Here are key features and definitions of physical abuse.

Key features in identifying injuries that have been caused due to physical abuse are:

  • Their placement
  • The explanation provided for them
  • The frequency and/or sequencing of such injuries

Injuries in non-accidental injury sites should be seen as suspicious. Injuries that are unexplained or are inconsistent with the parent or caretaker’s explanation and/or the developmental stage of the child are also red flags. Injuries that appear to be in various stages of healing, or are numerous but inconsistent with the explanation provided should also be viewed with concern.

Additionally, caregivers should not strike children with objects such as belts, switches, or other objects. If this is suspected it should be called in to the SCR, whether an injury is visible or not.

Physical Indicators of Physical Abuse

  • Bruises, welts and bite marks in various stages of healing regularly appearing after an absence, weekend or vacation on several different areas in non-accidental injury sites such as face, lips, mouth, both eyes or cheeks, neck, wrists, ankles, torso, back, buttocks or thighs clustered or in the pattern of a purposeful instrument such as a belt buckle or electric cord that mimic grab marks on arms or shoulders that provide evidence of a human bite (wide tooth imprint, compressed flesh)
  • Lacerations or abrasions to mouth, lips, gums, eyes, external genitalia or on back, arms, legs or torso; burns patterned like an electric burner, an iron or end of cigar/cigarette in non-accidental injury sites such as soles, palms, back or buttocks resembling rope burns on arms, legs, neck or torso resembling immersions by scalding water (sock-like, glove-like, or doughnut-shaped on buttocks or genitalia, purposefully dunked)
  • Fractures to skull, nose or other facial structures in various stages of healing multiple or spiral in nature accidentally discovered during a regular exam
  • Skeletal injuries accompanied by other injuries
  • Head Injuries, subdural hematoma (due to severe hitting or shaking), retinal hemorrhage or detachment (due to shaking), whiplash shaken infant syndrome, injuries to the eye, jaw, nose, teeth or frenulum or absence of hair and/or hemorrhaging beneath the scalp due to vigorous hair pulling
  • Munchausen Syndrome by Proxy (MSP) symptoms that suggest parentally induced or fabricated illness (e.g., repeatedly causing a child to ingest quantities of laxatives sufficient to cause diarrhea, dehydration and hospitalization)

Child Behavioral Indicators

  • Wary of contact with parents or other adults
  • Apprehensive when other children cry
  • Exhibits behavioral extremes, such as aggression and then withdrawal
  • Afraid to go home, frightened of caretaker
  • Frequent incidents of running away
  • Reports injury by caretaker or parents
  • Displays symptoms of habit disorders, such as self-injury, neurotic reactions (obsessive, compulsive, phobic, hypochondria)
  • Attempts to conceal injury with long sleeves, etc.
  • Manifests low self-esteem
  • Attempts suicide
  • Seeks affection from any adult

Adapted from: Identifying and Reporting Child Abuse and Maltreatment/Neglect: Mandated Reporter Trainer’s Resource Guide. New York State Office of Children and Family Services: CDHS/Research Foundation of SUNY/BSC (2009).

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