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  1. Could this be an abused child?

  2. Are there indicators of family violence?(violence may be towards people and/or animals)

  3. Should a report be made to ChildLine?

  4. What can be done to help this child and family?

The possibility of child abuse must be included in the differential diagnosis of all childhood injuries. Many times, child abuse is easily and quickly eliminated from the diagnosis, however it must always be considered. A key to reporting suspected child abuse and neglect is being able to recognize common indicators, keeping in mind that one or more indicators does not always mean abuse has occurred. Thorough medical and child protective service assessments will help to make that determination.

Whenever a child presents to your office for care, ask yourself these four questions:

  • Shows sudden changes in behavior or school performance

  • Has not received help for physical or medical problems brought to the parents’ attention

  • Has learning problems (or difficulty concentrating)
    that cannot be attributed to specific physical or psychological causes

  • Is always watchful, as though preparing for something bad to happen

  • Lacks adult supervision

  • Is overly compliant, passive, or withdrawn

  • Comes to school or other activities early, stays late, and does not want to go home

  • Is reluctant to be around a particular person

  • Discloses maltreatment

The Child:

What Is Child Abuse and Neglect? Recognizing the Signs and Symptoms

The Parent:

  • Denies the existence of—or blames the child for—the child’s
    problems in school or at home

  • Asks teachers or other caregivers to use harsh physical discipline
    if the child misbehaves

  • Sees the child as entirely bad, worthless, or burdensome

  • Demands a level of physical or academic performance the
    child cannot achieve

  • Looks primarily to the child for care, attention, and satisfaction
    of the parent’s emotional needs

  • Shows little concern for the child

The Parent and Child:

  • Rarely touch or look at each other

  • Consider their relationship entirely negative

  • State that they do not like each other

Signs of Physical Abuse

Consider the possibility of
physical abuse when the child:

Consider the possibility of physical abuse when the parent or other adult caregiver:

  • Offers conflicting, unconvincing, or no explanation for the child’s injury, or provides an explanation that is not consistent with the injury

  • Describes the child as “evil” or in some other very negative way

  • Uses harsh physical discipline with the child

  • Has a history of abuse as a child

  • Has a history of abusing animals or pets

  • Has unexplained burns, bites, bruises, broken bones, or black eyes

  • Has fading bruises or other marks noticeable after an absence from school

  • Seems frightened of the parents and protests or cries when
    it is time to go home

  • Shrinks at the approach of adults

  • Reports injury by a parent or another adult caregiver

  • Abuses animals or pets

Signs of Neglect

Consider the possibility of
neglect when the child:

Consider the possibility of neglect
when the parent or other adult caregiver:

  • Appears to be indifferent to the child

  • Seems apathetic or depressed

  • Behaves irrationally or in a bizarre manner

  • Is abusing alcohol or other drugs

  • ​​Is frequently absent from school

  • Begs or steals food or money 

  • Lacks needed medical or dental care, immunizations, or glasses

  • Is consistently dirty and has severe body odor

  • Lacks sufficient clothing for the weather

  • Abuses alcohol or other drugs

  • States that there is no one at home to provide care

Signs of Sexual Abuse

Consider the possibility of
sexual abuse when the child:

​Consider the possibility of sexual abuse when the parent or other adult caregiver:

  • ​Is unduly protective of the child or severely limits the child’s
    contact with other children, especially of the opposite sex

  • Is secretive and isolated

  • Is jealous or controlling with family members

  • ​Has difficulty walking or sitting

  • Suddenly refuses to change for gym or to participate in physical activities

  • Reports nightmares or bedwetting

  • Experiences a sudden change in appetite

  • Demonstrates bizarre, sophisticated, or unusual sexual knowledge or behavior

  • Becomes pregnant or contracts a venereal disease, particularly if under age 14

  • Runs away

  • Reports sexual abuse by a parent or another adult caregiver

  • Attaches very quickly to strangers or new adults in their environment

Signs of Emotional Maltreatment

Consider the possibility of emotional maltreatment when the child:

Consider the possibility of emotional maltreatment when the parent or
other adult caregiver:


  • ​Constantly blames, belittles, or berates the child

  • Is unconcerned about the child and refuses to consider offers of help for the child’s problems

  • Overtly rejects the child

  • Shows extremes in behavior, such as overly compliant or demanding behavior, extreme passivity, or aggression

  • Is either inappropriately adult (parenting other children, for example) or inappropriately infantile (frequently rocking or head-banging, for example)

  • Is delayed in physical or emotional development

  • Has attempted suicide

  • Reports a lack of attachment to the parent

The above list may not be all the signs of abuse or neglect. It is important to pay attention to other behaviors that may seem unusual or concerning. Reproduced with permission from Child Welfare Information Gateway




Have a Question?

The Pennsylvania Department of Human Services provides authoritative answers to the most frequently asked questions from mandated reporters. Updates to this document can be found at

General questions related to child abuse, mandated reporting or certifications can be submitted via email to

Find additional information
using the following links:


mandated reporters
AAP Policy Statements
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