Physical Signs of Child Abuse

1
Physical Signs of Child Abuse

• The jigsaw in the diagnosis of physical abuse.

2
History from parent History from child History from third party
Physical symptoms Bruises / other soft tissue injuries Fractures / head injury / abdominal injury
Physical exam Blood test / clotting disorder Skeletal survey / brain scan / other radiology
Police inquiry Social work assessment Siblings
3
Method of examination

• Consent
• Description of child and his injuries
• Organize equipment / assessment
• Notes / documentation
• Complete history, full physical examination,
  growth, and developmental level.

4
Method of examination

• Differential diagnosis
• Skin disorders
• Blood dyscrasia
• Fractures due to osteogenesis imperfecta,
  osteoporosis
• Failure to thrive due to disease process

5
Characteristic of Abuse

• Repetitive pattern of injury
• Injuries not consistent with injury
• Presence of other signs of abuse
• Unusual behavior of parent
• Incidental discovery of injury

6
Patterns of injury

• Bruising to young baby
• Multiple injuries following a moderate fall
• Sever head injuries in babies or toddlers
• Rib fractures subdural hematoma and retinal
  hemorrhage
• Multiple cigarette burns
• Fractures in infant and toddler

7
History of Falling off Bed
8
Sub-conjunctival hemorrhage and bruising
9
Fell down stairs
10
Abnormal bruising patterns
11
Abnormal Bruising Patterns
12
Abdominal Trauma
13
Human Bites
14
Mouth Trauma
15
Eye Trauma
16
Scald Burns
17
Neglect
18
Sexual Abuse

• Genital injuries in boys
• Bruising to the penis and scrotum, petechiae and
  swelling
• Torn frenulum of penis
• A red circumferential mark due to a ligature
• Burn or scald
• Bites
• Damage to the urethral meatus

19
Injuries to male genitalia
20
Sexual Abuse in Girls

• Tears in hymen
• Thinning and destruction of hymen
• Enlarged hymenal opening
• Bleeding
• Labial fusion
• Dilated urethral opening
• Foreign body

21
Injuries to female genitalia
22
Types of Child Abuse

• Physical
• Sexual
• Neglect
• Emotional or Psychological abuse

23
Physical Abuse

• An injury intentionally inflicted on a child by a
  caregiver, paramour of a parent, or anyone
  residing in the childs home.

24
Sexual Abuse

• The use of a child for sexual gratification or
  financial gain, by an adult,older child, or
  adolescent, whether by physical force, coercion,
  or persuasion.

25
Neglect

• Acts or omissions by the perpetrator that fail to
  meet the childs needs for basic living,
  including food, hygiene, medical care, clothing,
  and a safe warm environment.

26
Emotional or psychological abuse

• Verbal abuse or excessive demands on the child
  that result I impaired growth, negative
  self-image, and disturbed child behavior.