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Physical abuse

A form of abuse which may involve hitting, shaking, throwing, poisoning, burning or scalding, drowning, suffocating or otherwise causing physical harm to a child. Physical harm may also be caused when a parent or carer fabricates the symptoms of, or deliberately induces, illness in a child. Indicators of physical abuse include:

  • An explanation which is inconsistent with an injury
  • Several different explanations provided for an injury
  • Unexplained delay in seeking treatment
  • The parents/carers are uninterested or undisturbed by an accident or injury
  • Parents are absent without good reason when their child is presented for treatment
  • Repeated presentation of minor injuries (which may represent a “cry for help” and if ignored could lead to a more serious injury)
  • Family use of different doctors and A&E departments
  • Reluctance to give information or mention previous injuries

Other indicators are bruising, bite marks, burns and scalds, fractures and scars:

Bruising: children can have accidental bruising, but the following must be considered as non accidental unless there is evidence or an adequate explanation provided:

  • Any bruising to a pre-crawling or pre-walking baby
  • Bruising in or around the mouth, particularly in small babies which may indicate force feeding
  • Two simultaneous bruised eyes, without bruising to the forehead, (rarely accidental, though a single bruised eye can be accidental or abusive)
  • Repeated or multiple bruising on the head or on sites unlikely to be injured accidentally
  • Variation in colour possibly indicating injuries caused at different times
  • The outline of an object used e.g. belt marks, hand prints or a hair brush
  • Bruising or tears around, or behind, the earlobe/s indicating injury by pulling or twisting
  • Bruising around the face
  • Grasp marks on small children
  • Bruising on the arms, buttocks and thighs may be an indicator of sexual abuse

Bite marks: bite marks can leave clear impressions of the teeth. Human bite marks are oval or crescent shaped. Those over 3 cm in diameter are more likely to have been caused by an adult or older child. A medical opinion should be sought where there is any doubt over the origin of the bite.

Burns and scalds: it can be difficult to distinguish between accidental and non-accidental burns and scalds, and will always require experienced medical opinion. Any burn with a clear outline may be suspicious, as examples:

  • Circular burns from cigarettes (but may be friction burns if along the bony protuberance of the spine)
  • Linear burns from hot metal rods or electrical fire elements
  • Burns of uniform depth over a large area
  • Scalds that have a line indicating immersion or poured liquid (a child getting into hot water is his/her own accord will struggle to get out and cause splash marks)
  • Old scars indicating previous burns/scalds which did not have appropriate treatment or adequate explanation

Scalds to the buttocks of a small child, particularly in the absence of burns to the feet, are indicative of dipping into a hot liquid or bath.

Fractures: may cause pain, swelling and discolouration over a bone or joint. Non-mobile children rarely sustain fractures. There are grounds for concern if:

  • The history provided is vague, non-existent or inconsistent with the fracture type
  • There are associated old fractures
  • Medical attention is sought after a period of delay when the fracture has caused symptoms such as swelling, pain or loss of movement
  • There is an unexplained fracture in the first year of life

Scars: a large number of scars or scars of different sizes or ages, or on different parts of the body, may suggest abuse.