Physical Abuse

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 or deformity.

Indicators of reportable suspected child abuse:

  • 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 child).
  • 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 or caretaker.

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 this.
  • 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

Physical neglect is suspected if the following conditions exist:

  • 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.

 

 
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