Physical Child Abuse

The definition of physical child abuse is any physical force or action that results in or may result in a non-accidental injury of a child. Physical abuse may involve striking the child a single time or it may involve a pattern of occurrences.

Physical abuse is usually connected to physical punishment or is confused with child discipline.

Other Physical Child Abuse pages on this site:

Abuse & Discipline	Physical Abuse Effects	Physical Abuse Statistics

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 Signs of Physical Abuse Categories:

Bruising	Beatings
Burning	Choking & Hanging
Smothering & Drowning	Poisoning
Hair-Pulling	Pushed From Heights
Shaken Baby Syndrome	Munchausen Syndrome by Proxy

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Signs of physical abuse can include injuries such as bruising and burning. Shaken Baby Syndrome and the lesser known, Munchausen Syndrome by Proxy, are two other injuries identified. Each of these listed physical abuse injuries is accompanied by what to look for in the way of injury patterns.

The five most often indicated concerns were:

»   behaviour problems (39%)
»   negative peer relations (15%)
»   depression or anxiety (15%)
»   violence to others (11%)
»   developmental delay (9%)

Signs of physical child abuse #1: Bruising

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Bruising is the most common of abuse injuries. There are four factors to take into account when determining whether or not the bruising is suspicious: location, size, colour and frequency.

Location

Normal bruising can be found on the knees, shins, elbows, and the forehead. Toddlers are especially vulnerable to forehead bruising, as they frequently bump into furniture, counters, anything that is at their head level.

But the size of the bruise(s), the colour, and the frequency in which bruising occurs can turn even normal bruising into suspicious bruising.

Suspicious bruising can be found on the face, head, chest, back, arms, genitalia, thighs, back of the legs, and buttocks.

Size

The size of the bruise(s) can tell us what object or body part the child was struck and/or harmed with. See under beatings and choking for more details on size of bruising.

Colour

The colour of the bruise(s) can tell us how fresh the bruise is and the force with which the child was struck. With Caucasian people, a bruise takes on a red, purple, black or blue appearance when it first appears, depending on the force of the blow. As the bruise heals it will turn green, then become a jaundice yellow before fading away completely. Though it seems obvious, I'll say it anyway: these changes in colour will be difficult to see in dark-skinned children. Just remember that bruising is only one sign; keep reading for other signs.

Frequency

The more frequent the bruising incidents occur, the more likelihood of physical child abuse. The child may have a legitimate reason for the bruising, but if there are too many incidences, then the red flags of suspicion should go up.

Signs of physical child abuse #2: Beatings

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The pattern of bruising and/or abrasions will resemble the shape of the object or body part used. The most common are belts, sticks, bats, bottles, and fists. But children are frequently attacked with firearms and knives.

If a belt is used, there will be red welts that are the width of the belt. There may also be bruising, and/or bleeding. The length of the welt depends on how much of the belt came in contact with the skin. Typically, caregivers who use a belt will strike the buttocks, the back, and the backs of the legs.

If a child is beaten with a fist, the shape of the bruise(s) can be that of a whole fist, or the bruising can show up as a cluster of lines (the imprint of the fingers of the fist). If the knuckles were used, bruising will be a line of roundish discolorations that are somewhere between the size of a dime and a quarter, depending on the size of the fist. Caregivers who use their fists generally give blows to the face, head, chest, stomach, and arms. Injuries are often to the face and head: black eyes, bloody and/or broken nose, fat and split lips, swelling of the eyes, cheeks or jaw, bruising and abrasions to the side of the head. Broken ribs and internal injuries can also result with severe blows to the chest and stomach.

Signs of physical child abuse #3: Burning

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There are several kinds of burns: chemical, cigarette, electrical, heat, and water burns. Each present their own unique signs of physical abuse.

With chemical burns on the skin's surface, depending on the chemical used, there can be a rash, blistering, and/or open sores that are pussing and/or bleeding. When caustic substances such as lye or acid are thrown, they are typically aimed at the child's face. If a child is forced to ingest chemicals, there will likely be nausea, vomiting, cramping, chest and abdominal pain, distention, and possibly unconsciousness.

Cigarette burns will be the size and shape of the cigarette tip. Typically, caregivers who burn children/youth with cigarettes do so on the backs of the arms, the buttocks, and the backs of the legs.

Electrical burns appear as black marks at the site of the burn, and can extend beyond, depending on the electrical appliance used, and the volts of electricity the child is exposed to. Size and shape are also determined by these latter two factors.

Heat burns such as that from a flame and/or flammable liquid can encompass any part of the body. If clothing is ignited, the whole body can be burned. Victims of this type of burning are often older children.

It is important to note here that not all water burns constitute signs of physical abuse. Accidental water burns generally appear as a splatter of splash burns. With non-accidental water burns, excessive splash marks will appear above the site of the primary impact, on body parts where accidental burning is unlikely. A child who is held under flowing hot water or immersed in scalding water will learn that the pain is lessened if they keep perfectly still. What results is what the medical profession calls the red sock or red glove. There will be a clear margin of bright red skin starting where the water line was and continue to all parts of the body that were immersed. Typically, the buttocks, legs, feet, and hands. Eventually, there will be peeling of skin layers.

Signs of physical child abuse #4: Choking and Hanging

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With these signs of physical abuse, a child who is choked will have bruising around the front and back of the neck that will resemble the fingers and thumb of the caregiver doing the choking. The bruising can also take the shape of a red band, depending on the pressure used, the length of time the pressure was exerted, and how much of the hand came in contact with the skin. If the caregiver is facing the child, the bruises at the front of the neck will be two thumb imprints, while the bruising at the back of the neck will be a tier of finger marks. This will be reversed (finger marks at the front, thumb marks at the back of the neck) if the caregiver is behind the child when doing the choking.

Bruising and possibly 'rope burns' around the neck will be evident when a child is hanged. The bruising will take on the imprint of the rope or material used to hang the child.

With these two signs of physical abuse, the child may be hoarse and/or have a cough, especially immediately and shortly after the choking or hanging incident. Damage to the larynx can occur in more severe cases. In extreme incidences', the neck may be broken.

Signs of physical child abuse #5: Smothering and Drowning

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During smothering, a child's breathing may be compromised, but other than this immediate effect, there may not be any noticeable physical abuse evidence. There can be bruising around the face, especially the nose and eyes, and upper chest area, depending on the item used to do the smothering, and the force exerted to asphyxiate the child.

With drowning, there may be hand or finger bruising at the back or side of the neck, or at the shoulders where the child was held under water with force.

The child's breathing may be jeopardized on a more long-term basis when these two signs of physical abuse are done regularly. If the child's breathing is raspy or the child has difficulty catching his/her breath, this may be a sign of smothering or drowning.

Signs of physical child abuse #6: Poisoning

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Poisoning may be difficult to detect because quantity is what determines the ill effects. Children can be poisoned with drugs, dish liquid, gas (i.e., combination of ammonia and bleach), and other noxious substances. A child who has been poisoned may suffer from nausea, vomiting, abdominal cramping, diarrhea, lethargy, sleepiness, light-headedness, dizziness, and, in more severe cases, unconsciousness. When noxious substances are force-fed to a child, depending on the substance, signs of physical abuse are: redness, chemical burns or bleeding in and around the mouth. If a child is forced to ingest dish liquid, the child will not be able to control his/her bowels, and a rash may be present around the mouth and lips.

Signs of physical child abuse #7: Hair-pulling

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Thinning hair and bald patches on the scalp may be present with severe hair-pulling. The child may experience headaches, and may also exhibit neck pain if the hair-pulling incidents are accompanied with jerking or snapping of the child's head.

Signs of physical child abuse #8: Pushed from Heights

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Bruising and broken bones are the most common abuse injuries when a child is pushed from heights. If a child is pushed down a flight of stairs, bruising may be present anywhere and everywhere on the child's body.

Signs of physical child abuse #9: Shaken Baby Syndrome

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Shaken Baby Syndrome (SBS) is the most common cause of infant mortality and accounts for the most long-term disability in infants and young children due to physical child abuse. It is frequently a single event and there may be no visible signs of injury.

The most common trigger for SBS is inconsolable crying. Feeding problems and difficulties with toilet training are also common triggers. Though there is often no intent to harm the child, the resulting injuries of SBS may be severe. Depending on the force used and the length of time the child is violently shaken, the signs of physical abuse are:

»   retinal damage in one or both eyes that may result in blindness
»   lethargy
»   tremors
»   vomiting
»   irritibility
»   siezures
»   coma
»   death

Shaken Baby Syndrome Statistics

Signs of physical child abuse #10: Munchausen Syndrome by Proxy

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Perpetrators may use the following to cause the victims' illness, resulting in a variety of signs of physical abuse:

»   administering laxatives, causing severe diarrhea and dehydration
»   applying substances to the skin that cause burns or rashes
»   altering lab test results
»   withholding required medication or over/under medicating
»   administering barbiturates, anti-depressants and/or poisonous substances
»   contaminating the child's urine sample with blood, feces or other substances

Munchausen Syndrome by Proxy results in the child suffering from the caregiver's actions. The child is at risk for long-term psychological problems, physical illnesses, as well as death. Health care professionals unknowingly become accomplices when they provide unnecessary and potentially dangerous testing procedures and therapies.

MSBP is very difficult to prove, in part, because this form of physical child abuse is so difficult to believe. Often, it is only suspected after a child is repeatedly admitted to hospital for treatment. The red flag for MSBP is when the child exhibits no symptoms or illness when the caregiver is away from the child for an extended period of time.

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References

NOTE: Information pages on this site were based on material from the Canadian Red Cross RespectED Training Program. Written permission was obtained to use their copyrighted material on this site.

Signs of Physical Child Abuse

1 Trocme, N. & Wolfe, D. (2001). Child maltreatment in Canada: Canadian incidence study of reported child abuse and neglect: Selected results. Ottawa: National Clearinghouse on Family Violence, Health Canada.

2 Feldman, K. (1987). Child abuse by burning. In R. Helfer & R. Kempe (Eds.), The Battered Child (197-293). Chicago: The University of Chicago Press.

3 Child abuse by burning. In R. Helfer & R. Kempe (Eds.), The Battered Child (197-293). Chicago: The University of Chicago Press.

4 Salazar, A. (2001). The second conference on Shaken Baby Syndrome syllabus. Saskatchewan Institute on Prevention of Handicaps: Government of Saskatchewan.

5 Statistics Canada. (2002). Family violence in Canada: A statistical profile 2002. Catalogue no. 85-224-xie. Ottawa: Government of Canada.

6 Ramirez, D. (1996, November). Beware of the dangers of shaking infants. Star Telegram (Fort Worth, Texas), B2.

7 Poissaint, A. & Linn, S. (1997, spring/summer). Fragile: Handle with care. Newsweek: Special Issue.

8 Reece, R. (2002). Shaken baby syndrome. Retrieved October 2002 from http:www.dontshake.com.

9 Barnett, O., Miller, P., & Perrin, R. (1997). Family violence across the life span. Thousand Oaks, California: SAGE Publications, Inc.

10 Barnett, O., Miller, P., & Perrin, R. (1997). Family violence across the life span. Thousand Oaks, California: SAGE Publications, Inc.

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Last updated Feb 21, 2017