Bruises are the most common injury; the pattern, shape and location should be noted, because certain instruments such as belt or hanger will make a specific mark on the body. Those over boney areas such as the knee and elbow are frequently accidental. Areas that are in protected and padded areas, such as the face ad buttocks, should be of concern. Lacerations and coloring will give an indication of timing. Blood clotting time and platelet count should be ordered to rule out other reasons for bruising. Bite marks are a concern due to infection, and if they are caused by an animal or a human (child or adult). The most common cause of burns is scalding from hot liquid. About 10 to 25% of all burns are abuse, and most occur in children under three. Again, pattern, location and characteristics must be noted. Accidental burns normally leave an irregular pattern on the face, hands and trunk due to splashes. Other burns, such as those that are uniform, are more suspect of emersion or purposeful scalding. Cigarette burns are also common, because the child may accidentally come in contact with the lit end. A more pronounced and deeper burn is indicative of purposeful cigarette burns.

It is essential for the healthcare provider to keep in mind that there are mimickers of child physical abuse. For example, Mongolian spots, most often seen...

These can be taken for bruises. The child should be reassessed in a week, if necessary. Erythema multiforme minor is caused by a reaction to drugs or infections. These lesions can also be mistaken for abuse.
Any fracture in a child that is not yet walking should be of concern. About 60% of fractures in children a year old and younger are nonaccidental. Multiple fractures or those in different stages of healing are also very suspect. Those that are most likely accidental are clavicular and linear skull fractures.

Inflicted head injury and shaken baby syndrome is the leading cause of death. It usually occurs in children under two, and most often in infants under six months. However, it can occur up to age five. Blunt abdominal trauma is the second most common cause of death in abused children. Most occur in children between six months and three years of age. In such situations, caregivers delay seeking medical care, but problems such as vomiting, lethargy, abdominal distention and anemia could be cause for alert.

As a result of the possibility of child abuse, it is essential for healthcare providers to recognize the signs and respond appropriately. Continued harm could be stemmed and lives saved.