4050-CINDICATORS OF CHILD ABUSE AND NEGLECT
Appendix C
INDICATORS OF CHILD ABUSE AND NEGLECT
Indicators of Physical Abuse
HISTORICAL
Delay in seeking appropriate care after injury
No witnesses
Inconsistent or changing descriptions of accident by child and/or parent
Child's developmental level inconsistent with history
History of prior "accidents"
Absence of parental concern
Child is handicapped (physically, mentally, developmentally) or otherwise perceived as "different" by parent
Unexplained school absenteeism
History of precipitating crisis
PHYSICAL
Soft tissue injuries on face, lips, mouth, back, buttocks, thighs or large areas of the torso
Clusters of skin lesions; regular patterns consistent with an implement
Shape of lesions inconsistent with accidental bruise
Bruises/welts in various stages of healing
Burn pattern consistent with an implement on soles, palms, back, buttocks and genitalia; symmetrical and/or sharply demarcated edges
Fractures/dislocations inconsistent with history
Laceration of mouth, lips, gums or eyes
Bald patches on scalp
Abdominal swelling or vomiting
Adult-size human bite mark(s)
Fading cutaneous lesions noted after weekends or absences
Rope marks
BEHAVIORAL
Wary of physical contact with adults
Affection inappropriate for age
Extremes in behavior, aggressiveness/withdrawal
Expresses fear of parents
Reports injury by parent
Reluctance to go home
Feels responsible (punishment "deserved")
Poor self-esteem
Clothing covers arms and legs even in hot weather
Indicators of Sexual Abuse
HISTORICAL
Vague somatic complaint
Excessive school absences
Inadequate supervision at home
History of urinary tract infection or vaginitis
Complaint of pain; genital, anal or lower back/abdominal
Complaint of genital itching
Any disclosure of sexual activity, even if contradictory
PHYSICAL
Discomfort in walking, sitting
Evidence of trauma or lesions in and around mouth
Vaginal discharge/vaginitis
Vaginal or rectal bleeding
Bruises, swelling or lacerations around genitalia, inner thighs
Dysuria
Vulvitis
Any other signs or symptoms of sexually transmitted disease
Pregnancy
BEHAVIORAL
Low self-esteem
Change in eating pattern
Unusual new fears
Regressive behaviors
Personality changes (hostile/aggressive or extreme compliance)
Depression
Decline in school achievement
Social withdrawal or poor peer relationships
Indicates sophisticated or unusual sexual knowledge for age
Seductive behavior, promiscuity or prostitution
Substance abuse
Suicide ideation or attempt
Runaway
Indicators of Emotional Abuse
HISTORICAL
Parent ignores/isolates/belittles/rejects/scapegoats child
Parent's expectations inappropriate to child's development
Prior episode(s) of physical abuse
Parent perceives child as "different"
PHYSICAL
(Frequently none)
Failure to thrive
Speech disorder
Lag in physical development
Signs/symptoms of physical abuse
BEHAVIORAL
Poor self-esteem
Regressive behavior (sucking, rocking, enuresis)
Sleep disorders
Adult behaviors (parenting sibling)
Antisocial behavior
Emotional or cognitive developmental delay
Extremes in behavior - overly aggressive/compliant
Depression
Suicide ideation/attempt
Indicators of Physical Neglect
HISTORICAL
High rate of school absenteeism
Frequent visits to school nurse with nonspecific complaints
Inadequate supervision, especially for long periods and for dangerous activities
Child frequently unattended; locked out of house
Parental inattention to recommended medical care
No food intake for 24 hours
Home substandard (no windows, doors, heat), dirty, infested, obvious hazards
Family member addicted to drugs/alcohol
PHYSICAL
Hunger, dehydration
Poor personal hygiene, unkempt, dirty
Dental cavities/poor oral hygiene
Inappropriate clothing for weather/size of child, clothing dirty; wears same clothes day after day
Constant fatigue or listlessness
Unattended physical or health care needs
Infestations
Multiple skin lesions/sores from infection
BEHAVIORAL
Comes to school early, leaves late
Frequent sleeping in class
Begging for/stealing food
Adult behavior/maturity (parenting siblings)
Delinquent behaviors
Drug/alcohol use/abuse
Revised: 11/20/2023
Approved 11/20/2023
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