Caring for Our Children: Appendix K - Clues to Child Abuse and Neglect Clues to Child Abuse and Neglect Type of Abuse Physical Signs Behavioral Signals Physical Abuse Bruises or welts in various stages of healing or other visible injuries that appear on a child recurrently and cannot be explained by developmentally expected behavior. Explanation for a physical injury that is inconsistent with the injury, or the child's developmental age. Unexplained or multiple broken bones, especially a broken rib, severe skull fracture or other major head injury. Persistent or repetitive physical complaints of unclear cause, such as headache or belly pain. . The parent/caregiver reports that a significant injury was self-inflicted or the child reports being injured by a parent or other caregiver. Burns or injuries in the shape of an object used to cause the injury such as bite marks, hand prints, cigar or cigarette burns, belt buckle markings. Burns from immersion in scalding water or other hot liquids. The parent/caregivers have delayed seeking appropriate medical care. Unexplained or repetitive dental injuries. . Failure to grow at the expected rate in a child who seems hungry and eager to eat when offered food. . Sexual Abuse Pain, itching, bruises or bleeding around the genitalia. Stained or bloody underclothing. Bizarre, too sophisticated, or unusual sexual knowledge or behavior for the child's age such as asking others to do sex acts, putting mouth on sex parts, trying to have intercourse. Venereal disease. Child reports sexual abuse by a parent or adult. Difficulty walking or sitting. . Discharge from the vagina or urine openings. . Emotional Abuse Delayed physical, emotional or intellectual development that is not otherwise explicable. Impaired sense of self-worth, depression, withdrawal. Habits such as rocking, sucking on fingers in excess of expectation for developmental stage. Extremes of behavior, such as overly aggressive or passive, apathetic, empty facial appearance, decreased social interaction with others, phobias, generalized fearfulness, fear of parent. Neglect Constant hunger, begging for food or hoarding food. Fatigue or listlessness. Poor hygiene such as dirty hair, skin and clothes. Inappropriate dress. Lack of supervision for long periods of time, inappropriate to the child's age or developmental stage. Malnutrition or failure to thrive not explained by physical illness. . Delayed seeking of professional attention for physical or dental problems. . Impairment of parent or caregiver due to substance abuse, physical or mental illness. . Any Type of Abuse Substance abuse. Unexplained absences from the child care program. Over and under compliance of the child. Lack of selectivity in friendly approach to adults. Developmental regression, such as a previously toilet-trained child reverting to incontinence. Sleep and appetite disturbances. Depression. Self-destructive behavior. Excessive/inappropriate fears. Adapted from: Child Abuse Primer for Health Care Professionals © 2000 Project Child, 2200 West Broad St. Bethlehem, PA 18018-3200. Caring for Our Children, 2nd ed. Copyright 2002. National Resource Center for Health and Safety in Child Care 1-800-598-KIDS(5437) info@nrckids.org