Child abuse pediatrics

Recognize physical abuse

Physical child abuse is the INTENTIONAL injury of a child by a parent or caretaker 

When bruises occur on the ears or neck, back, or on an infant, consider that they may have been caused by abuse.

You may notice that a child has frequent, unusual or unexplained injuries. Sometimes the child will tell you that an adult is abusing them. It is not your job to investigate. Report the child's story to Child Protective Services and leave the investigation to them.

Injuries suspicious for child abuse include:

• Frequent accidents or injuries
• Any unexplained injury
  

  Bruises that have the pattern of an instrument, such as a belt or a looped cord, are highly concerning for abuse. Punishing a child by hitting them, with or without an object, is an ineffective and dangerous form of punishment.

• Lots of bruises or bruises in an infant or child who is not walking yet

• Bruises in unusual places: on or behind ears, on the neck, abdomen or on the back of arms or legs

• Burns or bruises showing the pattern of an object

• Frequent and/or unexplained broken bones

• Broken bones in an infant or a child who is not walking yet
• Human bite marks
• An injury that obviously requires medical care but the parent delays seeking medical care  

Suspect physical child abuse

If the child:

Fractures like this are painful and should be immediately obvious to a caregiver. Suspect abuse if a parent or caregiver doesn't know what happened, says the child wasn't in pain, or didn't notice a very obvious injury like the one above.

• Reports the injury is from a parent or adult caregiver
• Wears clothing to purposely conceal an injury or that is not seasonal, such as long sleeves and pants in the summer
• Refuses to undress for gym or for required physical exams at school
• Seems frightened by parents or caregivers
• Is often late or absent from school
• Comes early to school and seems reluctant to go home afterwards
• Is overly compliant, withdrawn, gives in readily and allows others to do for him without protest

If the parent(s):

• Takes the child to different physicians or hospitals for each injury
  

  Burns that show the pattern of an object, such as an iron or cigarette burns rarely occur accidentally. If a child has a patterned burn and the explanation doesn't make perfect sense, contact your local authorities immediately.

• Gives inconsistent or vague explanations for the child's injuries
• Describes the child as evil or bad
• Has  little or no interest in the child's well-being
• Does not respond appropriate to the child's pain
• Blames the child for his injuries
• Consistent critcizes and has inappropriate expectations of the child

Be aware that parents and others who care for children may be caring and good caretakers under most circumstances, but given a particular set of circumstances, they may hurt a child.

Content last reviewed: April 2010