A child who's being abused may feel guilty, ashamed or confused. He or she may be afraid to tell anyone about the abuse, especially if the abuser is a parent, other relative or family friend. In fact, the child may have an apparent fear of parents, adult caregivers or family friends. That's why it's vital to watch for red flags, such as:

  • Withdrawal from friends or usual activities
  • Changes in behavior — such as aggression, anger, hostility or hyperactivity — or changes in school performance
  • Depression, anxiety or a sudden loss of self-confidence
  • An apparent lack of supervision
  • Frequent absences from school or reluctance to ride the school bus
  • Reluctance to leave school activities, as if he or she doesn't want to go home
  • Attempts at running away
  • Rebellious or defiant behavior
  • Attempts at suicide

Specific signs and symptoms depend on the type of abuse. Keep in mind that warning signs are just that — warning signs. The presence of warning signs doesn't necessarily mean that a child is being abused.

Physical abuse signs and symptoms

  • Unexplained injuries, such as bruises, fractures or burns
  • Injuries that don't match the given explanation
  • Untreated medical or dental problems

Sexual abuse signs and symptoms

  • Sexual behavior or knowledge that's inappropriate for the child's age
  • Pregnancy or a sexually transmitted infection
  • Blood in the child's underwear
  • Statements that he or she was sexually abused
  • Trouble walking or sitting
  • Abuse of other children sexually

Emotional abuse signs and symptoms

  • Delayed or inappropriate emotional development
  • Loss of self-confidence or self-esteem
  • Social withdrawal
  • Depression
  • Headaches or stomachaches with no medical cause
  • Avoidance of certain situations, such as refusing to go to school or ride the bus
  • Desperately seeks affection

Neglect signs and symptoms

  • Poor growth or weight gain
  • Poor hygiene
  • Lack of clothing or supplies to meet physical needs
  • Taking food or money without permission
  • Eating a lot in one sitting or hiding food for later
  • Poor record of school attendance
  • Lack of appropriate attention for medical, dental or psychological problems, even though the parents have been notified
  • Emotional swings that are inappropriate or out of context to the situation
  • Indifference

Parental behavior

Sometimes a parent's demeanor or behavior sends red flags about child abuse. Warning signs include a parent who:

  • Shows little concern for the child
  • Appears unable to recognize physical or emotional distress in the child
  • Denies that any problems exist at home or school, or blames the child for the problems
  • Consistently blames, belittles or berates the child and describes the child with negative terms, such as "worthless" or "evil"
  • Expects the child to provide him or her with attention and care and seems jealous of other family members getting attention from the child
  • Uses harsh physical discipline or asks teachers to do so
  • Demands an inappropriate level of physical or academic performance
  • Severely limits the child's contact with others
  • Offers conflicting or unconvincing explanations for a child's injuries or no explanation at all

Although most child health experts condemn the use of violence in any form, some people still use corporal punishment (such as spanking) as a way to discipline their children. Corporal punishment has limited effectiveness in deterring behavior and is associated with aggressive behavior in the child. Any corporal punishment may leave emotional scars.

Parental behaviors that cause pain or physical injury — even when done in the name of discipline — could be child abuse.

When to see a doctor

If you're concerned that your child or another child has been abused, seek help immediately. The sooner you get help and support for the child, the better the child's chance of recovery.

If the child needs immediate medical attention, call 911 or your local emergency number. Depending on the situation, contact the child's doctor, a local child protective agency, the police department, or a hotline such as Childhelp National Child Abuse Hotline (800-422-4453).

Keep in mind that health care professionals are legally required to report all suspected cases of child abuse to the appropriate county or state authorities.

Oct. 23, 2012