Symptoms

A child who's being abused may feel guilty, ashamed or confused. He or she may be afraid to tell anyone about the abuse, especially if the abuser is a parent, other relative or family friend. That's why it's vital to watch for red flags, such as:

• Withdrawal from friends or usual activities
• Changes in behavior — such as aggression, anger, hostility or hyperactivity — or changes in school performance
• Depression, anxiety or unusual fears, or a sudden loss of self-confidence
• An apparent lack of supervision
• Frequent absences from school
• Reluctance to leave school activities, as if he or she doesn't want to go home
• Attempts at running away
• Rebellious or defiant behavior
• Self-harm or attempts at suicide

Specific signs and symptoms depend on the type of abuse and can vary. Keep in mind that warning signs are just that — warning signs. The presence of warning signs doesn't necessarily mean that a child is being abused.

Physical abuse signs and symptoms

• Unexplained injuries, such as bruises, fractures or burns
• Injuries that don't match the given explanation

Sexual abuse signs and symptoms

• Sexual behavior or knowledge that's inappropriate for the child's age
• Pregnancy or a sexually transmitted infection
• Blood in the child's underwear
• Statements that he or she was sexually abused
• Inappropriate sexual contact with other children

Emotional abuse signs and symptoms

• Delayed or inappropriate emotional development
• Loss of self-confidence or self-esteem
• Social withdrawal or a loss of interest or enthusiasm
• Depression
• Avoidance of certain situations, such as refusing to go to school or ride the bus
• Desperately seeks affection
• A decrease in school performance or loss of interest in school
• Loss of previously acquired developmental skills

Neglect signs and symptoms

• Poor growth or weight gain or being overweight
• Poor hygiene
• Lack of clothing or supplies to meet physical needs
• Taking food or money without permission
• Hiding food for later
• Poor record of school attendance
• Lack of appropriate attention for medical, dental or psychological problems or lack of necessary follow-up care

Parental behavior

Sometimes a parent's demeanor or behavior sends red flags about child abuse. Warning signs include a parent who:

• Shows little concern for the child
• Appears unable to recognize physical or emotional distress in the child
• Blames the child for the problems
• Consistently belittles or berates the child, and describes the child with negative terms, such as "worthless" or "evil"
• Expects the child to provide him or her with attention and care and seems jealous of other family members getting attention from the child
• Uses harsh physical discipline
• Demands an inappropriate level of physical or academic performance
• Severely limits the child's contact with others
• Offers conflicting or unconvincing explanations for a child's injuries or no explanation at all

Child health experts condemn the use of violence in any form, but some people still use corporal punishment, such as spanking, as a way to discipline their children. Any corporal punishment may leave emotional scars. Parental behaviors that cause pain, physical injury or emotional trauma — even when done in the name of discipline — could be child abuse.

When to see a doctor

If you're concerned that your child or another child has been abused, seek help immediately. Depending on the situation, contact the child's doctor or health care provider, a local child protective agency, the police department, or a 24-hour hotline such as Childhelp National Child Abuse Hotline (1-800-422-4453).

If the child needs immediate medical attention, call 911 or your local emergency number.

Keep in mind that health care professionals are legally required to report all suspected cases of child abuse to the appropriate county authorities or the police.