Bruising: Bruises resulting from abuse are found on multiple surfaces of the body, particularly the buttocks, back, genitals, and face. The bruises might appear in a characteristic pattern (such as an outline of hand or paired bruises from pinching), or they may clearly resemble an impression of an item of jewelry (a ring), or a disciplinary imprint (a paddle, switch, or coat hanger). Linear bruise marks, strap marks, or loop marks going around a curved body surface are almost always evidence of abuse. Any bruising in any location on a child who is not walking or pulling up yet is always cause for concern.

Abrasions/Lacerations: Similar to bruising, the amount and location of the wounds should be considered. For example, lacerations under the tongue could be caused by falling with an object in the mouth or by the use of excessive force during feeding, which is a suspicious injury when the victim is an infant who is still unable to stand. Whipping a child with a belt buckle or belts or cords that are looped may cause lacerations resembling a “C” or “U” shape or other wounds with distinctive shapes.

Bite Marks: Bite marks may be found on any part of a child’s body. They may appear to be doughnut shaped, double horseshoe shaped, or oval in configuration. Individual teeth or a blurry area with varying colorations may be observed, depending on the age of the bite mark lesion.

Burns: The location of a burn and its characteristics (shape, depth, margins, etc.) may indicate abuse. It is important to keep in mind that children instinctively withdraw from pain. Burns, without some evidence of withdrawal, are highly suspect because a child will usually try to escape, which will result in splashes, uneven burns, and sometimes burns on the hands. Scalding a child with hot liquid is the most common abuse burn. Young infants are commonly scalded by immersion, and older children by having liquids thrown or poured on them. Other types of burns can include branding, cigarette burns, and rope burns.

Internal Injuries: Blunt blows to the body can cause serious internal injuries to the liver, spleen, pancreas, kidneys, and other vital organs and occasionally can cause shock and result in death. Internal injuries are the second leading cause of death for victims of child abuse. Detectable surface evidence of such trauma is present only about half the time. Physical indicators of serious internal injuries may include distension of the abdomen, blood in the urine, vomiting, and abdominal pain.

Head Injuries: Head injuries are the most common cause of child abuse related deaths and an important cause of chronic neurological disabilities. Whenever abuse or neglect is suspected, a careful examination of the child’s eyes and nervous system should be performed to look for signs of intracranial injury, as well as a psychological evaluation.

Abusive Head Trauma: Abusive head trauma (Shaken Baby Syndrome) describes a constellation of signs and symptoms resulting from violent shaking or shaking and impacting of the head of an infant. For more information, check out our Shaken Baby Syndrome program.

Fractures: Any unexplained fracture in an infant or toddler is cause for additional inquiry or investigation. Rib fractures, especially of back ribs, are the most common fractures found in abused children and are caused from either blunt force (hit) or compression (squeezed). Fractures are most suspicious for inflicted trauma when there are multiple lesions, they are in different stages of healing, and there are unsuspected lesions.