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A child who's being abused may feel guilty, ashamed or confused. He or she may be afraid to tell anyone about the abuse, especially if the abuser is a parent, other relative or family friend. That's why it's vital to watch for red flags, such as:

• Changes in behavior or school performance
• Withdrawal from friends or usual activities
• An apparent lack of supervision
• Frequent absences from school
• Reluctance to leave school activities, as if he or she doesn't want to go home
• Attempts at running away
• Physical clues, such as bruising or blood in underwear

There also are specific signs and symptoms to look out for, depending on the type of abuse.

Physical abuse signs and symptoms

• Unexplained injuries, such as bruises, fractures or burns
• Untreated medical or dental problems
• Poisoning
• An apparent fear of parents or adult caregivers
• A discrepancy between the extent of the injuries and the explanation given for the injuries

Sexual abuse signs and symptoms

• Inappropriate sexual behavior for child's age
• Sexual knowledge that's inappropriate for the child's age
• Sleep problems, such as nightmares or night terrors
• Changes in behavior, such as aggression or hyperactivity
• Blood in the child's underwear
• Depression or anxiety
• Social withdrawal
• Abuse of other children sexually
• Statements that he or she was sexually abused
• Attempts to undress other people
• Trouble walking or sitting

Emotional abuse signs and symptoms

• Delayed or inappropriate emotional development
• Extremes in behavior, from very aggressive behavior to complete passivity
• Loss of self-confidence or self-esteem
• Sleep problems
• Headaches
• Stomachaches
• Avoidance of certain situations, such as refusing to go to school
• Seeks affection from other adults
• Depression

Neglect signs and symptoms

• Poor growth
• A lack of fat in cheeks, buttocks and extremities
• Indifference
• Poor hygiene
• Frequent absences from school

Sometimes a parent's demeanor or behavior also sends red flags about child abuse. Warning signs include a parent who:

• Shows little concern for the child
• May not offer comfort during a medical exam
• Denies that any problems exist at home or school, or blames the child for the problems
• Consistently blames, belittles or berates the child
• Describes the child with negative terms, such as "worthless"
• Uses harsh physical discipline or asks teachers to do so
• Demands an inappropriate level of physical or academic performance
• Severely limits the child's contact with others
• Offers conflicting or unconvincing explanations for a child's injuries, or no explanation at all
• Appears unable to recognize physical or emotional distress in children
• Seems jealous of other family members getting attention from the child

Keep in mind that warning signs are just that — warning signs. The presence of warning signs doesn't necessarily mean that a child is being abused.

Although most child health experts strongly advise against the use of violence in any form, some people still use corporal punishment (spanking etc.) as a way to discipline their children. Sometimes it can be difficult to tell if the line between discipline and abuse has been crossed. Corporal punishment that injures or leaves marks is excessive and considered abuse by child protection agencies in the United States. Any corporal punishment may leave emotional scars.

Certain parental behaviors — even when done in the name of discipline — are clearly child abuse, such as:

• Biting
• Kicking
• Burning
• Scalding
• Threatening extreme violence, such as using a knife or a gun
• Cutting
• Breaking bones
• Bruising
• Spanking multiple times a day
• Spanking an infant

When to see a doctor
If you're concerned that your child or another child has been abused, seek help immediately. Contact the child's doctor, a local child protective agency or the local police department. Keep in mind that health care professionals are legally required to report all suspected cases of child abuse to state authorities.

If you're worried that you might abuse your own child, stop what you're doing and put some distance between you and your child. If there's someone who can watch your child, leave the house and go for a walk. Call your own primary care doctor or your child's pediatrician for advice and a treatment referral. If you don't think you can control your temper, call 911 or take your child to the nearest emergency room for help.

©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.

Child abuse occurs across all socioeconomic levels and ethnic groups. Factors that may increase a person's risk of becoming abusive include:

• A history of mistreatment as a child
• Depression
• Anxiety
• Marital conflict or single parenting
• Domestic violence
• Financial stress
• Social isolation
• Lower parental education
• Alcoholism or other forms of substance abuse
• A child in the family who was born prematurely or who is developmentally or physically disabled
• Young children in the family, especially multiple children under age 5

©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.

Some children overcome the physical and psychological effects of child abuse, particularly those who have high self-esteem, an optimistic attitude and strong social support. For others, however, child abuse has lifelong consequences. For example, child abuse may lead to:

• Death
• Physical disabilities
• Learning disabilities
• Low self-esteem
• Depression
• Difficulty establishing or maintaining relationships
• Challenges with intimacy and trust
• An unhealthy view of parenthood
• Anxiety
• Substance abuse
• Eating disorders
• Post-traumatic stress disorder
• Personality disorders
• Delinquent or violent behavior
• Abuse of others
• Suicide attempts

©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.

Options for the abused child
Psychotherapy can help a child who has been abused learn to trust again, as well as teach the child about normal behavior and relationships. Therapy can also teach children conflict management and can boost self-esteem. Several different types of therapy may be effective for children who've been abused:

• Trauma-focused cognitive behavioral therapy. This type of therapy helps an abused child to better manage distressing feelings and to deal with trauma-related memories. Eventually, the nonabusing parent and the child are seen together so the child can let the nonabusing parent know exactly what happened.
• Child-parent psychotherapy. This treatment focuses on improving the parent-child relationship and on building a stronger attachment between the two.

Children who are placed in foster care because their home situation was deemed too dangerous will also need mental health services, and specific therapies are available for children in foster care.

Options for the abusing parent
Psychotherapy can help an abuser discover the roots of abuse and learn effective ways to cope with life's inevitable frustrations. If the child is still in the home, social services may schedule home visits and make sure essential needs, such as food, are available.

Several different types of therapy have been found helpful for parents, including:

• Parent-child interaction therapy. This therapy is a short-term treatment that teaches positive ways to manage children's behavior. This therapy also teaches parents how to build a better relationship with their children.
• Abuse-focused cognitive behavioral therapy. This short-term treatment helps parents learn to regulate emotions. It also teaches parenting skills and what behaviors to expect from different ages of children, as well as positive ways to discipline children.

Places to turn for help
If you need help because you're at risk of abusing a child, or you think someone else has abused or neglected a child, there are organizations that can provide you with information and referrals, such as:

• National Child Abuse Hotline: 800-4-A-CHILD (800-422-4453)
• Prevent Child Abuse America: 800-CHILDREN (800-244-5373)
• Stop It Now (for sexual abuse): 888-PREVENT (888-773-8368)

©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.

If a child tells you he or she is being abused, take the situation seriously:

• Encourage the child to tell you what happened. Remain calm as you assure the child that it's OK to talk about the experience, even if someone has threatened him or her to keep silent. Ask open-ended questions such as, "What happened then?"
• Remind the child that he or she isn't responsible for the abuse. The responsibility for child abuse belongs to the abuser. Say, "It's not your fault" over and over again.
• Offer comfort. You might say, "I'm so sorry you were hurt," "I'm glad that you told me," and "I'll do everything I can to help you." Let the child know you're available to talk or simply listen at any time.
• Report the abuse. Contact a local child protective agency or the local police department. Authorities will investigate the report and, if necessary, take steps to ensure the child's safety.
• Seek medical attention. If necessary, help the child seek appropriate medical care.
• Help the child remain safe. Don't let the child be alone with the abuser. If that's not possible, do what you can to eliminate the abuser's access to the child. Make sure the child knows how to call for emergency help if needed.
• Consider additional support. You might help the child seek counseling or other mental health treatment. Age-appropriate support groups also can be helpful.

©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.

You can take simple steps to protect your child from exploitation and child abuse, as well as prevent child abuse in your neighborhood or community. For example:

• Offer your child love and attention. If you feel overwhelmed or out of control, take a break. Don't take out your anger on your child.
• Think supervision. Don't leave young children home alone. In public, keep a close eye on your child. Volunteer at school and for extracurricular activities so that you get to know the adults who are spending time with your child. Don't allow your child to go anywhere or accept anything without your permission. When your child is old enough to leave home without parental supervision, encourage your child to hang out with friends rather than alone — and to tell you where he or she is at all times.
• Know your child's caregivers. Check references for baby sitters and other caregivers. Make unannounced visits to observe what's happening. Don't ever allow substitutes for your usual child care provider if you don't know the substitute.
• Emphasize the importance of saying no. Make sure your child understands that he or she doesn't have to do anything that seems scary or uncomfortable. Encourage your child to leave a threatening or frightening situation immediately and seek help from a trusted adult. If something does happen, encourage your child to talk to you or another trusted adult about the episode. Assure your child that it's OK to talk, and that he or she won't get in trouble.
• Teach your child how to stay safe online. The Internet is a tremendous tool, but it's important to use it safely. Cover ground rules such as not sharing personal information and not responding to inappropriate, hurtful or frightening messages. Don't allow your child to share photos or videos online or arrange to meet an online contact in person without your permission. Check your child's privacy settings on social networking sites, and tell your child to let you know if someone he or she doesn't know makes contact via a social networking site. Consider it a red flag if your child is secretive about his or her online activities. Place the computer in a common area of the home, and use the parental controls to restrict the types of Internet sites your child can visit.
• Reach out. Meet the families in your neighborhood, including both parents and children. Or, join a parent support group so you have an appropriate place to vent your frustrations. If a friend or neighbor seems to be struggling, offer to baby-sit or help in another way.

If you're concerned that you might abuse your child, seek help immediately, especially if you were abused as a child. Start by talking with your family doctor. He or she may offer a referral to a parent education class, counseling or a support group for parents so that you can learn appropriate ways to deal with your anger. If you're abusing alcohol or drugs, ask your doctor about treatment options. Remember, child abuse is preventable — and often a symptom of a problem that may be treatable. Ask for help today.

If you, the parent, were a victim of any type of child abuse, get counseling to assure you don't continue the abuse cycle or teach those destructive behaviors to your child.

©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.