Job Aid: Indicators of Abuse

Type of Possible Indicators

Abuse
• An injury that has not been cared for properly
Physical • Any injury incompatible with history
Abuse • Pain on touching
• Cuts, lacerations, or puncture wounds
• Dehydration and/or malnourishment without illness-related cause;
weight loss
• Pallor
• Sunken eyes or cheeks
• Evidence of inadequate care
• Eye problems (e.g., retinal detachment)
• Poor skin hygiene
• Absence of hair or hemorrhaging below scalp
• Soiled clothing or bed
• Burns
• Being locked in a room
• Absence of bandages on injuries or stitches when indicated, or
evidence of unset bones
• Heavy or excessive medication
• Fractured or broken bones, dislocations, or sprains
• Burns of unusual sizes or in unusual locations
• Ligature marks on arms, legs, or torso
• Cuts or bruises
• Unexplained injuries to internal organs
• History of similar injuries or numerous suspicious hospitalizations
• Injuries that are inconsistent with the story given about their origin

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 Job Aid: Indicators of Abuse

• Behavior changes (e.g., acting out, expressing anger, lashing out, or

Sexual Abuse showing inappropriate affect)
• Exhibiting symptoms of depression, anxiety, or other behavioral
health issues
• Acting afraid in the presence of their abuser
• Refusing to be alone with their abuser
• Signs of genital or anal bruises, vaginal (non-menstrual) or anal
bleeding, or swelling or redness of the genitals or anus
• Frequent urinary tract infections
• Sexually transmitted infection(s) or pregnancy
• Exhibiting discomfort while walking or sitting
• Having bloody clothes, linens, or undergarments
• Changes to eating habits
• Sitting or walking difficulties
• Bruising on inner thighs or genitals
• Refusing or reluctance to remove clothing for showers, toileting, etc.
• Changes to appearance to make themselves unattractive to repel
sexual advances
• Tattoos or brands

• Evidence of lack of control (e.g., prohibited or limited access to

Psychological transportation, telephone, money, or other resources)
Abuse • Social isolation from friends and family
• Feelings of their needs disregarded or trivialized
• Having property damaged or destroyed property
• Significant changes in weight that cannot be explained by other
sources
• Stress-related disorders
• Insomnia
• Disorientation or despondency
• Indications of fearfulness around others
• Struggling to control emotions
• Acting in ways that are inappropriate for their age
• Seems uncomfortable in most situations
• Lacks self-assurance
• Has difficulty making or maintaining relationships
• Startles easily
• Reluctant to share personal opinions

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