Symptoms of Physical Abuse

Bruise alerts and symptoms:

• Unexplained bruises
• Reoccurring bruises
• Bruises that do not match the child’s explanation
• Bruising on the face, lips or mouth
• Bruising on the torso, back, buttocks, thighs or back of the legs
• Bruises in various stages of healing
• Clustered bruises that form regular patterns
• Bruises that bear the shape of the implement used (hand, belt buckle, spatula or spoon, etc.)
• Bruises on various parts of the body
• Bruises that regularly occur after absence from school, weekends, vacations or visits to certain relatives
• Bruises that are covered by clothing (e.g. long sleeves on a hot day)
• Bruises on infants
  
  

All bruises go through a biochemical process. The normal biological progression for the aging of bruises is as follows:

1. Red
2. Blue
3. Black or purple
4. Dark greenish tint
5. Dark, pale green
6. Yellow
   
   

Remember, it is much more difficult to see bruises on dark-skinned people. Also be aware of medical conditions that can mimic bruising, such as Mongolian spots, birthmarks and so on. The key is that these marks are consistently on the skin and don’t change color. It is important when making a report to include the color, shape and size of the bruise as well as where it is located.

Burn alerts and symptoms:

• Cigarettes are a common tool used to burn children. Look for a small, round burn on unusual places, such as the soles of the feet, palms of the hands, back or buttocks.
• Immersion burns look sock-like on the feet, glove-like on the hands, and doughnut-shaped on the buttocks or genitalia.
• Burns may match the pattern of the implement used, such as an iron or electric burner.
• Rope burns may occur on the arms, legs, neck or torso.
• Note it if there is a delay in seeking medical treatment for a burn.
• Burns are a product of temperature and time. It is normal to withdraw from the source as soon as heat is felt. Therefore, bad burns for which there is no reasonable explanation are suspect.

Fracture (determined by a physician) alerts and symptoms:

• Fractures to the skull, nose facial structure
• Fractures in various stages of healing
• Multiple or spiral fractures
• Leg fractures on nonwalking infants

Lacerations/abrasions alerts and symptoms:

• To the mouth, lips, eyes
• To external genitalia
• To the neck or upper torso

Abdominal injuries include:

• Bruises to the abdominal wall
• Unexplained blunt trauma to the abdomen
• Intestinal perforation
• Ruptured liver, spleen or blood vessels
• Injuries to the kidney, pancreas or bladder
• Unexplained blunt injury trauma

Central nervous system injuries include:

• Subdural (below skin) hematoma (reflective of violent shaking or blunt trauma)
• Retinal hemorrhage
• Brain hemorrhaging (reflective of violent shaking as in Battered Child Syndrome)

Dental injuries may include:

• Scars on the lips (which rarely scar)
• Missing teeth (in children who are not in the developmental stage of losing their baby teeth)
• Fractures of the jaw
• Fractures to the teeth (especially crown or roots)
• Discolored teeth (suggestive of previous dental trauma to the dental pulp which has caused the tooth to die)
• Lacerations to or abnormal appearance, mobility or scarring of the tongue
• Internal bruising or lacerations to the cheek or jaw mucosa
• Bald patches on the scalp with red, patchy bruising underneath may be an indicator of hair-pulling. (Be aware, however, that other medical conditions can cause hair loss, such as ringworm of the scalp, etc.)

Dangerous acts by caregivers are also included in the physical abuse category. This could include the reckless endangerment of a child, as when a parent drives at high speeds while under the influence of drugs or alcohol, or uses a weapon recklessly around a child. It can also include hitting a child with a closed fist or implement on the head, genitals, or soft tissue areas of the body; forcefully twisting or yanking the child’s extremities; throwing the child; or physically disciplining an infant. Cruel and inhumane punishment is any act that causes extreme and/or mental pain and may put the child at risk for substantial harm.

Examples of cruel and inhumane punishment would be:

• Smearing the child’s feces or urine in his or her face
• Submerging a child’s head in the toilet bowl
• Restraining a child with ropes or handcuffs
• Preventing a child from breathing for a short period of time
• Depriving a child of sleep
• Forcing a child to sit in a corner for hours or sit in a tub of cold water
• Locking a child out of the house in cold weather or at night
• Locking a child in a dark closet or basement
• Forcing a child to eat a non-food item