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Recognising signs of abuse at different stages of a child’s development

NSPCC factsheet

April 2014

This factsheet describes signs of abuse in the context of stages of child development. It aims to help anyone working with children to distinguish between normal child behaviour and those injuries and behaviours which might indicate abuse.

What is child abuse?
Child abuse definitions
General signs of abuse
Physical abuse
Sexual abuse
Neglect
Emotional abuse
What to do if you are concerned about a child
References
Related content
Further reading
Further help and information


What is child abuse?

Child abuse happens when an adult inflicts harm on a child or young person, even, in some cases, if the adult’s actions are not deliberate. There are four broad categories of child abuse:

  • physical abuse
  • sexual abuse
  • neglect
  • emotional abuse.

Sometimes children are sexually abused by other children.


Child abuse definitions

Physical abuse happens when a child is deliberately hurt, causing injuries such as cuts, bruises and broken bones. It can involve hitting, shaking, throwing, poisoning, burning, slapping or suffocating. It is also physical abuse when a parent or carer fabricates, or induces, the symptoms of an illness in a child.

Sexual abuse involves forcing or enticing a child or young person to take part in sexual activities. It does not necessarily involve violence and the child may or may not be aware of what is happening. Sexual abuse includes: grooming a child with the intention of sexually abusing them; all forms of penetrative and non-penetrative sex; sexually exploiting a child in return for gifts, money or affection; and making, looking at and distributing indecent images of a child.

Neglect is persistently failing to meet a child’s basic physical and/or psychological needs resulting in serious damage to their health and development. Neglect is difficult to define as it is hard to describe the absence of something such as love or attention (Daniel et al, 2011). In practical terms, neglect may involve a parent’s or carer’s failure to:

  • provide adequate food, clothing and shelter
  • protect the child from physical and emotional harm or danger
  • supervise the child properly
  • make sure the child receives appropriate medical care or treatment.

Neglect often happens at the same time as other types of abuse (Daniel et al, 2011; Rees et al, 2011).

Emotional abuse is persistent and, over time, it severely damages a child’s emotional development. Active emotional abuse involves an adult deliberately trying to scare, humiliate or verbally abuse a child. Passive emotional abuse happens when a parent or carer denies the child the love and care they need in order to be healthy and happy. Such adults might be emotionally unavailable; fail to offer their child praise and encouragement; interact with them in an age-inappropriate way; be over-protective, limiting their opportunities to explore, learn and make friends; or expect the child to meet the parent’s own emotional needs.


General signs of abuse

Abused children may be afraid to tell anybody about the abuse. They may struggle with feelings of guilt, shame or confusion – particularly if the abuser is a parent, caregiver or other close family member or friend. Anyone working with children or young people needs to be vigilant to the signs listed below.

Whilst these signs do not necessarily mean that a child is being abused, they probably indicate that the child or family is having some problems which should be investigated.

  • Regularly experiencing nightmares or sleeping problems.
  • Changes in personality.
  • Outbursts of anger.
  • Changes in eating habits.
  • Showing an inexplicable fear of particular places or making excuses to avoid particular people.
  • Self-harming (includes head banging, scratching, cutting).
  • Not receiving adequate medical attention after injuries.
  • Showing violence to animals, toys, peers or adults.
  • Knowledge of "adult issues" e.g. alcohol, drugs, sexual behaviour.
  • Lacking in confidence or often wary/anxious.
  • Regressing to the behaviour of younger children.
  • Regular flinching in response to sudden but harmless actions, e.g. someone raising a hand quickly.

Whether or not a child’s behaviour or appearance is concerning depends on their age or stage of development. Below are signs of potential abuse to look out for in children of specific age groups. Remember that children with learning difficulties, physical disabilities or health-related issues may be at a different developmental stage to most of their peers. However, children who have experienced abuse or neglect from a young age may also display developmental delays compared to children their own age. In such cases, the lack of a clear medical explanation for these delays may be an indicator of abuse.

Infancy to preschool

  • Doesn’t cry or respond to parent’s presence or absence from an early age (usually because they have learnt that their parent will not respond to their distress, this is known as a lack of attachment).
  • Late in reaching developmental milestones such as learning to speak, with no medical reason.
  • Acting out excessive violence with other children.
  • Significantly underweight but eats well when given food.
  • Talks of being left home alone or with strangers.

Middle childhood

  • Talks of being left home alone or with strangers.
  • Lacks social skills and has few if any friends.
  • Shows lack of attachment to a parent.
  • Becomes secretive and reluctant to share information.
  • Acting out excessive violence with other children.

School age (5 to 16 years)

  • Reluctant to go home after school.
  • Unable to bring friends home or reluctant for professionals to visit the family home.
  • Poor school attendance and punctuality, or late being picked up.
  • Parents show little interest in child’s performance and behaviour at school.
  • Parents are dismissive and non-responsive to professional concerns.
  • Is reluctant to get changed for PE etc.
  • Wets or soils the bed.
  • Acting out excessive violence with other children.

Adolescence

  • Drinks alcohol regularly from an early age.
  • Is concerned for younger siblings without explaining why.
  • Becomes secretive and reluctant to share information.
  • Talks of running away.
  • Shows challenging/disruptive behaviour at school.
  • Is reluctant to get changed for PE etc.

Physical abuse

It is normal for children to have cuts and bruises on their bodies caused by accidents which happen whilst they are moving about and/or playing. These are marks that have an acceptable and reasonable explanation.

Marks or injuries which do not have an acceptable explanation may indicate that a child has been abused. This may include:

Bruising

  • Bruises on the cheeks, ears, palms, arms and feet.
  • Bruises on the back, buttocks, tummy, hips and backs of legs.
  • Multiple bruises in clusters, usually on the upper arms or outer thighs.
  • Bruising which looks like it has been caused by fingers, a hand, or an object i.e. belt, shoe etc.
  • Large oval shaped bite marks.

Burns or scalds

  • Any burns which have a clear shape of an object, e.g. cigarette burns.
  • Burns to the backs of hands, feet, legs, genitals, or buttocks.

Other signs of physical abuse include multiple injuries (i.e. bruising, fractures) inflicted at different times. It is particularly concerning if parents/carers are unable to explain these injuries and it is not clear whether they took the child to receive medical treatment at the time of the injury.

Be vigilant to possible abuse if a child is frequently described as ill by their parent but does not have any symptoms which are obvious to others. In addition, the parent will be unable to provide details of a medical diagnosis for the child’s apparent condition.

Find out more about fabricated or induced illness

There are other signs and indicators of abuse that are age specific.

Infancy to pre-school

  • Unexplained head injuries to a baby.
  • Bruises on babies who are not yet crawling or walking.
  • Acting out excessive violence either with toys or peers.

Sexual abuse

It is normal for children to show signs of sexual behaviour at each stage in their development. Children also develop at different rates and some may be slightly more or less advanced than other children in their age group. Behaviours which might be concerning depend on the child’s age and the situation.

‘Normal’ sexual behaviour in children

Infancy to pre-school

  • Kisses and hugs others.
  • Is curious about and looks at other's private body parts; has limited understanding of privacy needs.
  • Talks about private body parts.
  • Uses words such as 'poo', 'bum' and 'willy' freely.
  • Plays 'house' or 'doctor' games.
  • Shows, touches, or rubs own genitals, or masturbates as a 'comfort' habit.

Middle childhood

  • Kisses and hugs others.
  • Displays an interest in others' private body parts but is aware of the need for privacy.
  • Talks about and occasionally shows private body parts to others.
  • Uses words such as 'poo', 'bum' and 'willy' freely and delights in being 'shocking'.
  • Sometimes uses swear words and/or 'sex' words copied from others.
  • Plays 'house' or 'doctor' games.
  • Sometimes touches or rubs own genitals, or masturbates as a comfort habit.

Pre-adolescent children (aged 10 to 12 years)

  • Kisses, hugs, and may 'date' others.
  • Is interested in others' private body parts and in the changes occurring in puberty, is aware of the need for privacy.
  • May ask questions about relationships and sexual behaviour.
  • May look at sexual pictures including internet images.
  • Masturbates in private.

Adolescents (aged 13 to 16 years)

  • Kisses, hugs, dates others, may have longer term relationships.
  • Is interested in and asks questions about body parts, relationships and sexual behaviour. Is aware of the need for privacy.
  • Uses sexual language and talks about sexual acts with peers.
  • May look at sexual pictures including internet images.
  • Masturbates in private.
  • Experiments sexually with adolescents of similar age.

The following are age-specific signs and indicators of sexual abuse:

Infancy to pre-school

  • Talking about sexual acts or using sexually explicit language.
  • Having sexual contact with other children.
  • Using toys or other objects in a sexual way.
  • Becoming withdrawn or very clingy.
  • Physical signs such as anal or vaginal soreness or an unusual discharge.

Middle childhood

  • Masturbating in public.
  • Showing adult-like sexual behaviour or knowledge.
  • Using toys or other objects in a sexual way.
  • Becoming withdrawn or very clingy.
  • Physical signs such as anal or vaginal soreness or an unusual discharge.

Adolescence

  • Masturbating in public.
  • Having sexual contact with younger children or older adults.
  • Pregnancy when the child does not have a boyfriend.
  • Sexually transmitted diseases.

Neglect

It is important to remember that some children are very picky eaters whilst others may refuse to wear a coat regardless of how cold it is outside. A child may also appear to be underweight, but is, in fact, naturally thin.

Some of the most obvious signs of neglect (e.g. children being thin, dirty or not wearing a coat) are not in themselves indicators of abuse. However, if, over time, it is clear that a child is not receiving an adequate level of care and supervision appropriate to their age, it may indicate that the child is being neglected. The following are general and age-specific signs of neglect.

General signs of neglect for children of all age groups:

  • medical needs are not being met: not being registered with a G.P.; not being taken to the dentist despite having obvious dental problems; failing to ensure that the school has a child’s medication, e.g. asthma inhalers
  • not taking the child to see a doctor when they are ill or have been injured.

There are other signs and indicators of neglect that are age-specific.

Infancy to pre-school

  • Frequent and untreated nappy rash.
  • Child has numerous accidental injuries and the explanations given suggest a lack of supervision.
  • Immunisations are not up to date.
  • Child is significantly underweight but eats well when observed.

Middle childhood

  • Child has poor school attendance and punctuality and is often picked up late at the end of the day.
  • A child is frequently tired at school due to a lack of routine at home (e.g. regular bedtimes).
  • Parents are unsupportive and uninterested in the child’s education or behaviour.
  • A child frequently appears to be hungry and does not have a packed lunch or money to buy food.

Adolescence

  • A child is often tired at school due to a lack of routine at home (e.g. regular bedtimes).
  • A child frequently appears to be hungry and does not have a packed lunch or money to buy food.
  • Parents are dismissive and non-responsive to professional concerns (e.g. the need for medical care or taking action over bullying).

Emotional abuse

It is important to remember that some children are naturally open and affectionate whilst others are quieter and more self-contained. Children also develop at different rates from one another and some may be slightly more or less advanced than other children in their age group. Mood swings and challenging behaviour are also a normal part of growing up for teenagers and children going through puberty. Be alert to behaviours which appear to be out of character for the individual child.

The following signs may indicate emotional abuse for children of all age groups:

  • inappropriate knowledge of ‘adult’ matters such as sex, alcohol and drugs
  • extreme emotional outbursts
  • regularly experiencing nightmares or sleep difficulties.

There are other signs and indicators of emotional abuse that are age specific.

Infancy to pre-school

  • Over-affectionate towards strangers or people they haven’t known for very long.
  • Lacks confidence and is often wary or anxious.
  • Displays lack of attachment to parent, e.g. when being taken to or collected from nursery etc.
  • Is frequently aggressive or nasty towards other children and animals.

Middle childhood

  • Frequently soils the bed.
  • Language and behaviour are not socially appropriate.
  • Struggles to control strong emotions.
  • Shows lack of attachment to a parent.
  • Lacks social skills and has few if any friends.
  • Self-harms, e.g. scratching, head banging.

What to do if you are concerned about a child

Anyone who is concerned that a child is at risk of abuse or neglect should follow their organisation's child protection procedures. Or they can contact the NSPCC on 0808 800 5000 for advice and support about what action they can take to safeguard a child they are working with.


References

Daniel, B. et al (2011) Recognizing and helping the neglected child: evidence-based practice for assessment and intervention. London: Jessica Kingsley.

Rees, G. et al (2011) Adolescent neglect: research, policy and practice. London: Jessica Kingsley.


Assessing children and families: NSPCC factsheet
Aimed at practitioners, this factsheet describes the process of assessing children and families and highlights aspects of good practice drawn from research literature and guidance.

Assessing parenting capacity: NSPCC factsheet
Aimed at practitioners, this factsheet describes the process of assessing parenting capacity. It highlights aspects of good practice drawn from research literature and guidance.


Further reading

Search the NSPCC Library Online for more information about identifying child abuse and neglect.


Contact the NSPCC's information service for more information on child abuse, child neglect or child protection