral Indicators of Physical Abuse

The behavioral indicators of physical abuse are varied and are influenced by the severity and frequency of the abuse, the age of the child at onset, the nature of the child's relationship to the abuser, the availability of supportive persons and the child's genetic endowment for coping.

A child who is abused at an early age, frequently and severely will likely exhibit these behavioral characteristics:

• Unusually neat in eating habits.
• Overly compliant to avoid confrontation.
• Lacks curiosity; rarely exhibits enjoyment.
• Fearful of physical contact; may appear autistic.
• Excessively self-controlled; cries little.

Lacks in development due to efforts all being directed to self-protection.

A child who is abused less severely and less often and is a little older at onset will likely exhibit some of these behavioral characteristics:

• Timid, easily frightened.
• Psychosomatic complaints.
• Craves affection; indiscriminate attachment to strangers.
• Continues to affirm love for abusing adult; protective of that adult.
• Experiences language delay.
• Difficulty in school in spite of normal ability.
• Sporadic temper tantrum.
• Assumes role of parent or is extremely immature in parent/child interactions.

A child who is mildly, infrequently or inconsistently abused at an older age will likely exhibit these characteristics:

• Hurts other children.
• Manipulative.
• Shows extreme aggressiveness; demanding; temper tantrums.
• Hyperactive; short attention span.
• Shows lag of development.
• May seem accident prone or clumsy.

Other overall behavioral indicators of physical abuse:

• Requests punishment; punishes other children.
• Afraid to go home; afraid of parents or other adults.
• Behavioral extremes.
• Reports injuries that seem unbelievable.
• Extremely aggressive or withdrawn.
• Uncomfortable when other children cry.
• Exhibits drastic behavior changes.
• Poor self-concept.
• Self-mutilating.

EMOTIONAL ABUSE

Emotional abuse is often hard to detect. Emotional abuse is any chronic and persistent act by an adult that endangers the mental health or emotional development of a child. It is a series of acts or lack of action that deprives the child of needed love, affection, support and encouragement to grow into a healthy adult. It may be a pattern of behaviors belittling, humiliating or ridiculing a child.

Physical Indicators of Emotional Abuse

• Eating disorders.
• Nightmares or restlessness.
• Wets the bed.
• Speech disorders.
• Fails to thrive.
• Exhibits developmental lags physical, emotional and/or mental growth).
• Hyperactive.

Behavioral Indicators of Emotional Abuse

• Frequently bangs head; rocking behavior.
• Frequent thumb sucking at older age; biting.
• Poor peer relationships; seeks adult contact.
• Overly eager to please; unrealistic goal setting.
• Views abuse as being warranted; feels responsible for abuse.
• Exhibits noticeable changes in behavior.
• Depressed; excessively anxious; impatient.
• Exhibits aggressive or bizarre behavior; fits of screaming.
• Apathetic; passive; withdrawn.
• Exhibits inconsistent behavior at home and school.
• Runs away from home; attempts suicide.
• Low self-esteem; self-depreciation; lacks self confidence.
• Sabotages his/her chances of success.

Unable or unwilling to express feelings, needs or problems.


SEXUAL ABUSE

Sexual abuse is exploitation of a child or adolescent for the sexual gratification of another person. Incest is sexual abuse within a family. Sexual abuse is relatively difficult to detect outside the clinical setting. Physical evidence of sexual abuse, if present at all, tends to be temporary. The physical trauma is not exposed. The victim is usually reluctant to reveal the abuse. There is a general lack of awareness of the prevalence of child sexual abuse and lack of confidence in detecting it.

Physical Indicators of Sexual Abuse

• Pain or irritation of genitals.
• Bruises, swelling or bleeding in genital or anal regions.
• Sexually transmitted disease.
• Difficulty walking or sitting.
• Torn, bloody and/or stained underclothing.
• Is pregnant.
• Unexplained infections (sore throat, yeast or urinary infections).
• Vaginal or penile discharge.
• Wets bed.

Behavioral Indicators of Sexual Abuse

These behavioral indicators are frequently the best or only signs you may have.

• Behavioral extremes.
• Avoids dressing or changing clothes in front of others.
• Wears lots of clothing, especially to bed.
• Withdrawn; isolated; fearful; anxious; self-mutilating.
• Reluctance to participate in recreational activity.
• Regression (may appear mentally retarded).
• Inappropriate understanding of sex for age.
• Reluctance to be alone with a particular person.
• Pre-occupation with sexual organs of self, parents or other children.
• Persistent and inappropriate sex play with peers or toys.
• Fear of touch; self-conscious.
• Sexual promiscuity; seductive behavior.
• Obsessively clean.
• Psychosomatic complaints (headaches, backache).
• Either avoids or seeks out adults; poor peer relationships.
• Pseudo-mature.
• Delinquent or aggressive behavior.
• Engages in fantasy or infantile behavior.

Exhibits extreme compliance or defiance.

The presence of any of these indicators should cause consideration of the possibility that sexual abuse has occurred. They are not, in and of themselves, conclusive evidence that the child has been victimized. Usually when a child says he or she has been abused, it is true.

Environmental Indicators of Sexual Abuse

• Prolonged absence of one parent.
• Overcrowding of living conditions.
• Alcoholism.
• Social and/or geographical isolation.
• Inter-generational pattern of incest.
• Parental characteristics such as extreme protection of child, jealousy of child, refusing to allow child social contact, distrusting child, accusing child of sexual promiscuity.

Adapted From: For Their Sake by Becca Cowan Johnson and For Kids Inc.
It Shouldn't Hurt To Be A Child, North Dakota Department of Human Services Identifying Possible Signs of Child Abuse, Ohio Extension Service.