Signs of child abuse in babies, toddlers, and kids

How can I tell whether my child is being abused?

If your child spends any amount of time away from you – whether it's with a babysitter, with a trusted family friend or relative, or at daycare – it's natural to be concerned about their safety. And like any parent, you've probably wondered whether you'd be able to tell if your child was being mistreated.

Some parents mistakenly overlook signs of abuse because they don't want to face what's happening. Most abusers are family members, which makes the situation even harder to accept. On the other hand, even when you do keep an eye out for the physical symptoms and behavioral changes that may point to abuse, it can be tricky to figure out exactly what's going on.

"You're always playing a guessing game," says Kathy Baxter, director of the San Francisco Child Abuse Council. "A child could have many other reasons for being fussy or becoming withdrawn. But parents are really good at knowing their children, so you have to try to put together a picture and go with your gut instinct."

If your child is old enough to communicate well, regularly asking them questions such as, "Did anything happen to you today that you didn't like?" or "Have you ever been frightened at daycare?" If they're in the habit of telling you what makes them uncomfortable, they'll be more likely to tell you when anything is seriously amiss.

"When it comes to abuse and neglect, most kids tell the truth," Baxter says. "But in most cases, they're reluctant. They don't want to get the person in trouble. They feel guilty. They may feel it happened because they were bad."

If your child can't tell you what's going on (because they're too young or not very communicative), pinpointing abuse can be even more difficult. What you can do is keep a close eye on them for signs that all is not well.

Some parents discover signs of abuse – such as internal bleeding and injuries – only when they take their child to the doctor because they won't stop crying or are being excessively fussy. Emotional abuse (such as threats or constant criticism) is even harder to detect.

According to the U.S. Department of Health & Human Services, in 2019 about 656,000 American children suffered from abuse. The majority of cases (61 percent) involved neglect, and 10 percent involved physical abuse.

Signs of child abuse to watch for

Signs of physical abuse

A child who has been physically abused may:

• Cry and put up a fight when it's time to go to daycare or a sitter's, or appear frightened around the caregiver or other adults. (Of course, this could also be normal separation anxiety. Again, you'll need to factor in other things, including your instincts.)
• Show other sudden changes in behavior or performance at daycare or school.
• Come home with unexplained bruises, abrasions, burns, broken bones, black eyes, cuts, bite marks, or other injuries. Repeated injuries of any type are a warning sign. Any rib fracture, long bone fracture, or bruising in a baby who isn't yet walking or very mobile should raise concerns about abuse.

If your child is still a baby, learn the signs of shaken baby syndrome – which doctors call abusive head trauma.

Shaken baby syndrome usually happens when babies are violently shaken. In extreme cases of abusive head trauma, the abuse involves hitting a child's head against a hard object, like the wall or the floor. When a baby has shaken baby syndrome, even severe injuries may not be immediately visible.

Shaken baby syndrome usually happens to children who are younger than a year old, though it can affect kids as old as 5.

A child with shaken baby syndrome may seem glassy-eyed and appear rigid, lethargic, and irritable. They may also have a decreased appetite, have difficulty feeding, or be vomiting. A combination of any of these symptoms with unexplained bruising in an infant is a strong indicator of abuse.

In severe cases, a baby may be unable to focus on an object or lift their head. Or they may be unconscious or have difficulty breathing. They may also have seizures or be in a coma.

If you suspect your child is suffering from shaken baby syndrome, call 911 right away. Every moment counts in terms of minimizing the damage from a baby's head injury.

Signs of emotional abuse

A child who has been emotionally abused may:

• Display behavioral problems or changes such as shunning a parent's affections – or becoming excessively clingy. Abused children often show extremes in behavior: A normally outgoing and assertive child may become unusually passive, while a generally mild child may act in an aggressive manner.
• Become less talkative or stop communicating almost completely
• Act inappropriately infantile. For example, a child may revert to behaviors like rocking and head banging.
• Complain of headaches or stomach aches that have no medical cause. They may lose their appetite.
• Exhibit fearful behavior, such as nightmares or trouble sleeping. Or they may act as if they're waiting for something bad to happen. (Though nightmares and night terrors can be normal in kids as well.)

Signs of sexual abuse

A child who has been sexually abused may:

• Have pain, itching, bleeding, or bruises in or around the genital area.
• Have difficulty walking or sitting, possibly because of genital or anal pain.
• Demonstrate sexual knowledge, curiosity, or behavior beyond their age (obsessive curiosity about sexual matters, for example, or seductive behavior toward peers or adults).
• Be secretive or want to be alone much of the time.

Keep in mind, though, that most children who are sexually abused have no physical signs or complaints, so it's important to pay attention to signs of abuse and investigate behavioral changes. With older children, keep the lines of communication open by asking questions such as "Did anything happen to you today that you didn't like?"

Signs to watch for in your child's caregiver

No parent wants to think their child's caregiver is abusive or neglectful – especially if the caregiver is a family member. But don't hesitate to act if your child's caregiver:

• Offers conflicting or unconvincing explanations for bruises or injuries
• Offers no explanation for bruises or injuries
• Describes your child in an extremely negative way
• Constantly belittles your child
• Seems indifferent to your child
• Is apathetic or depressed
• Abuses drugs or alcohol
• Starts to behave irrationally
• Is secretive or isolated, or acts extremely jealous or controlling with family members
• Seems harsh when it comes to discipline. (Abuse often results from excessive or inappropriate physical discipline.)

What to do if you suspect child abuse

If you have concerns about the possibility of abuse, don't delay in taking action. The sooner you address the problem, the better for your child.

If you think your child might have been abused, keep your child away from the suspected abuser and seek help right away. You can report your concerns to your child's healthcare provider. (Keep in mind that doctors, nurses, social workers, psychologists, and other care providers are legally obligated to report cases of suspected abuse.)

Or you can take your child to a hospital or to their provider to be examined for signs of physical abuse. The doctor who examines your child must file a report with Child Protective Services if abuse is suspected.

You can contact the police or call your local child protective services agency (or the department of human services) in your city, county, or state. The Childhelp National Child Abuse Hotline can provide advice and local referrals. Call (800) 4-A-CHILD or (800) 422-4453.

After you make a report, a social worker or law enforcement officer will contact you to talk about what happened. If your child hasn't been examined by a doctor, the social worker can refer you to one. They can also let you know about support groups and other community services.

It isn't always easy to tell whether a child has been abused. You may notice signs of abuse but be unsure whether your child has been abused or is coping with some other issue. If you're worried, trust your instincts and discuss your concerns with your child's doctor, or call a child abuse hotline.

Risk factors for child abuse

Most parents don't abuse or neglect their children. However, most child abuse and neglect happens at home, at the hands of a parent.

Family risk factors for abuse include:

• A history of drug abuse, alcohol abuse, or psychiatric illness
• Family separation
• Prior history of abuse
• A mom who is very young
• A baby who is sick, premature, or has medical issues
• A baby who has colic (cries incessantly)

Parents who feel overwhelmed and are struggling may lash out at their children. Financial or relationship problems can be contributing factors, too. If the underlying problems aren't addressed, the abuse is likely to happen again.

If you've lost control with your child or feel close to the edge, or if you're worried someone else in your home could be a danger to your child, get help right away. Call your family healthcare provider, social services, or an organization such as the National Parent Helpline at (855) 4-A-Parent or (855) 427-2736. It's possible to get your family back on track and make your home safe for your children.

Learn more:

• What to do if your baby cries for no reason
• Signs of a bad daycare center
• Childcare options: Pros and cons