Child abuse - physical

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Fracture types (1)

Battered child syndrome; Physical abuse - children

Adult may bring an injured child to an emergency room with a strange explanation of the cause of the injury. The child's injury may not be recent.

Symptoms include:

• Broken bones that are unusual and unexplained
• Bruise marks shaped like hands, fingers, or objects (such as a belt)
• Bruises in areas where normal childhood activities would not usually result in bruising
• Burn (scalding) marks, seen when a child is placed in hot water as a punishment -- particularly "glove" or "sock" burn patterns
• Burns from an electric stove, radiator, heater or other hot objects, usually seen on the child's hands, arms or buttocks
• Cigarette burns on exposed areas or the genitals
• Black eyes in an infant or a similar, unexplained injury in a child
• Human bite marks
• Lash marks
• Choke marks around neck
• Circular marks around wrists or ankles (indicating twisting or tying up)
• Separated sutures
• Bulging fontanelle
• Evidence of unexplained abdominal injury (such as bruised or ruptured intestines due to punching)
• Unexplained unconsciousness in infant

Typical injuries in abused children include:

• Bleeding in the back of the eye, seen with shaken baby syndrome or a direct blow to the head
• Internal damage, such as bleeding or rupture of an organ from blunt trauma
• Any fracture in an infant too young to walk or crawl
• Evidence of fractures at the tip of long bones or spiral-type fractures that result from twisting
• Fractured ribs, especially in the back
• Evidence of skull fracture (multiple fractures of different ages may be present)
• Subdural hematoma (collection of blood in the brain) without plausible explanation
• Multiple bruises that occured at different times -- especially in unusual areas of the body or in patterns that suggest choking, twisting, or severe beating with objects or hands
• Other unusual skin damage, including burns or burn scars

• Bone x-ray -- a skeletal survey is done whenever physical abuse is suspected. All the child's bones, including the skull, are x-rayed to look for unseen fractures or old, healing fractures.
• MRI or CT scan of the head or abdomen are done if there is a skull fracture, bleeding in the eye, unexplained vomiting, severe bruising of the face, skull or abdomen, or unexplained neurological symptoms, headaches, or loss of consciousness.