• Recurrent injuries, cuts or burns on body, or bald patches on head
• Refusing to explain injuries or coming up with improbable excuses for them
• Showing self-destructive and aggressive tendencies
• Fear of physical contact
• Fear of medical help or examination

• Physical, mental and emotional development lags
• Self-deprecating behaviour
• Overreacting to mistakes

• Extreme mood swings
• Excessive crying
• Being isolated or withdrawn
• Fear of being alone
• Sexualised behaviour, such as drawing sexually-explicit pictures, rubbing of private parts
• Bedwetting and nightmares
• Regression to younger behaviour like thumb-sucking or being clingy
• Being overly affectionate or knowledgeable in a sexual way that is inappropriate to the child's age
• Fear of being alone with someone they know well, such as a babysitter or a close relative

• Constant hunger
• Poor personal hygiene
• Injuries or illnesses go untreated
• No social relationships
• Apparent lack of adult supervision

In Singapore, cruelty to children or young persons (below 16 years of age) can constitute child abuse. This includes acts of maltreatment to a child by an adult that result in unnecessary suffering, bodily harm or emotional wellbeing. Most cases of child abuse happen in a child's home, with much fewer cases being reported as happening in the schools or communities the child interacts with.

The good news is that the number of child abuse cases being reported has fallen since 2003 and has remained stable at about 100 cases a year. Here, cases of physical and sexual abuse are more commonly reported than those of emotional abuse or neglect. Most reports of abuse happened to primary-school-age children, between seven and 12 years old who are vulnerable and dependant on their caregivers.

1. Physical abuse: When a child is intentionally subjected to violence that causes mild to severe bodily harm, such as slapping, beating, scalding, burning, choking or poisoning.
2. Emotional abuse: When a child is put down by an adult or caregiver in such a way as to destroy confidence in themselves, such as by belittling or shaming them.
3. Sexual abuse: When a child is exposed to suggestive comments regarding their sexual parts, forced to engage in sexual acts with an adult and/or other inappropriate behaviours.
4. Neglect: When a child does not have basic needs like adequate food, shelter, medication and adult supervision met, or when a child is subjected to emotional neglect like being ignored.

But the effects of child abuse can be even more far-reaching. Research has shown that children exposed to violence can grow up to perpetuate violence in their own families. This can result in an inter-generational cycle of violence. In a study of more than 9300 participants that was published in the October 2007 issue of the American Journal of Preventive Medicine, it is found that victims of violence in childhood are more likely to continue the pattern into adulthood, either as victims or perpetrators.

Also, a recent study published in the August 2008 issue of British Journal of Psychiatry has shed new light on the links between child abuse and suicidality. It suggests that children who are abused - whether it is physical or sexual - are at a higher risk of attempting suicide in later life. Those are repeatedly abused are at an even higher risk.

Children, especially those who are abused, are unable to protect themselves in adversity. So it's up to the adults around them should learn to recognise the signs of abuse and do something about it. It will make a world of difference to a defenceless child.

There are various channels for you to get help for the abused child. This involves calling hotlines, making police reports or heading down to the Child Protection and Welfare department in Ministry of Community Development, Youth and Sports (MCYS).

In Singapore, the authorities treat reports of child abuse seriously. Once a case of child abuse has been reported, it will be properly investigated under the Children and Young Persons Act. Then, a network of social workers, psychologists or even foster parents will take care to help them rebuild their broken lives.