General clinical signs of abuse:
- Damage to the skin and surface tissues, such as bruises, burns,
abrasions, lacerations or swelling.
- Damage to the brain, as evidenced by convulsions; altered mental
status, such as coma or irritability; retardation of developmental
progress or change in the rate of head growth.
- Damage to other internal organs, as suggested by shock, abdominal
pain or distention or bleeding with the organs.
- Damage to the skeleton, as evidenced by swelling, pain on movement
Indicators of reportable suspected child
- Child states that injury was caused by abuse.
- Any injury unusual for a specific age group (e.g., any fracture
in an infant).
- Unexplained injury (e.g., parent unable to explain reason for
injury; discrepancies in given explanations; blame placed on a
third party; explanations inconsistent with medical diagnosis).
- A history of previous or recurrent injury.
- Bruising in an unusual area, other than on shins, elbows, and
knees. Certain specific bruising patterns also indicate child
abuse, such as belt buckle marks, handprints, bite marks or pinches.
- Evidence of poor supervision (repeated falls down stairs; repeated
ingestion of harmful substances; a child cared for by another
- Evidence of neglect (see physical neglect).
- Any indication of sexual abuse (see sexual abuse).
- Verbal threats against the life of a child made by a parent
Suspected physical abuse indicates the
following type of injuries:
- Burns - The location of the burn and its characteristics (shape,
depth, margins, etc.) may indicate abuse.
- Bruises - Inflicted abuse should be suspected when bruises are
either multiple and all of the same color, or multiple and of
different colors; the child is less than 12 months old; bruises
are found on multiple surfaces of the body, particularly on the
back, genitals or mouth; bruises have a characteristic pattern
(outline of hand, etc. or resemble an impression of an item of
jewelry, such as a ring; and/or are on both sides of the face).
- Bite marks - Due to the uniqueness of the human dentition, human
bite marks can be used to reveal the identity of the abuser.
- Abrasions, lacerations, scar - Multiplicity and location of
wounds should be considered.
- Whipping - Linear marks or strap marks sometimes covering a
curved body surface are evidence of intentional abuse.
- Head injuries - Whenever abuse or neglect is suspected, a careful
examination of the child's eyes and nervous system should be performed.
- "Whiplash/shaken infant syndrome" - Shaking using
excessive force; usually no outward injuries noted. This injury
may go undiagnosed for years and perhaps first be manifest at
school age as minor learning problems. Death can be caused by
- Pummeling - Blows from heavy type blunt object. May cause serious
internal injuries. Detectable surface evidence of such trauma
is present only half of the time.
- Fractures - Any fracture in an infant or toddler is suspect.
Arm and leg fractures that are a result of twisting are called
"spiral" fractures. These are almost always due to inflicted
trauma. Other fractures which are suspicious are: "chip"
fractures, fractures resulting from yanking and jerking; rib fractures;
healed or healing fractures revealed by x-ray.
Additional signs of physical abuse:
Very young children with injuries on the back surfaces of the body
from the neck to the knees; bruises, scars and wounds on the backs
of arms and hands which are called "defense" wounds; excessive
layers of clothing, especially in hot weather.
Physical neglect is suspected if the following
- Unsanitary conditions in home.
- Lack of heating or plumbing in home.
- Fire hazards or other unsafe home conditions.
- Nutritional quality of food in home is poor.
- Meals are not prepared.
- Child is lacking in medical or dental care.
- Child is always sleepy or hungry.
- Child is always dirty or maintains poor personal hygiene.