If you share child care with another caregiver, such as an ex-spouse or babysitter, or if you are taking over care of a child who previously lived with other caregivers — if you recently began caring for a stepchild or foster child, or have adopted — then it's possible your child has been abused by another caregiver. Child advocates are sometimes accused of arousing unwarranted suspicion; while it's true that sensational media reports stir people into a frenzy, child abuse is a serious and all-too-frequent problem that deserves attention, prevention, and intervention. Nearly one million children are the victims of abuse or neglect each year in the United States. If you are concerned your child may have been or is being abused, take a look at these warning signs of abuse to see if there is a pattern emerging.

Warning Signs of Neglect

Except for blatant signs of physical abuse such as a bruised neck that indicates strangulation, warning signs of abuse are usually subtle and can indicate other problems and stressors that you've read about earlier in this book. For that reason, in the absence of a serious physical injury or immediate danger, it's important to look for a pattern of behaviors before taking action as described in the next section. The warnings signs of abuse are adapted from Speaking Up: How to Help the Children You Work with Who Live in Abusive Homes.

• Unkempt, poor hygiene

• Inappropriate dress for the weather (shorts in winter, overcoat in summer)

• Unmet medical or dental needs, especially when the family has the means to provide adequate medical care

• Routinely hungry and thirsty (more so than is to be expected from daily activities) or reports not having had meals

• Fatigue and lethargy

• Lack of basic emotional and intellectual skills

• Unusually thin, weak, or of poor muscle development

• Chapped lips and skin on a regular basis

• Reports being left alone for long periods of time

Young Children (Ages 0-5)

Young children may have trouble articulating what's bothering them, or may have been told they can't disclose something because it's a secret. Please take all disclosures of abuse seriously and take action as described later in this chapter. Note that many of these behaviors can be classified as “regressive.”

• Bruises, cuts, burns, or unexplained injuries

• Trouble sitting or moving

• Acts out violently and inappropriately

• Easily frustrated

• Refusal to cooperate with instructions or participate in group activities

• Withdrawal from social life

• Difficulty learning and paying attention

• Delayed verbal development

• Poor motor skills, lack of coordination

• Psychosomatic symptoms (frequent headaches and stomachaches) and lack of bowel/bladder control, especially in new environments or around new people

• Difficulty sleeping

• Insecurity, clinginess

• Anxiety

• Disclosure of abuse. Please take all disclosures of abuse seriously.

Older Children

Again, look for a pattern of behavior rather than a one-time instance since these symptoms can indicate other problems as well, as discussed in the section titled “The Markers” in Chapter 12.

• Difficulty learning and paying attention; poor grades

• Low self-esteem

• Aggressive behavior

• The homicidal triad

• Other violent outbursts

• Bullying

• Social withdrawal

• Poor social skills

• Clinginess

• Psychosomatic symptoms (frequent headaches and stomachaches)

• Anxiety

• Property destruction and vandalism

• Reckless, risk-taking behavior

• Inability to express feelings

• Drug/alcohol use

• Bullying

• Involvement in abusive dating relationships

Warning Signs of Teen Dating Violence

Teen dating violence (including physical and nonphysical types of abuse) is extremely common in our society. Children who are abused or controlled at home often go on to mimic these behaviors in their own abusive romantic relationships. Here are the warning signs for teen dating violence; some apply more to the abuser than the victim, and vice versa.

• Presence of a dating relationship (may be heterosexual or homosexual)

• Low self-esteem

• Anxiety

• Violent outbursts

• Property destruction

• Reckless behavior

• Lying to parents and authorities, sneaking around with boy/girlfriend

• Controlling behaviors

• Trying to be perfect

• Cutting class

• Psychosomatic symptoms

• Clinginess

• Inability to express feelings

• Alcohol/drug use

• Victim is socially isolated from friends or previously enjoyable activities

Most teens will not want to leave an abusive dating relationship. Dr. Jill Murray is the nation's leading expert on teen dating violence; see her book But I Love Him for more information.