Which physical findings should raise suspicion of physical child abuse?

Updated: Apr 24, 2017
  • Author: Angelo P Giardino, MD, MPH, PhD; Chief Editor: Caroly Pataki, MD  more...
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Physical examination of the child with an injury obviously is important, and the order of the complete examination is determined by the presenting condition of the child. Children with less severe injuries in stable condition can have the injured area examined last, since that area is most likely to be uncomfortable. Severely injured children in critical condition require life saving measures first, following the standards of care for trauma life-support; other components of the examination follow from that point.

Because physical abuse is often an ongoing pattern of unsafe care, [20, 21] performing a thorough head-to-toe examination is essential in order to find other areas of either current or previous injury. Physical indicators that should raise suspicion for maltreatment include the following:

  • Injury pattern inconsistent with the history provided

  • Multiple injuries/multiple types of injuries

  • Injuries at various stages of healing

  • Poor hygiene

  • Presence of pathognomonic injuries including loop marks; forced immersion burn pattern; and classic abusive head trauma findings of subdural hematoma, retina hemorrhage, and skeletal injuries

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