Appendix 3: Indicators of Child Abuse

Possible Indicators of Child Abuse

Updated: October 2023

The objectives of this section are:

to provide guidelines for documenting indicators of abuse
to provide a list of indicators which will serve as a tool to detect and report suspicions of child abuse
to recognize normal and problematic sexual behaviour in school-age children.

Signs, symptoms or clues, which, when found on their own or in various combinations may point to child abuse, are called indicators. Indicators may:

be apparent in the child’s physical condition and/or manifested in the child’s behaviour;
manifest in the behaviours and attitudes of adults who abuse children, and cause others to question their care of children (although most adults who have abused children are not mentally ill, risk factors to take into account are adults that present with some personal dysfunction, such as mental illness, personality disorder or substance abuse);
be non-specific and common in children and therefore difficult to assess why they are present, for example, bed-wetting nightmares, clinging or increased self-stimulation may be related to stress in the child’s life such as marital discord, family illness or death;
point to a history of abuse such as the re-enactment of adult sexual behaviour or explicit sexual knowledge inappropriate to the child’s age and stage of development.

Some examples of indicators are as follows:

Physical abuse is when a child is injured or harmed by their caregiver, or when the caregiver fails to do something to protect the child. Subtle signs of physical abuse may include (but are not limited to):

Child wears long sleeves/long pants even in warm weather
Excessive crying
Child seems anxious when other children cry
Avoidance of physical contact with others
Recurrent nightmares or disturbed sleep patterns
Behaviour extremes—aggressiveness or withdrawal
Poor self-concept
Whispered speech
Loss of appetite for no apparent reason, or excessive appetite
Child is wary of adults
Re-enactment of abuse using dolls, drawings or friends
Clinging
Delinquent behaviour
Abrupt decline in school performance

Emotional abuse is when a caregiver treats a child in an extremely negative way that damages self-esteem and the concept of self. Subtle signs of emotional abuse may include (but are not limited to):

Sudden change in self-confidence
Headaches or stomach aches with no medical cause
Destructive behaviour
Abnormal fears, increased nightmares
Failure to gain weight (especially in infants)
Desperately affectionate behaviour
Speech disorders (stuttering, stammering)
Habit disorders (biting, rocking, head-banging)
Argumentative or consistent temper tantrums
Bullying tactics
Being easily frustrated
Behaviour extremes—disobedient or overly compliant

Sexual abuse is any sexual exploitation of a child by a caregiver or someone else. Subtle signs of sexual abuse may include (but are not limited to):

Frequent sore throats or urinary infections
Constant sadness
Re-enactment of abuse using dolls, drawings or friends
Clinging
Thumb-sucking
Sudden fear of the dark
Behaviour extremism—aggressiveness or withdrawal
Recurrent nightmares or disturbed sleep patterns
Loss of appetite for no apparent reason, or excessive appetite
Bedwetting
Avoidance of undressing or wearing extra layers of clothes
Abrupt decline in school performance

Neglect is a pattern where a child’s caregiver fails to provide basic needs such as food, sleep, safety, supervision, appropriate clothing or medical treatment. Subtle signs of neglect may include (but are not limited to):