Includes any non-accidental physical injury caused by the child's caretaker. Physical abuse may result from severe corporal punishment or from punishment which is inappropriate to the child's age or condition.
1. Unexplained bruises and welts (other than the common scrapes on elbows, knees, shins, etc.):
- on face, lips, mouth, torso, back, buttocks, thighs -- in various stages of healing.
- clustered, forming regular patterns
- reflecting shape of article used to inflict injury (electric cord, belt buckle, wooden spoon)
- on several different surface areas
- Bite marks, especially in multiples and in various stages of healing. Injuries appearing after absence, weekend or vacation.
2. Unexplained burns:
- cigar or cigarette burns, especially on soles, palms, back or buttocks
- immersion burns (sock-like, glove-like, doughnut shaped) on buttocks or genitals.
3. Unexplained fractures:
- to skull, nose, facial structure
- in various stages of healing
- multiple long bone or spiral fractures
- injuries to growth centers in bone structure.
4. Unexplained lacerations or abrasions:
- to mouth, lips, gums, soft palate, eyes
- to external genitals
- to limbs, back, chest, abdomen
- ruptured frenulum
- beneath scalp due to hair pulling/absence of hair.
6. Dental/Oral injuries:
- torn labial/lingual frenulum
- fractured or missing teeth without adequate explanation
- scars of previous intra-oral lesions
- lip scars
- jaw fractures
- multiple healed tooth root fractures
- unusual malocclusions (badly arranged teeth.)
Behavioral Indicators in Children
Behavioral Indicators in Caretaker
- Too eager to please, indiscriminate attachment.
- Low self-esteem.
- Wary of adult contact.
- Apprehensive when other children cry.
- Behavioral extremes -- extremely aggressive, demanding, rageful, overly compliant, passive, withdrawn, self-destructive.
- Role reversal - child seems to parent the parent; child acts inappropriately adult-like and responsible.
- Developmental lags - may fall behind in toilet training, motor skills, socialization,
- Appears frightened of caretaker.
- Wears long sleeved shirts in hot weather (to cover bruises).
- Cringes or jumps at a sudden movement.
- Verbally reports abuse.
- School absenteeism.
- Uses harsh discipline which is inappropriate to child's age, behavior, and/or condition.
- Describes the child in a consistently negative manner (bad, stupid, evil, ugly, etc.)
- Gives explanations of the child's injuries that do not make sense given the child's age, developmental stage, type or extent of injuries.
- Becomes defensive or refuses to explain when questioned about the child's injury.
- Attempts to conceal the child's injury.
- Misuses drugs or alcohol.
- Munchausen's Syndrome by Proxy - describes the actions of an adult caretaker, usually the mother, which cause the child to appear to be ill and result in extensive medical care, including hospitalization or surgery for the child. Examples are the elaborate description of violent seizures in the child, the deliberate warming of a thermometer to mimic high fever in the child, inducing vomiting or diarrhea, or putting blood in the child's urine or stool sample. Once the child is hospitalized, the adult may introduce fecal material or other foreign substances into the child's IV actualizing the child's fabricated symptoms. Some caretakers also suffocate the child, then call for someone to revive the child or do it themselves. The perpetrator of this abuse is usually one who has sophisticated knowledge of medical systems, appears to be a dedicated, attentive parent, but uses the attention paid by the medical staff to gratify personal unmet needs. Children abused through Munchausen's Syndrome by Proxy can have long term physical and psychological effects from unnecessary medical procedures. Death of the child, although usually not deliberate, is not uncommon.