Recognising Signs of Abuse and Neglect

Recognising abuse and neglect is one of the most important and most difficult safeguarding skills. Abuse rarely comes with a clear label. Children may not disclose what is happening to them – indeed, they may not recognise what is happening as abuse, or may be too frightened, ashamed or loyal to speak about it. The responsibility falls on the adults who work with children to notice the signs, trust their professional instinct and act appropriately when something seems wrong.

It is important to understand that no single indicator is definitive. A bruise may have an entirely innocent explanation. A change in behaviour may reflect a family bereavement rather than abuse. What matters is the pattern – multiple concerns over time, indicators that do not have convincing innocent explanations or that persist despite reassurance, and the overall picture of a child’s circumstances and presentation. Practitioners should record concerns carefully, share them with their designated safeguarding lead and allow the professionals with investigative powers to make the assessment.

Physical Abuse: Signs and Indicators

Physical signs of physical abuse include unexplained bruising or marks, particularly in areas unusual for accidental injury in children of that age (the torso, back, buttocks, face and ears are more concerning than the shins and knees); burns or scalds with a clear edge that suggest deliberate application; bite marks; fractures inconsistent with the explanation offered; and multiple injuries in various stages of healing suggesting repeated harm over time.

Behavioural indicators include: flinching when adults make sudden movements; extreme wariness around a particular adult; wearing long sleeves in warm weather to conceal marks; explaining injuries in ways that are inconsistent, change over time or are developmentally implausible (a two-year-old is unlikely to have climbed a set of shelves and pulled them on themselves); and a parent or carer who is reluctant to allow a medical examination or who gives different accounts to different people.

Emotional Abuse: The Most Hidden Form

Emotional abuse is, by its nature, the most difficult form of abuse to recognise because it leaves no physical marks. It involves persistent patterns of interaction that convey to a child that they are worthless, unloved, inadequate or in danger. This can include chronic criticism, humiliation, threats, rejection, being forced to witness domestic abuse, or being used as a pawn in adult conflicts. Emotional abuse almost always accompanies other forms of abuse but can also occur independently.

Indicators include:

• low self-esteem and a pervasive sense of worthlessness
• extreme anxiety or fearfulness, particularly around specific adults or situations
• developmental delays that do not have a medical explanation
• physical symptoms with no medical cause (psychosomatic presentations)
• excessive people-pleasing behaviour alongside an inability to express needs
• overly rigid or overly chaotic responses to routine situations

Emotionally abused children often have significant difficulties with emotional regulation and relationships.

Neglect: The Most Common, Most Missed

Neglect is the most prevalent category of abuse in England and the one most likely to go unrecognised for extended periods, partly because it presents gradually and partly because its signs can be rationalised away individually. The Child Safeguarding Practice Review Panel has repeatedly found neglect as a factor in child deaths and serious harm cases where professionals had identified concerns but had not acted with sufficient urgency.

Physical signs include persistent hunger, poor hygiene, inappropriate clothing for the weather, untreated medical conditions or dental problems, and being significantly underweight for age. Behavioural signs include:

• arriving at school or a setting hungry
• poor concentration linked to fatigue or hunger
• compulsive eating when food is available
• significant tiredness
• frequent absences
• developmental delays
• a general presentation of being unkempt, unwell and uncared for. Crucially, neglect is not simply poverty: many families in poverty provide excellent care
• neglect involves a failure of parental care that is not explained by material deprivation alone

Sexual Abuse: Disclosure and Indicators

Sexual abuse is most commonly identified through disclosure – a child tells a trusted adult what has happened. When a child discloses, the adult’s response in the immediate moment matters enormously. You should listen carefully, remain calm, not express shock or disbelief, use the child’s own words and avoid asking leading questions. You should make clear that the child has done the right thing by telling you, that what has happened is not their fault and that you will need to tell someone who can help. You should not promise confidentiality or probe for details – detailed questioning is the job of specialist interviewers, not practitioners.

Physical indicators of sexual abuse include injuries to the genital or anal area, unexplained sexually transmitted infections or urinary tract infections, soiling, wetting or encopresis in a child who has previously been dry, and self-harm. Behavioural indicators include: age-inappropriate sexual knowledge, language or behaviour; sexual play with peers that goes beyond normal exploration; drawing or acting out sexually explicit scenarios; significant anxiety or avoidance around specific adults or places; and regression to younger behaviour. Any of these indicators warrants a conversation with your DSL.

Child Sexual Exploitation and Child Criminal Exploitation

Child Sexual Exploitation (CSE) and Child Criminal Exploitation (CCE, including county lines) are forms of abuse that may not present with obvious physical indicators and in which children may not recognise themselves as victims. In CSE, a young person (usually an older child or adolescent) is manipulated into sexual activity, often through the offer of gifts, status, affection or the threat of violence. Indicators include: unexplained gifts or money; going missing regularly; associating with older people who cannot be identified; arriving late to school, coming in dishevelled or having slept rough; and showing signs of physical or psychological harm.

CCE involves children being exploited to carry out criminal activity, most commonly drug supply through county lines operations but also theft, fraud and violence. Indicators overlap with CSE and include going missing, unexplained money or property and involvement with older or controlling peer groups. Both CSE and CCE are increasingly recognised as national safeguarding priorities and are addressed in the government’s Child Sexual Exploitation Action Plan and the statutory guidance on county lines.

What to Do With a Concern

If you have a concern about a child, however small, you should record it accurately and in detail (what you observed or heard, in the child’s own words where possible, the date and time and who was present) and share it with your DSL. You should not investigate yourself, confront the parent or alleged abuser, or wait to see whether the concern resolves. Individual concerns may seem minor in isolation; when combined with other observations, they may form a significant picture.

If you believe a child is in immediate danger, you should call 999. You do not need your manager’s permission to call the police in an emergency. The welfare of the child is the paramount consideration.

For related guidance, see also our articles on safeguarding requirements under the EYFS, the Childcare Act 2006, SEND and safeguarding vulnerabilities and how Ofsted inspects childcare.