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Recognizing Abuse & Its Effects

Most instances of maltreatment are never observed, and the majority of children who are its victims do not self-disclose. Many adult survivors of childhood abuse – especially sexual abuse –

delay the disclosure of their abuse for years or decades. The longer child abuse remains undiscovered the greater the possibility of negative long-term effects. Early detection and intervention are key, but not knowing how to talk about it, the fear of being blamed or disbelieved, threats of consequences by the abuser, or the feeling that they were somehow at fault prevents many victims from disclosing their abuse.

For these reasons, the prevention of child maltreatment, or its discovery at the earliest possible time, depends in part on the ability of adults to recognize the warning signs and symptoms that children show when they are experiencing abuse and neglect. In cases of sexual abuse, some of the behavioral signs (both of the children who are being targeted, and the individuals who abuse them) can occur prior to the act of abuse and can possibly be used – if recognized – to prevent the abuse from taking place. These are discussed more fully in Section 5 below.

Obvious physical signs of child abuse are usually easily visible, and may be mild or severe or, in some cases, more subtle. Behavioral indicators usually, but not always, accompany the physical manifestations of child abuse and neglect. Of course, it is important to note here that not all physical injury is the result of child abuse. Children and youth are prone to many injuries on knees, shins, elbows and chins that are the result of normal play and activity.  But when normal behaviors, injuries, or a combination of the two fall outside of those ranges, it should be a cause for concern. It is therefore helpful for all adults to be aware of the following physical and behavioral symptoms of child abuse and neglect:

Indicators of physical abuse – While injuries can occur accidentally when a child is at play, physical abuse should be suspected if the explanations do not fit the injury, or if a pattern of frequency is apparent (for example, handprints or multiple marks of a belt or cord). The presence of many injuries in various stages of healing makes it obvious that the injuries did not all occur as the result of one accident. Physical indicators of abuse include bruises, lacerations, swollen areas, and marks on the child’s face, head, back, chest, genital area, buttocks or thighs. Wounds like human bite marks, cigarette burns, broken bones, puncture marks or missing hair may indicate abuse. A child’s behavior might also signal that something is wrong. Victims of physical abuse may display withdrawn or aggressive behavior, complain of soreness or uncomfortable movement, wear clothing that is inappropriate for the weather, express discomfort with physical contact or become chronic runaways. ¹

Indicators of emotional abuse – Although the visible signs of emotional abuse in children can be difficult to detect, the hidden scars of this type of abuse manifest in numerous behavioral ways, including insecurity, poor self-esteem, destructive behavior, angry acts (such as fire setting and animal cruelty), withdrawal, poor development of basic skills, alcohol or drug abuse, suicide attempts, difficulty forming relationships and unstable job histories. Emotionally abused children often grow up thinking that they are deficient in some way. A continuing tragedy of emotional abuse is that, when these children become parents, they may continue the cycle with their own children. ²

Indicators of emotional abuse – Although the visible signs of emotional abuse in children can be difficult to detect, the hidden scars of this type of abuse manifest in numerous behavioral ways, including insecurity, poor self-esteem, destructive behavior, angry acts (such as fire setting and animal cruelty), withdrawal, poor development of basic skills, alcohol or drug abuse, suicide attempts, difficulty forming relationships and unstable job histories. Emotionally abused children often grow up thinking that they are deficient in some way. A continuing tragedy of emotional abuse is that, when these children become parents, they may continue the cycle with their own children. ²

Indicators of sexual abuse – The physical indicators of child sexual abuse include pain or irritation to the genital area, difficulty walking or sitting, vaginal or penile discharge and difficulty with urination.  Some children contract venereal disease as a result of being abused. In addition, children who are sexually abused may exhibit behavioral changes based on their age. Children up to age 3 may exhibit fear or excessive crying, vomiting, feeding problems, bowel problems, sleep disturbances, or failure to thrive. Children ages 2 to 9 may exhibit a fear of particular people, places or activities, regression to earlier behaviors such as bed wetting or stranger anxiety, victimization of others, excessive masturbation, feelings of shame or guilt, nightmares or sleep disturbances, withdrawal from family or friends, fear of the attack recurring, eating disturbances, sexual provocativeness, and knowledge of sexual activity beyond their years. Symptoms of sexual abuse in older youth and adolescents include depression, nightmares or sleep disturbances, poor school performance, promiscuity, substance abuse, aggression, running away from home, fear of attack recurring, eating disturbances, early pregnancy or marriage, suicidal gestures, anger about being forced into situations beyond one’s control, and pseudo-mature behaviors. ³

Indicators of neglect – Children who are the victims of persistent neglect are unhappy, have poor emotional and social support, and appear to be lonely and isolated. Their disturbed behavior reflects inner turmoil, distress, and confusion. Their development is delayed and problematic, and their attachments to their parents or caregivers are insecure. Parental relationships with these children are often hostile, neglectful, rejecting, dismissive, or paralyzing of development of individuality and independence. They suffer from low self-esteem, believing that they are not worthy of being loved, wanted, or able to achieve anything in lives. They seem to be in a never-ending state of stress, anxiety, and uncertainty. Their relationships with other children lack assertiveness and personal appeal, and their educational achievements are poor.

¹ Child Welfare Information Gateway, Identification of Child Abuse and Neglect: (https://www.childwelfare.gov/topics/can/identifying/)

² Iwaniec, D. (2006). Emotional Abused and Neglected Child: Identification, Assessment and Intervention. New York: John Wiley and Sons.

³ Cynthia Crosson-Tower, Understanding Child Abuse and Neglect (Boston: Allyn and Bacon 2010).