**3.2 At every dental visit, observe child patient for changes in behavior**

It is very important to note that abused children are often scared to reach out for help and do not trust most people [12]. Their extended families and people who are in regular contact with them play a crucial role in identifying if there is abuse as they are the first point of reference to observe any behavioral changes [13, 23].

Individuals with whom the child comes into contact with regularly play an essential role in identifying probable abuse cases as they may be the first to become conscious of any noticeable fluctuations in behavior [23]. Any cautioning signs of potential abuse which are noted should be immediately and meticulously documented [13, 23].

There should be an awareness of how the pediatric patient respond to others. Abused children may act aggressively by showing inappropriate anger and loss of control, or they may be sullen, stoic or withdrawn [2, 5]. Psychological indicators include avoidance, fear, anxiety, low self-esteem, and depression as indicated in **Table 2**. These psychological indicators are usually clearly visible and the victim is highly withdrawn [23]. Behavioral indicators of abuse may also include: child not making eye contact, is wary of parents, demonstrates fear of touch or an intense

fear of being examined, dramatic mood changes, withdrawal or aggressiveness, has a history of suicide attempts and running away [5, 13].
