Common physical indicators are severe unexplained or suspicious bruises and welts, fractures, burns, lacerations, or abrasions. Specific physical indicators are3:

Unexplained bruises and welts On face, lips, mouth, torso, back, buttocks or thighs.

Handprint Injury4

(AbuseWatch.net, 2012)

Bruising4

Bruising of torso, buttocks, and thighs Bruises in various stages of healing clustered bruises forming regular patterns that might reflect the shape of an article used to inflict the injury Bruises on several different areas Bruises regularly appear after absence, weekend, or vacation

Unexplained fractures To nose, skull, or facial structure In various stages of healing Multiple or Spiral fractures

Spiral Fracture4



Swollen or tender lambs

Unexplained burns Cigar, cigarette burns especially on the soles of feet, palms, back and buttocks

Cigarette burn4



Immersion burns: sock-like, glove-like, doughnut-shaped on buttocks or genitalia

Glove-like burn4



Sock-like burn4



Patterned like electric burner or iron

Steam Iron Injury4



Rope burns on arms, legs, neck, or torso

Looped cord injury4

Unexplained lacerations or abrasions To mouth, lips, gums, or eyes To external genitalia On the back of arms, legs, or torso Human bite marks Frequent injuries that are accidental or unexplained

Accidental injuries usually involve injury on a bony prominence of the body such as elbows and knees and shins. Suspicious injuries usually occur in areas not susceptible to accidental age-appropriate areas. The following pictures indicate areas where children would normally bruise, and suspicious bruising areas, as well as other suspicious areas of injury.

Bruising Areas4



Suspicious areas of bruising4

Clues to the mechanism of injury4

Consider the size and shape of the injury, as well as the location of the injury.3 Consider the relationship of the mechanism of injury (explanation of how the injury occurred) to the child’s developmental stage. For example, toddlers fall when they learn to walk, and young children scrape their knees when learning to ride a bicycle. Consider if the story that was given as an explanation for an injury would produce the physical indicators that are present. For instance, a toddler falls to the floor while walking, not striking anything when he fell. That toddler has bruises on the back of his legs. One would expect that from a fall while walking. The toddler would have bruises and scrapes on his hands, knees, and shins, not bruises on the back of his legs.

Child behavioral indicators of physical abuse may be3:

The child is wary of adult contact Apprehensive when other children cry Demonstrates behavioral extremes Frightened of parents Afraid to go home Reports injury by a parent Wears long sleeve or similar clothing to hide injuries Seeks affection from adults

Parent behavioral indicators of physical abuse may be3: