Appendix 6: Signs of possible abuse in children

Signs of possible abuse in children

Physical abuse

Physical signs include:

                  Unexplained injuries.

                  Injuries that are inconsistent with the explanation.

                  Injuries that reflect an article being used e.g. an iron.

                  Bruising, especially the trunk, upper arm, shoulders, neck or finger tip bruising.

                  Burns/scalds, especially from a cigarette.

                  Human bite marks.

                  Fractures, especially spiral.

                  Swelling and lack of normal use of limbs.

                  Serious injury with lack of / inconsistent explanation.

                  Untreated injuries.

Psychological/emotional signs include:

                  Unusually fearful with adults.

                  Unnaturally compliant to parents.

                  Refusal to discuss injuries/fear of medical help.

                  Withdrawal from physical contact.

                  Aggression towards others.

                  Wears cover up clothing.


Fictitious illness by proxy

This is a psychiatric illness, whereby a parent or carer deliberately inflicts harm onto a child, normally the child’s mother. The child has commonly had genuine serious illness in the first year of life and a dependency on medical attention has developed in the mother. It is very difficult to diagnose/evidence.


Female Genital Mutilation

A cultural (not religious) procedure whereby parts of female genitalia are removed - also referred to as female circumcision. This is normally undertaken on pre-pubescent girls, who are either taken abroad for procedure or “practitioners” come to the UK. There can be no anaesthetic and no sterile equipment used. Complications include serious infection, septicaemia, numerous gynaecological problems and in some cases, death.


Emotional abuse

The classic description of emotional abuse is a “Low Warmth, High Criticism” style of parenting. Signs include:

 ●                   Physical, mental and emotional lags.

                  Acceptance of punishments, which appear excessive.

                  Over reaction to mistakes.

                  Continual self-depreciation.

                  Sudden speech disorders.

                  Fear of new situations.

                  Neurotic behaviour (such as rocking, hair twisting, thumb sucking).


                  Extremes of passivity or aggression.

                  Drug/solvent abuse.

                  Running away.


                  Overly compliant behaviour.

                  Overeating or loss of appetite.



                  Sleep disorders.



Physical signs include:


                  Poor personal hygiene.

                  Poor state of clothing.

                  Emaciation, potbelly, short stature.

                  Poor skin tone and hair tone.

                  Untreated medical problems.

                  Failure to thrive with no medical reason.


Psychological/emotional signs include:

                  Constant hunger.

                  Constant tiredness.

                  Frequent lateness/non-attendance at school.

                  Destructive tendencies.

                  Low self-esteem.

                  Neurotic behaviour.

                  No social relationships.

                  Running away.

                  Compulsive stealing/scavenging.

                  Multiple accidents/accidental injuries.


Sexual abuse

Physical signs include:

                  Damage to genitalia, anus or mouth.

                  Sexually transmitted disease.

                  Unexpected pregnancy, especially in very young girls.

                  Soreness to genitalia area, anus or mouth.

                  Repeated stomach aches.

                  Loss of weight.

                  Gaining weight.

                  Unexplained recurrent urinary tract infections, discharges or abdominal pain.

                  Unexplained gifts/money.


Psychological/emotional signs include:

                  Sexual knowledge inappropriate for the child’s age.

                  Sexualised behaviour in young children.

                  Sexually provocative behaviour/promiscuity.

                  Hinting at sexual activity.

                  Sudden changes in personality.

                  Lack of concentration, restlessness.

                  Socially withdrawn.

                  Overly compliant behaviour.

                  Poor trust in significant adults.

                  Regressive behaviour, onset of wetting – day or night.

                  Suicide attempts, self-mutilation, self-disgust.

                  Eating disorders.