Indicators of Physical Abuse:

*Locaton of Injury

*The primary area for infliction of injuries is the
back surface of the body from the neck to the knees.
*They are not typically located on the shins, elbows, knees, or forehead.

Behavioral Indicators

These may result from abuse although they are not definitive signs of abuse.
*Child is excessively passive, overly compliant, apathetic, withdrawn, or fearful; or excessively agressive, destructive, or physically violent.
*Child and/or parent attempts to hide injuries. Child wears excessive layers of clothing and is frequently absent from school or physical education classes.
*Child is frightened or overprotective of parents.
*Child is frightened of going home.
*Child is clingly and forms indiscriminate attachments.
*Child is apprehensive when other children cry.
*Child is wary of physical contact with adults
*Child exhibits drastic behavioral changes in and out of parental presence.
*Child is hypervigilant.
*Child suffers from seizures or vomiting.
*Adolescent exhibits depression, self-mutilation, suicide attempts, substance abuse, or sleep and eating disorders.

Bruises: Found on multiple surfaces of the body, particularly the buttocks, back, genitals,and face.
Abraisions/Lacerations: As with bruising, the multiplicity and location of the wounds should be considered.
Bite Marks: May be found on any part of the child's body. They may appear to be doughnut-shaped, double horseshoe-shaped, or oval in configuration.
Burns: The location of a burn and its characteristics (shape, depth, margins, etc) may indicate abuse. Burns without some evidence of withdrawl are highly suspect because a child will usually try to escape-which will result in splashes, uneven burns and sometimes burns on the hands.
Head Injuries: The most common cause of child abuse related deaths and an important cause of chronic neurological disabilities
Shaken Baby Syndrome: The constellation of signs and symptoms resulting from violent shaking or shaking and impacting the head of an infant. Signs and symptoms range on a spectrum of neurological alterations from minor (irritability, lethargy, tremors, vomiting) to major (Seizures, coma, stupor, death). Approximentely 20% of cases are fatal in the first few days after injury. Survivors suffer from handicaps ranging from mild- learning disorders, behavioral changes- to moderate and severe, such as profound mental and developmental retardation, paralyses, blindness, inability to hear, or a permanent vegetative state. Damage to Other Internal Organs: Blunt blows to the body can cause serious internal injuries to the liver, spleen, pancreas, kidneys, and other vital organs and occasionally can cause shock and result in death. Internal injuries are a leading cause of death for victims of child abuse. Physical indicators of serious internal injuries may include distension of the abdomen, blood in the urine, vomiting, and abdominal pain.
Damage to the Skeleton: Any unexplained fracture in an infant or toddler is cause for additional inquiry or investigation. Rib fractures, especially of back ribs, are the most common fractures found in abused children and are caused from either blunt force (hit) or compression (squeezed).