Before you read: one sign is not proof
The Child Welfare Information Gateway, part of the U.S. Department of Health and Human Services, puts it plainly: a single sign does not necessarily mean a child is being harmed. There may be other causes. But when signs show up repeatedly or in combination, a closer look is warranted.
The American Academy of Pediatrics (AAP) adds the other half of the truth: many children who have been sexually abused show no obvious signs at all. So a lack of signs is not proof that everything is fine, either.
That is why the most protective thing an adult can be is someone a child can talk to.
What abuse and neglect mean
The CDC describes four main types of child abuse and neglect, for children under 18:
| Type | What it means (CDC) |
|---|---|
| Physical abuse | Intentional use of physical force that can result in physical injury, such as hitting, kicking, or shaking. |
| Sexual abuse | Any completed or attempted sexual act or sexual contact with a child. |
| Emotional abuse | Behaviors that harm a child's self-worth or emotional well-being, such as name-calling and shaming. |
| Neglect | Failure to meet a child's basic physical and emotional needs, such as housing, food, education, and medical care. |
The CDC reports that at least one in seven children in the United States experienced abuse or neglect in the past year, and notes this is likely an undercount. The CDC also states that child abuse and neglect can be prevented.
The Child Welfare Information Gateway notes that living in poverty is not abuse or neglect. Sometimes a family simply needs information or help.
General signs in a child
From the Child Welfare Information Gateway. A child who:
- Shows sudden changes in behavior or school performance.
- Has not received help for physical or medical problems that were brought to a parent's attention.
- Is always watchful, as though preparing for something bad to happen.
- Lacks adult supervision.
- Is overly compliant, passive, or withdrawn.
- Comes to school or activities early, stays late, and does not want to go home.
- Is reluctant to be around a particular person.
- Tells you about mistreatment.
General signs in a parent or caregiver
From the Child Welfare Information Gateway. A parent or caregiver who:
- Denies the child's problems at school or home, or blames the child for them.
- Asks teachers or other caregivers to use harsh physical discipline.
- Sees the child as entirely bad, worthless, or a burden.
- Demands a level of physical or school performance the child cannot reach.
- Looks mainly to the child to meet the parent's own emotional needs.
- Shows little concern for the child.
Signs by type
All of the lists below summarize the Child Welfare Information Gateway factsheet "What Is Child Abuse and Neglect? Recognizing the Signs and Symptoms."
Physical abuse
In the child: injuries that are not explained, such as burns, bites, bruises, broken bones, or black eyes; fading bruises after an absence from school; seeming frightened of a parent or protesting when it is time to go home; shrinking at the approach of adults; changes in eating or sleeping.
In the adult: explanations for an injury that conflict, do not convince, or do not match the injury; harsh physical discipline; little concern for the child.
Neglect
In the child: often absent from school; begging or stealing food or money; missing needed medical care, dental care, or glasses; consistently dirty; not dressed for the weather; saying there is no one at home to care for them.
In the adult: seeming indifferent to the child, apathetic, or depressed; using alcohol or other drugs in ways that affect care.
Sexual abuse
In the child: difficulty walking or sitting; suddenly refusing to go to school; nightmares or bedwetting; sudden changes in appetite; sexual knowledge or behavior that is unusual for their age; running away; attaching very quickly to strangers or new adults.
The AAP adds: withdrawing from family and friends, struggling at school, anger, extreme fears, and avoiding certain adults.
In the adult: trying to be the child's friend instead of acting as an adult; making excuses to be alone with the child; talking with the child about the adult's personal or relationship problems.
Emotional abuse
In the child: extremes in behavior, such as being overly compliant or very demanding; acting far too adult (for example, parenting other children) or far too young for their age; delays in development; signs of depression or thoughts of suicide.
In the adult: constantly blaming, belittling, or berating the child; describing the child negatively; openly rejecting the child.
If a child talks about suicide or wanting to die, call or text 988. If they are in immediate danger, call 911.
Grooming: the pattern to watch for
Grooming is how someone who intends to harm a child builds trust and access first. RAINN describes it as a process, not a one-time event, often unfolding over weeks, months, or years. It often targets the family and community too, not just the child, so the adult is trusted by everyone.
The AAP notes that abusers are usually someone the child knows, such as a relative, family friend, teacher, coach, or babysitter, and that they often use persuasion rather than force.
RAINN, citing the National Center for Victims of Crime, describes grooming as generally moving through these stages:
- Identifying and targeting a child.
- Gaining trust and access.
- Playing a bigger and bigger role in the child's life.
- Isolating the child and creating secrecy.
- Starting sexual contact.
- Keeping control through fear or false affection.
Adult behaviors that are warning signs
From RAINN. Look for patterns, not one-off moments:
- Isolating: seeking one-on-one time with a child, inventing reasons to be alone, discouraging other adults from being involved.
- Secrecy: asking a child to keep secrets, using private messages, encouraging a child to lie to parents.
- Ignoring boundaries: too much touching, ignoring privacy, sexual jokes, or showing a child sexual content.
- Special treatment: favoritism, gifts given without a parent's okay, comments about the child's looks, help that seems too good to be true.
- Role creep: stepping far outside their role and acting as if the relationship with the child is closer than it is.
Online grooming and sextortion
The National Center for Missing & Exploited Children (NCMEC) describes patterns seen in online exploitation:
- Learning about a child's interests, friends, school, and family from social media before making contact.
- Asking for sexual images soon after connecting.
- Moving the conversation from one app to a more private app or video chat.
- Using fake identities, including pretending to be younger or a different gender.
- Building a fake friendship or romance.
- Threatening to share images, or to create fake ones, to get more images or money. This is called sextortion. NCMEC reports that teenage boys have been the most common targets of financial sextortion.
NCMEC's message to young people is clear: the blackmailer is to blame, not you. Paying or cooperating rarely stops it. Block the account, but do not delete the messages or profile, because they can help stop the person. Then report it. See Get Help Now and Online Safety.
If a child tells you
A child who tells you something is trusting you with something very hard. How you respond matters. The American Academy of Child and Adolescent Psychiatry (AACAP) notes that a supportive, caring response is the first step in getting help for the child and rebuilding their trust in adults.
Guidance from the AACAP, the AAP, and the National Child Traumatic Stress Network (NCTSN):
- Stay calm. The NCTSN notes that hearing this can bring up powerful feelings, but if you become upset, angry, or out of control, it makes it harder for the child to keep talking.
- Listen. Let the child talk. Do not make judgmental comments.
- Believe them, and say so. Show that you take what they are saying seriously.
- Tell them they did the right thing by telling you.
- Tell them it is not their fault. Children often think they caused it. The adult is always responsible, even if a teenager says they agreed.
- Tell them they are not in trouble.
- Promise to help keep them safe, and then act.
- Report it. For abuse inside the family, report to your state's child protective services. For abuse by someone outside the family, report to the police. If you are not sure, call Childhelp at 1-800-422-4453 and they will help. The AACAP notes that people who report in good faith are protected from prosecution.
- Get the child seen by a doctor. A pediatrician or family doctor can check on the child and refer them to a qualified mental health professional.
A few more things from the NCTSN:
- Do not make promises you cannot keep, such as promising not to tell anyone. Instead, let the child know you will do everything in your power to protect them.
- Keep the child informed about what will happen next.
- If a child later "takes it back," that does not mean they were lying. The NCTSN explains that taking it back (called recantation) is common, and most children who recant were telling the truth the first time. They may have mixed feelings, may have been pressured, or may have been sworn to secrecy.
- Children's Advocacy Centers in many communities offer coordinated support for children who have been abused.
- If the child is in danger right now, call 911.
The NCTSN also notes that many children never tell anyone, and some take weeks, months, or years to tell. Children often stay quiet because they fear being hurt, not being believed, being blamed, or breaking up the family.
Simple things that help protect children
From the AAP:
- Teach children the real names for all body parts, and that it is normal and healthy to talk about their bodies.
- Explain who may see or touch private parts and when, for example a doctor checking their health with a parent in the room.
- Teach that it is okay to say no to touches or hugs, even from adults.
- Teach the difference between a surprise (like a birthday present, which is fine to keep for a while) and a secret that should always be told to a trusted adult.
- Start early and keep the conversation going as children grow.
Sources
- Child Welfare Information Gateway, Children's Bureau, U.S. Department of Health and Human Services, "What Is Child Abuse and Neglect? Recognizing the Signs and Symptoms," factsheet, April 2019, https://www.childwelfare.gov/resources/what-child-abuse-and-neglect-recognizing-signs-and-symptoms/. Checked October 2026.
- Centers for Disease Control and Prevention, "About Child Abuse and Neglect," https://www.cdc.gov/child-abuse-neglect/about/index.html (last reviewed May 16, 2024). Checked October 2026.
- American Academy of Pediatrics, HealthyChildren.org, "Preventing Child Sexual Abuse: What Parents Need to Know," by Shalon Nienow, MD, FAAP, https://www.healthychildren.org/English/safety-prevention/at-home/Pages/Sexual-Abuse.aspx (last updated April 18, 2025). Checked October 2026.
- American Academy of Child and Adolescent Psychiatry, Facts for Families No. 28, "Responding to Child Sexual Abuse," https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Responding_To-Child-Sexual-Abuse-028.aspx (updated September 2023). Checked October 2026.
- National Child Traumatic Stress Network, "What to Do If Your Child Discloses Sexual Abuse: Information for Parents and Caregivers" (Caring for Kids series), April 2009, https://www.nctsn.org/sites/default/files/resources//what_if_your_child_discloses_sexual_abuse.pdf. Checked October 2026.
- RAINN, "Get the Facts About Grooming," https://rainn.org/get-the-facts-about-sexual-violence/get-the-facts-about-grooming/ (cites the National Center for Victims of Crime for the six stages). Checked October 2026.
- National Center for Missing & Exploited Children, "Sextortion," https://www.missingkids.org/theissues/sextortion. Checked October 2026.
- Childhelp National Child Abuse Hotline, https://www.childhelphotline.org/. Checked October 2026.