Indicators of child physical abuse
We find out about physical abuse when children tell us that they have been abused and through other indicators of abuse. Indicators of physical abuse may be behavioural or physical or both. The presence of a single indicator does not necessarily prove that a child has been physically abused; although in some instances single indicators clearly suggest the possibility of abuse. The repeated occurrence of one indicator or the presence of several indicators raises the possibility that the child has been abused.
Knowledge about how children disclose abuse and the behavioural and physical indicators of child physical abuse enables adults who work with children to provide a protective and sensitive response to children who may be the victims of physical abuse.
Disclosures of physical abuse by children of any age must always be taken seriously.
A child or adolescent may make a direct disclosure about the abuse or may allude indirectly to the abuse, for example 'I know someone whose father hits her across the face'.
Young children and adolescents often find it difficult to say that abuse is occurring, particularly when the abuser is a parent. Sometimes they are threatened by the abusive parent to keep them quiet about the abuse. Children often cover up for abusive parents when questioned about an injury, with statements like 'I can't remember', or 'It was my fault' or 'It doesn't happen very often'. Some children may accommodate themselves to a high level of family violence and may believe that physically abusive behaviour is normal. All children, particularly adolescents, are more likely to disclose physical abuse to an adult with whom they have developed a trusting relationship. For many children it takes great courage to speak about physical abuse, particularly if the abuse has been occurring for years.
If you observe signs of physical injury on a child you need to consider several factors before you decide whether or not they indicate possible physical abuse. The following physical indicators should raise concern:
The location, nature or extent of the injury do not fit with the explanation given.
The child's age or developmental stage is not consistent with the type of injury. The severity or type of the injury itself is of concern.
Physical indicators include the following:
- Bruises and welts. These may appear on the face, back, bottom, genitals and arms. Bruises or welts in unusual configurations may pattern the instrument used to inflict them, for example: hand or fingerprints or the linear marks of a cane. Clusters bruises and bruises of various colours may indicate repeated abuse, although it is difficult to date a bruise according to its colour. Bruising on babies and young children is of significant concern.
- Fractures. Any fracture in a child under the age of two years is a serious concern. Fractures are not often detected without xray, although the child may have a swollen joint and appear to be in pain or irritable.
- Burns and Scalds. These may show the shapes of the item used to inflict them. For example, iron, grill, cigarette burns. Other types of burns include boiling water, oil or flame burns.
- Abdominal injuries. Torn liver or spleen or ruptured intestines may be present without any outward signs of bruising on the abdominal wall. The signs are pain, vomiting, restlessness and fever.
- Head or brain injuries. There may be no outward signs that these injuries are present. They are usually observed by health professionals and include subdural haematoma and other brain injuries which may lead to permanent brain damage; eye damage caused by shaking; and absence of hair, which may indicate that hair has been pulled out.
- Lacerations and abrasions to the head, face and mouth. The shape may indicate the implement used, for example, fingernail scratches leave parallel linear marks.
- Human bite marks.
- Multiple injuries. These may be both old and new.
- A history of repeated injuries.
- Any injury to a very young baby.
Important: When a protective worker from Human Services investigates a case of alleged physical abuse and any of the above physical indicators are present, they will arrange a medical examination by a forensic physician or specialist medical practitioner.
Sometimes a child's behaviour can be an indication that something is wrong. Behavioural indicators must be interpreted with regard to the individual child's level of functioning and developmental stage. The following are some of the behavioural indicators which may suggest possible physical abuse:
- The child is unusually wary of physical contact with adults.
- The child seems to be unduly frightened of a parent or another adult.
- The child does not show emotion when hurt.
- The child offers unlikely, implausible explanations of injuries.
- The child is habitually absent from school without an explanation. The parent/ caregiver may be keeping the child at home until physical evidence of abuse has disappeared.
The child wears inappropriate long sleeved clothing on hot days (to hide bruising or other injuries).
- The child may be overly compliant, shy, withdrawn, passive and uncommunicative.
- The child may be hyperactive, aggressive, disruptive and destructive towards themself and others.
- The child displays regressed behaviour, such as bedwetting or soiling.
Other behavioural indicators, which may be more common to adolescents than younger children, include:
- running away;
- criminal behaviour;
- drug abuse; and
- acting out behaviour.
The adolescent may appear as if they completely reject or lack trust in the world.
Parents may try to deny or conceal physical abuse. For example, they may:
- accuse the child or adolescent of lying about the abuse;
- provide an explanation for the injury which is unbelievable, inadequate, or illogical. For example, the parent may say 'He bruises easily', 'Her brother hits her all the time and causes bruising', 'He is so clumsy and prone to accidents';
- change their explanation for the injury over time;
- appear unconcerned about the child's condition;
- delay seeking medical assistance;
- attempt to conceal the child's injury;
- take the child to several different doctors and hospitals, or to out of region services for treatment; or
- fail to attend school or health centre appointments.