A child's behavior will often reveal clues that point to abuse, even when he or she attempts to conceal them. Behavioral and emotional manifestations may require additional diagnosis, and you may want to refer the child to other experts.
The following indicators are not conclusive proof of child abuse. There can be other, reasonable explanations for what you observe:
The following cases illustrate how physical abuse of a child may come to light:
A physical education teacher was in the locker room when James changed his clothes. He noticed several large hematomas on the student's stomach and upper thighs. The teacher casually asked the student how he had gotten hurt. The child was evasive and anxious, and did not respond to questioning. The following week, he cut gym. On another occasion, the teacher noticed that James had a bruise on the side of his face. The student said he had tripped and fallen, but he avoided meeting the teacher's glance while he spoke. When the teacher sought to give James a note to take home to his parents, he would not accept it, saying that he would get into trouble at home. Suspecting abuse, the teacher referred the problem to the guidance counselor, who also suspected abuse. The teacher, who suspected abuse, caleld the New York State Central Register and reported the case.
In another case, Mary, a seven-year-old, was taken to the hospital emergency room at 9 p.m. by her father. She was unconscious and dirty; there appeared to be faded bite marks on her arms and on a calf. Questioned by the emergency room physician, the parent told the doctor that the girl had gone to sleep after coming home from school and did not get up in time for dinner. The parent also stated that the child did not get up after he tried several times to wake her. He then called a taxicab and brought her to the hospital. The emergency room physician found these circumstances suspicious, not only because the parent did not call 911 or emergency medical services, but also because of the bite marks on Mary's limbs. Consequently, the physician filed a report.