Signs of Abuse for Health Care Providers

Children may not be able to articulate that they are in abusive situations. Fortunately, health care providers can be aware of a number of signs of abuse. While these are not definitive indicators and many signs and symptoms can also be related to common childhood injuries and illnesses, health care providers should be aware of the possibility of abuse.

Physical Signs

• Indicators that raise a warning flag are poor hygiene, being dressed in a manner that is not appropriate to the weather, failure to thrive, inadequate weight gain, malnourishment, unattended medical needs, injuries of a defensive nature and bites.

  Burns, a significant indicator, include rope burns, cigarette burns, stun gun burns and burns in the shape of an object.

  Trauma to the ear, lacerations and facial, oral or dental injuries that are not well explained can be signs of abuse. Traumatic hair loss, head injuries, any change in mental status, hemorrhage of the retina, bruising, trauma to the abdomen especially if multiple organs are affected, and any rectal or genital area discharge, bleeding, tearing or bruising can be signs.

  A further sign of abuse is if a child is pregnant and/or diagnosed with a sexually transmitted disease.

Behavioral Signs

• In infants, crying excessively or exhibiting developmental delay can be a sign to observe. Others are excessive fear and phobias, clinging, anxiety, sleep problems and nightmares, withdrawing socially, wetting the bed, hyperactivity, and poor concentration and easy distractability. For school age children, a decrease in school performance or chronic absenteeism can be signs. Speech disorders, behavior that is regressive for the child’s age, and if the child appears fearful of the parent can be warning signs. Issues around food, depression, being very passive or increasingly verbally abusive or physically aggressive can be indicators. Health care providers should also take note of destruction of property and injury to pets, substance abuse, sexual and self-harming behaviors and post traumatic stress disorder symptoms.

  In a physical exam, if the child expresses undue fear of the exam or is excessively compliant, especially during painful or difficult parts of the exam, or avoids undressing or withdraws from touch can all be signs.

Symptomatic Signs

• Children who are in abusive situations can express physical complaints. Headaches are high on the list. Health providers should pay attention to abdominal pain, whether it is chronic or acute, and note tenderness, distention and absent bowel sounds, a sign of a severe intestinal problem. Vague complaints can be an indicator as can chronic and worsening medical problems, sore throats that are frequent and unexplained, abnormal weight gain or loss, a reluctance to employ an extremity, sitting or walking with difficulty, painful defecation, painful urination or discomfort associated with the genitals. Head trauma may be followed by vomiting, respiration that is abnormal and irritability. And finally, any symptoms that remain unexplained can be signs.