Detecting Child Abuse

What to Look For in Suspected Abuse Patients

Injuries that should be carefully evaluated:

Physical Abuse

Age 0–6 months: Any Injury.

Age 6 months or older:

  • Bruises, lacerations, or burns to protected, fleshy, or flexor surfaces—for example, inner thighs, abdomen, neck, and sides of the face, ears, and genitalia.
  • Bruises, lacerations, or burns showing an object pattern—for example, belt loop, cigarette burn, and curling iron.
  • Severe deep or extensive burns especially scald burns. (When no explanation or vague explanation is offered).
  • Arms or legs that are swollen, painful, crooked (suggesting a fracture), or not being used by the child.
  • Child that appears to be intoxicated or drugged.
  • Child (or witness) that tells you they have been hit in the face, hit with an object, whipped, punched, slapped, kicked, or beaten.
  • Child who is fearful of their parent or caretaker.

Sexual Abuse

  • Any history, statement, or witnessed incident consistent with sexual abuse.
  • Most sexually abused children will not present with acute injuries or other material evidence. “Normal” does NOT mean “Nothing happened!”

Neglect

  • Children left unsupervised in environments that are potentially dangerous or lethal.
  • Children that appear malnourished, or starved and/or who demonstrate deprivational behaviors such as begging for food or eating out of the trash.
  • Failure to protect or failure to provide the basic needs of the child; for example, soft drink in baby bottle, child found alone in the street, parenting while intoxicated.
  • Other situations that merit evaluation of the child:
  • Adult violence, including domestic violence, in the home.
  • Caretakers that are intoxicated (drugs or alcohol).

Responses of victims and abusers during initial report/investigation:

Abusive parent

  • Denial of any knowledge regarding child’s injury (“I have no idea how she hurt her head; her 2 year old brother plays rough with her.”)
  • Vague explanation (“I think she was choking or something because she made a funny noise. I patted her back.”)
  • Conflicting explanation (“She fell out of her car seat last week and today she stopped breathing and turned blue.”)
  • Changing explanation initial history: (“3 year old cousin pushed her off the tricycle,” history 2 days later: “She fell on the stairs.”)
  • Partial admission (“I dropped the baby by accident.”)

Non-abusive parent

  • Denial of any knowledge regarding child’s injury (“I left to go to work and when I came home, he said she wouldn’t wake up.”)
  • Defensive of abuser (“I know he didn’t hurt her because he said he loved her like his own daughter.”)
  • Evasive (“He gets mad sometimes and he has pushed me once before, a long time ago, but has never hurt me since.”)
  • Witness (“I heard the baby crying and when he went into the room her cry changed like she was hurt.”)

Victim

  • Denial (“I don’t know how I got those bruises on my back.”)
  • Protective of abuser (“I got those bruises when I was crawling under the fence. I made up the part about my dad whipping me ‘cause I was mad at him for yelling at me.”)
  • Truthful (“My dad got mad because I got in trouble at school for talking. He hit me with the belt 10 times.”)
  • Siblings of victim who witness abuse
  • Denial of any knowledge of how victim was injured.
  • Truthful.
  • What to Do
  • When to Call