Indicators of abuse and neglect

Risk of harm within the Children and Young Persons (Care and Protection) Act 1998 relates to the impact of abuse and neglect on a child or young person.  The following indicators have been developed from research and clinical experience over recent decades.  One indicator in isolation may not imply abuse or neglect. Each indicator needs to be considered in the context of other indicators and the child’s or young person’s circumstances. The lists are not in hierarchical order.

General indicators

The following factors in the life circumstances of the child or young person are relevant when considering indicators of abuse and neglect:

  • history of previous harm to the child or young person
  • social or geographic isolation of the child, young person or family, including lack of access to extended family or supports
  • abuse or neglect of a sibling
  • family history of violence including injury to children and young people
  • domestic or dating violence.

Issues for the parent or caregiver affecting their ability to care for the child or young person:

  • abuse of alcohol or other drugs affecting their ability to care for the child or young person or arrange for their education
  • a deficiency in functional parenting skills required to provide for the safety, welfare and well-being of children and young people
  • significant problems in managing the child or young person’s behaviour or their engagement with any educational options
  • the parent or caregiver has unrealistic expectations of age appropriate behaviour in the child or young person
  • the parent is experiencing significant problems in relating to the young person
  • unstable/unmedicated mental health conditions affecting their care of the child or young person
  • suspected experience/perpetration of domestic or family violence.

General indicators of abuse or neglect in children and young people:

  • where the child or young person gives some indication that the injury or event did not occur as stated
  • where the child or young person tells you she/he has been abused
  • when the child or young person tells you she /he knows someone who has been abused, may be referring to herself/himself
  • someone else tells you such as a relative, friend, acquaintance or sibling of the child or young person that the child or young person may have been abused
  • poor concentration
  • sleeping problems,  e.g. nightmares, bed wetting
  • marked changes in behaviour or mood, escalation in risk-taking behaviours, tantrums, aggressiveness, withdrawal
  • child or young person complains of stomach aches and headaches with no physical findings
  • unrealistic expectations of a young person including failure to allow the young person to participate in decisions that affect them or expecting adult behaviours.

General indicators of abuse or neglect in young people:

  • self harming behaviour such as cutting or burning self
  • high level of risk taking behaviours such as climbing up cliff faces while intoxicated
  • substance abuse
  • involvement in criminal activities such as stealing and fighting
  • social isolation
  • difficulty in maintaining long term peer relationships
  • persistently negative themes in art work and creative writing
  • homelessness.

Indicators of neglect

Indicators in children and young people:

  • poor standards of hygiene leading to social isolation
  • scavenging or stealing food
  • extended stays at school, public places, other homes
  • being focused on basic survival
  • extreme longing for adult affection
  • flat and superficial way of relating, lacking of a sense of genuine interaction
  • anxiety about being dropped or abandoned
  • self comforting behaviour, e.g. rocking, sucking
  • non-organic failure to thrive
  • delay in developmental milestones
  • loss of “skin bloom”
  • poor hair texture
  • untreated physical problems

Indicators in young people:

  • staying at the homes of friends and acquaintances for prolonged periods, rather than at home
  • resources are not provided which would allow the young person to care adequately for himself or herself, e.g. access to washing or food
  • exposure to serious risks through non-attendance at school e.g. crime, anti- social behaviour, drug and alcohol abuse.

Indicators in parents or carers:

  • failure to provide adequate food, shelter, clothing, medical attention, hygienic home conditions or leaving the child or young person inappropriately without supervision
  • inability to respond emotionally to a child or young person
  • child or young person left alone for long periods
  • keeping a child or young person at home from school to care for others
  • parent or carer actively avoids contact with the school to discuss attendance issues, despite extensive and repeated efforts
  • depriving of or withholding physical contact or stimulation for prolonged periods
  • failure to provide psychological nurturing
  • one child or young person treated differently, for example, scapegoated
  • absence of social support from relatives, other adults or social networks
  • parent/carer has agreed to services and/or support but has not taken this up, or cooperated within a reasonable timeframe.

Indicators of physical abuse or ill treatment

Indicators in children and young people:

  • facial head and neck bruising
  • lacerations and welts from excessive discipline or physical restraint
  • explanation offered by the child or young person is not consistent with the injury
  • other bruising and marks which may show the shape of the object that caused it e.g. a hand-print, buckle
  • bite marks and scratches where the bruise may show a print of teeth and experts can determine whether or not it is an adult bite
  • multiple injuries or bruises
  • ingestion of poisonous substances, alcohol, drugs, or major trauma
  • dislocations, sprains, twisting
  • fractures of bones, especially in children under 3 years
  • burns and scalds
  • head injuries where the child or young person may have indicators of drowsiness, vomiting, fits or retinal haemorrhages suggesting the possibility of the child having been shaken.

Indicators in young people:

  • aggressive or violent behaviour towards others, particularly younger children
  • explosive temper that is out of proportion to precipitating event
  • being constantly on guard around adults and cowering at sudden movements.

Indicators in parents or caregiver:

  • direct admissions by parents or carers that they fear they may injure the child or young person
  • family history of violence, including previous harm to children and young people
  • history of their own maltreatment as a child or young person
  • repeated presentations of the child or young person to health or other services with injuries, ingestions or with minor complaints
  • marked delay between injury and presentation for medical assistance
  • history of injury which is inconsistent with the physical findings
  • history of injury which is vague, bizarre or variable.

General indicators of female genital mutilation (FGM):

  • having a special operation associated with celebrations
  • reluctance to be involved in sport or other physical activities when previously interested
  • difficulties with toileting or menstruation
  • anxiety about forthcoming school holidays or a trip to a country which practises FGM
  • older siblings worried about their sisters visiting their country of origin
  • long periods of sickness.

General indicators a child or young person could be at risk of forced marriage:

  • anxiety about a forthcoming family holiday overseas
  • sudden announcement the child or young person is engaged
  • running away from home
  • older siblings left school early or were married early
  • controlling behaviour by family members
  • leaving school suddenly, unexpected absence or non-return from holidays.

Indicators of psychological harm

Indicators in children and young people:

  • feelings of worthlessness about life and themselves
  • inability to value others
  • lack of trust in people and expectations
  • lack of interpersonal skills necessary for adequate functioning
  • extreme attention seeking or risk taking behaviour
  • other behavioural disorders, e.g. disruptiveness, aggressiveness, bullying.

Indicators in young people:

  • avoiding all adults
  • being obsessively obsequious to adults
  • difficulty in maintaining long term significant relationships
  • being highly self critical.

Note: Children and young people sustain psychological harm from all types of abuse.

Indicators in parents or carers:

  • constant criticism, belittling, teasing of a child or young person, or ignoring or withholding praise and affection
  • excessive or unreasonable demands
  • persistent hostility and severe verbal abuse, rejection and scapegoating
  • belief that a particular child or young person is bad or evil
  • using inappropriate physical or social isolation as punishment
  • situations where an adult’s behaviour harms a child’s or young person’s safety, welfare and well-being
  • exposure to domestic violence.

Indicators of sexual abuse or ill treatment

Indicators in children and young people:

  • describe sexual acts e.g. Daddy hurts my wee wee
  • direct or indirect disclosures
  • age inappropriate behaviour and/or persistent sexual behaviour
  • self-destructive behaviour, drug dependence, suicide attempts, self-mutilation
  • persistent running away from home
  • going to bed fully clothed
  • regression in developmental achievements in younger children
  • child or young person being in contact with a known or suspected perpetrator of sexual assault
  • unexplained accumulation of money and gifts
  • being upset after using the internet or phone
  • becoming secretive about online activities and mobile phone use
  • bleeding from the vagina or external genitalia or anus
  • injuries such as tears or bruising to the genitalia, anus or perineal region
  • sexually transmitted diseases
  • adolescent pregnancy
  • trauma to the breast, buttocks, lower abdomen or thighs.

Indicators in young people:

  • particularly negative reactions to adults of only one sex
  • sexually provocative
  • desexualisation, e.g. wearing baggy clothes in order to disguise gender. Eating disorders may be a possible indicator in this category
  • art work or creative writing with obsessively sexual themes
  • preoccupation with causing harm to men they suspect are homosexual
  • engaging in violent sexual acts and talking about these acts
  • knowledge about practices and locations which are usually associated with prostitution.

General indicators of child or young person’s stress should be considered such as:

  • poor concentration at school
  • sleeping/bedtime problems e.g. nightmares bed-wetting
  • marked changes in behaviour or mood, tantrums, aggressiveness, withdrawal
  • child complains of stomach aches and headaches with no physical findings.

Indicators in parents, carers, siblings, relatives, acquaintances or strangers:

  • exposing a child or young person to prostitution or child pornography or using a child or young person for pornographic purposes
  • intentional exposure of child or young person to sexual behaviour in others
  • ever committed/been suspected of child sexual abuse
  • inappropriate curtailing, or jealousy regarding age appropriate development of independence from the family
  • coercing child or young person to engage in sexual behaviour with other children and young people
  • verbal threats of sexual abuse
  • denial of adolescent’s pregnancy by family
  • perpetration of spouse abuse or physical child abuse.
  • Offenders use a range of tactics including force, threats and tricks to engage children or young people in sexual contact and to try to silence the child or young person. They may also try to gain the trust and friendship of parents in order to obtain access to children and young people.
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