Professional Development

Abuse and Neglect

Physical Indicators of Abuse

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A.    Bruises and welts that may be indicators of physical abuse

1.     Bruises on any infant, especially facial bruises.

2.     Bruises on the posterior side of a child’s body.

3.     Bruises in unusual patterns that might reflect the pattern of the instrument used, or
        human bite marks.

4.     Clustered bruises indicating repeated contact with a hand or instrument.

5.     Bruises in various stages of healing.


B.    Burns that may indicate abuse

1.     Immersion burns indicating dunking in a hot liquid (“Stocking” burns on the arms or            
        legs or “doughnut” shaped burns of the buttocks and genitalia).

2.     Cigarette burns.

3.     Rope burns that indicate confinement.

4.     Dry burns indicating hat a child has been forced to sit upon a hot surface or has had
        a hot implement applied to the skin.


C.    Lacerations and abrasions that may indicate abuse

1.     Lacerations of the lip, eye, or any portion of an infant’s face (e.g., tears in the gum
        tissue which may have been caused by force feeding).

2.     Any laceration or abrasion to external genitalia.


D.   Skeletal injuries that may indicate abuse.

1.     Metaphyseal or corner fractures of long bones—a kind of splintering at the end of
        the bone (these are caused by twisting or pulling).

2.     Epiphyseal separation—a separation of the growth center at the end of the bone
        from the rest of the shaft (caused by twisting or pulling).

3.     Periosteal elevation—a detachment of the periosteum from the shaft of the bone
        with associated hemorrhaging between the periosteum and the shaft (also caused by
        twisting or pulling).

4.     Spiral fractures-fractures that wrap or twist around the bone shaft (caused by   
        twisting or pulling).


E.    Head injuries

1.     Absence of hair and/or hemorrhaging beneath the scalp due to vigorous hair pulling.

2.     Subdural hematomas—hemorrhaging beneath the outer covering of the brain (due to       
        shaking or hitting).

3.     Retinal hemorrhages or detachments (due to shaking).

4.     Jaw and nasal fractures.


F.    Internal injuries

1.     Duodenal or jejeunal hematomas—blood clots of the duodenum and jejunem (Small
        intestine). (due to hitting or kicking in the midline of the abdomen).

2.     Rupture of the inferior vena cava—the vein feeding blood from the abdomen and
        lower extremities (due to kicking or hitting)

3.     Pertonitus—inflammation of the lining of abdominal cavity (due to a ruptured organ,
        including the vena cave).


G.   Injuries considered to be indicators of abuse should be considered in light of:

1.     Inconsistent medical history.

2.     The developmental abilities of a child to injure itself.

3.     Other possible indicators of abuse.


H.   Questions to ask in identifying indicators of abuse:

1.     Are bruises bilateral or are they found on only one surface (place) of the body?

2.     Are bruises extensive—do they cover a large area of the body?

3.     Are there bruises of different ages—did various injuries occur at different times?

4.     Are there patterns caused by a particular instrument (e.g., a belt buckle, a wire, a
        straight edge, coat hanger, etc.)?

5.     Are injuries inconsistent with the explanation offered?

6.     Are injuries inconsistent with the child’s age?

7.     Are the patterns of the injuries consistent with abuse (e.g, the shattered egg-shell
        pattern of skull fractures commonly found in children who have been thrown against
        a wall)?

8.     Are the patterns of the burns consistent with forced immersion in a hot liquid (e.g.,
        is there a distinct boundary line where the burn stops—a “stocking burn,” for
        example, or a “doughnut” pattern caused by forcibly holding a child’s buttocks
        down in a tub of hot liquid)?

9.     Are the patterns consistent with a spattering by hot liquids?

10.  Are the patterns of the burns consistent with the explanation offered?

11.  Are there distinct patterns caused by a particular kind of implement (e.g., an electric
       iron, the grate of an electric heater, etc.) or instrument (e.g., circular cigarette burns,

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