− Loop-shaped marks can be caused by whipping a child with a cord or belt; no disease or accident looks like a loop or belt mark. − Cords or ropes tied around a child’s ankles or neck may result in a bruise or a rope burn. − If a child is slapped or hit, a mark in the shape of the offender’s fingers or hand may be left. ° Placement − Loose tissues, with little bony structure underneath (e.g., eyelids, genitals), bruise most easily and retain bruises longest; injuries at those locations often are not accidental. − Clinicians should be suspicious if a caretaker delays seeking treatment for a child with a genital injury. For example, the injury may have been caused by pinching a boy’s penis to punish him for touching himself or by using a string or rubber band around the penis (causing grooves) to prevent the child from wetting the bed. − Some individuals mistake the presence of Mongolian spots (birthmarks) as an indicator of abuse. These spots usually are grayish-blue, clearly defined spots on the buttocks, back, or extremities. They are most common in African-American and American Indian babies. Lacerations ° In cases of abuse, lacerations often occur on soft tissue areas, such as the abdomen, the throat, the buttocks, and the thighs. ° Some areas of the body are normally protected from lacerations by being inside or covered by other body parts (e.g., the side of the arm that normally lies against the body when in a standing position). It is difficult to fall and injure these areas. ° Lacerations of the ear, the nose, or the throat do not tend to occur accidentally. ° A torn frenulum of the upper lip (the tissue that connects the upper lip to the upper gum) may be an indicator of abuse if there is no reasonable explanation, especially in the case of infants. Bites ° Human bites appear as oval or horseshoe- shaped marks in which tooth impressions look like bruises facing each other. ° If the distance between the canines (the third tooth on each side) is greater than 3 centimeters, the bite is most likely from an adult. Adult bite marks are a sign of serious danger to a child. ° Depending on the location of the bite, the victim’s teeth should be examined and measured to exclude the possibility of a self-inflicted bite.
A physically abused child for example is often emotionally maltreated as well, and a sexually abused child may be also neglected. Any child at any age may experience any of the types of child abuse. Children over age five are more likely to be physically abused and to suffer moderate injury than are children under age five. 5
• Describes the child as “evil” or in some other very negative way • Uses harsh physical discipline with the child • Has a history of abuse as a child • Has a history of abusing animals or pets Additional signs of possible physical abuse may include: 6 • Fractures unexpectedly discovered in the course of an otherwise routine medical examination (e.g., discovering a broken rib while listening to the child’s heartbeat) • Injuries that are inconsistent with, or out of proportion to, the history provided by the caretaker or with the child’s age or developmental stage (e.g., a 3-month old burning herself by crawling on top of the stove) • Multiple fractures, often symmetrical (e.g., in both arms or legs), or fractures at different stages of healing • Fractures in children who are not able to walk • Skeletal trauma (e.g., fractures) combined with other types of injuries, such as burns and subdural hematomas (bleeding between the brain and its outer lining caused by ruptured blood vessels) • Burns on the buttocks, around the anogenital region, on the backs of the hands, or on both hands, as well as those that are severe.
Child Physical Abuse
What Is Physical Abuse? The physical abuse of children can include physical injury knowingly, intentionally, or recklessly caused by the child’s caretaker. Physical abuse can vary greatly in frequency and severity. It may include injuries sustained from burning, beating, kicking, or punching. Physical abuse may result from punishment that is inappropriate to the child’s age, developmental level, or condition. Additionally, it may be caused by a parent’s recurrent lapses in self- control that are brought on by immaturity, stress, or the use of alcohol or illicit drugs. Caretakers may physically abuse children during discipline or as a way to “teach the child a lesson.” What is Physical Abuse under Pennsylvania CPSL Child Abuse Laws? • Physical abuse rises to the level of child abuse when an individual intentionally, knowingly, or recklessly: ° Causes bodily injury to a child through any recent act or failure to act. ° Creating a reasonable likelihood of bodily injury to a child through any recent act or failure to act ° Bodily injury: which requires impairment of a physical condition or substantial pain rather than severe pain or lasting impairment.
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Bruises ° Color
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− Bruises go through a cycle of color. They are initially red, violet, black, or blue and later turn brown, green, or yellow. The color is affected by the depth and the placement of the bruise, as well as by the skin color and the quality of the light at the location where the bruise is being viewed. − Estimating the age of a bruise by its color is imprecise, but in general: − A bruise with any yellow is usually older than 18 hours. − Red, blue, purple, or black colors in a bruise may occur anytime from within 1 hour of bruising to resolution (i.e., when the bruise coloration disappears). − A red color may be present at any stage of the bruise. − Bruises of identical age and cause on the same person may not appear with the same coloration and may not change color in the same manner. ° Site − Ears and buttocks usually are not injured accidentally. − Knees, shins, foreheads, and elbows are normal bruising areas, particularly for toddlers. ° Shape − Bruises caused by pinching often have a symmetrical pattern.
What are the Signs of Physical Abuse?
Consider the possibility of physical abuse when the child: 5 • Has unexplained burns, bites, bruises, broken bones, or black eyes • Has fading bruises or other marks noticeable after an absence from school • Seems frightened of the parents and protests or cries when it is time to go home • Shrinks at the approach of adults • Reports injury by a parent or another adult caregiver • Abuses animals or pets Consider the possibility of physical abuse when the parent or other adult caregiver: 5 • Offers conflicting, unconvincing, or no explanation for the child’s injury, or provides an explanation that is not consistent with the injury
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