Child abuse: How to tell if something's wrong

How do I know if my child has been abused?
If your child spends any amount of time away from your care — whether he's with a babysitter or a relative, or at daycare or preschool — it's natural to wonder whether he's safe. And like any parent, you've probably wondered whether you'd be able to tell if your child was being mistreated. Of course, you can keep an eye out for physical symptoms and behavioral changes that may point to abuse, but it can be tricky figuring out exactly what's going on. "You're always playing a guessing game," says Kathy Baxter, director of the San Francisco Child Abuse Council. "A child could have many other reasons for acting out, being fussy, or becoming withdrawn. But parents are really good at knowing their
children, so you have to try to put together a picture and go with your gut instinct."

If your child is old enough to talk, Baxter suggests regularly asking him questions such as, "Did anything happen to you today that you didn't like?" or "Have you ever been frightened at daycare?" If he's in the habit of telling you what makes him uncomfortable, he'll be more likely to tell you if anything is seriously amiss. "When it comes to abuse and neglect, most kids tell the truth," Baxter says. "But in most cases, they are reluctant. They don't want to get the person in trouble. They feel guilty; they feel it happened because they were bad."

If your child isn't talking well enough to tell you what's going on, pinpointing abuse can be even more difficult. What you can do is keep a close eye on your child for signs that all is not well. Some parents discover signs of abuse — such as internal bleeding and injuries — only when they take their child to a pediatrician because he won't stop crying or is excessively fussy. Here are some signals to watch for.

A child who has been physically abused may:
• Cry and put up a fight when it's time to go to daycare, or appear frightened around the caregiver or other adults.
• Come home with unexplained bruises, abrasions, burns, broken bones, black eyes, cuts, bite marks, or other injuries. Repeated injuries of any type can be a warning sign.

A child who has been emotionally abused may:
• Display behavioral problems or changes such as shunning a parent's affections — or, alternately, becoming excessively clingy — or acting angry or depressed. Abused children often show
extremes in behavior: A normally outgoing and assertive child may become unusually compliant and passive, while a generally mild child may act in a demanding and aggressive manner.
• Become less talkative or stop communicating almost completely, or display signs of a speech disorder such as stuttering.
• Act inappropriately adult or infantile. For example, a child may either become overly protective and "parental" toward other children, or revert to rocking and head banging.
• Be delayed physically or emotionally, walking or talking later than expected or continuing to have regular temper tantrums. But since every child develops at a different rate, it can be difficult to determine whether a developmental delay stems from abuse.
• Complain of headaches or stomachaches that have no medical cause.

A child who has been sexually abused may:
• Have pain, itching, bleeding,
or bruises in or around the genital area.
• Have difficulty walking or sitting, possibly because of genital or anal pain.
• Suffer from urinary tract infections, or suddenly start wetting the bed.
• Be reluctant to take off his coat or sweater, even on a hot day, or insist on wearing multiple undergarments.
• Demonstrate sexual knowledge, curiosity, or behavior beyond his age (obsessive curiosity about sexual matters, for example, or seductive behavior toward peers or adults).