There are certain parental responses which are known, by research and experience, to suggest a cause for concern. These include:

An unexplained delay in seeking treatment that is obviously needed, or it is sought at an inappropriate time;
A lack of awareness or denial of any injury;
Incompatible explanations are offered; or the child is said to have acted in a way that is inappropriate to its age and development; or several different explanations are offered; (N.B. The child and/or other members of the family may support the explanations, however improbable);
A reluctance to give information, or failure to mention previous injuries known to have occurred;
The family has attended Accident and Emergency departments unusually frequently with appropriate and inappropriate requests for attention;
A constant presentation of minor injuries, which may represent ‘a cry for help’, which, if ignored, may lead to more serious injury. Attention may be sought for other problems unrelated to the injury, which may not even be mentioned;
Unrealistic expectations of the child, or constant complaints about the child. Parents may show a violent reaction to a child’s naughty behaviour;
Consent for further medical investigation is refused;
The parents are drunk or under the influence of drugs or cannot be found;
The parents ask for the child to be removed from home or indicate difficulties coping with the child.

Physical abuse may involve hitting, shaking, throwing, poisoning, burning or scalding, drowning, suffocating, or otherwise causing physical harm to a child. Physical harm may also be caused when a parent or carer fabricates the symptoms of, or deliberately induces, illness in a child.

Signs that may suggest physical abuse:

Any bruising to an immobile child;
Multiple bruising to different parts of the body;
Bruising of different colours indicating repeated injuries;
Fingertip bruising to the face, chest, back, arms or legs;
Burns or scalds with clear outlines e.g. a gloves and socks effect or burns of uniform depth over a large area. Also, splash marks above the main scald area – associated with throwing;
Retinal or pin point haemorrhaging - associated with shaking;
Rib fractures in very young children;
Adult bite marks;
An injury for which there is no adequate explanation.

Emotional abuse is the persistent emotional maltreatment of a child such as to cause severe and persistent adverse effects on the child’s emotional development. It may involve:

Conveying to a child that they are worthless or unloved, inadequate or valued only in so far as they meet the needs of another person;
Age or developmentally inappropriate expectations being imposed on children. These may include interactions that are beyond the child’s developmental capability, as well as overprotection and limitation of exploration and learning, or preventing the child participating in normal social interaction;
Not giving the child opportunities to express their views, deliberately silencing them or making fun of what they say or how they communicate;
Causing children frequently to feel frightened or in danger;
Seeing or hearing the ill treatment of another person;
The exploitation or corruption of children;
Serious bullying, including cyber-bullying;

Some level of emotional abuse is involved in all types of ill treatment of a child, though it may occur alone.

Signs that may suggest emotional abuse:

Excessive bedwetting/soiling, eating, rocking, head banging, aggression;
Self harm;
Attempted suicide;
High levels of anxiety, unhappiness or withdrawal;
Seek out or avoid affection;
Sleeplessness/night terrors;
Food refusal;
Attention seeking.

Sexual abuse involves forcing or enticing a child or young person to take part in sexual activities, not necessarily involving a high level of violence, whether or not the child is aware of what is happening. The activities may involve physical contact, including assault by penetration e.g. rape or oral sex or non-penetrative acts such as masturbation, kissing, rubbing and touching outside clothing. They may include non contact activities, such as involving children in looking at, or in the production of sexual images or in watching sexual activities, or encouraging children to behave in sexually inappropriate ways or grooming a child in preparation for abuse, including via the internet. Sexual abuse may be committed by men, women and children.

Signs that may suggest sexual abuse:

Injuries, infections, or abnormal discharge, in the genital/anal/oral area;
Pregnancy, and identity of father is a secret or vague;
Shows worrying sexualised behaviour in their play or with other children or adults;
Seems to have inappropriate sexual knowledge for their age;
A confusion of ordinary affectionate contact with abuse.

Health and social care

Child abuse