Injuries that do not fit an “accidental” explanation, such as bruises on both sides of the face or body; burns with a clear line between burned and unburned skin; “falls” that result in cuts, not scrapes

Repeated injuries, especially broken bones not properly tended (visible on X-ray)

Fantasy play, with dominant themes of violence or sexual knowledge

Slow physical growth, especially with unusual appetite or lack of appetite

Ongoing physical complaints, such as stomachaches, headaches, genital pain, sleepiness

Reluctance to talk, to play, or to move, especially if development is slow

No close friendships; hostility toward others; bullying of smaller children

Hypervigilance, with quick, impulsive reactions, such as cringing, startling, or hitting

Frequent absence from school

Frequent changes of address

Turnover in caregivers who pick up child, or caregiver who comes late, seems high

Expressions of fear rather than joy on seeing the caregiver