Appendix 1 - Signs and Symptoms of Abuse

Physical Injury

• Where the explanation of an injury is not consistent with the injury or with the stage of development of the child.

• Where there are changes of explanation or no explanation.

• Where there has been an unreasonable delay in seeking medical advice.

• Recurring injuries, even when the explanation on each occurrence appears adequate. This may indicate a lack of supervision or possible medical problems.

• Bruises of different ages on the child at any one time, other than on common sites of accidental injury in a child of that age.

• Facial bruising, particularly round the mouth, eyes or ears.

• Unexplained or inadequately explained burns, bite marks, severe bruising or any combination of these.

• Poisoning, particularly where there is more than one incident.

• Failure to thrive (with no medical reason).

• Stealing or gorging food.

• Lack of appetite and increased feeding difficulties.

• Poor hygiene or inadequate clothing (taking family circumstances into account).

• Lack of appropriate supervision.

• Developmental delay.

• Poor school attendance or academic achievement.

• Persistent failure to seek or to follow any necessary medical or nursing advice.

• Poor peer group relationships, but attention-seeking from adults.

• Physical signs of long-standing neglect, including poor growth, thinning hair, protuberant abdomen and persistently cold, reddened hands and feet.

• Impaired ability for enjoyment.

• Low self esteem and sense of worthlessness.

• Eating disturbances or growth failure.

• In severe cases, actual physical signs of deprivation, as described under previous section - Neglect, may be apparent.

• Physical signs: Eating problems/anorexia; Physical symptoms such as stomach pains, headaches etc; Persistent or recurrent urinary tract infections or discharge; Sexually transmitted disease; Pregnancy.

• Behavioural signs: Over sexualised behaviour; Withdrawn, overtly compliant behaviour; Mood swings, depression and suicidal behaviour; Self-mutilation, low self-image; School refusal, truancy; Drug and alcohol abuse.
  

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