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Bruises, fractures, burns, scalds and bites

Physical indicators of abuse and neglect

Most of the bruises, fractures and burns that children experience are caused by accidents. But sometimes bruises, fractures and burns can be indicators of physical abuse. Bite marks are always inflicted, but they may or may not be a sign of abuse.

Potential signs of abuse differ depending on the child and their age and stage of development.

Bruises, fractures, burns and bites should always be considered in the context of the child’s medical and social history, developmental stage and the explanation given for the injury.

If you think a child is in immediate danger, contact the police on 999. If you’re concerned about a child but they are not in immediate danger, you should record and report your concerns.

Bruises on babies, infants and children

Bruises don’t necessarily indicate physical abuse. However, bruises are the most common injury to a child who has been physically abused.

As children become mobile, starting to crawl, shuffle, roll over and move around independently, they are more likely to get bruises from their everyday activities – although some injuries are more likely to indicate physical abuse.

Bruising in a baby or infant who isn’t crawling or independently mobile is very unusual. Babies and young children are particularly vulnerable to serious injury from physical abuse.

When to worry about a bruise on a child 

If you are worried about a child you should report your concerns. The NSPCC Helpline can help when you’re not sure if a situation needs a safeguarding response.

Potentially concerning signs include:

  • bruises on the head, ear, neck or soft areas (abdomen, back and buttocks)
  • defensive wounds commonly on the forearm, upper arm, back of the leg, hands and feet
  • clusters of bruises on the upper arm, outside of the thigh or on the body
  • a bruised scalp and swollen eyes from hair being pulled violently
  • bruises in the shape of a hand or object
  • bruises on non-mobile babies
  • bruises with dots of blood under the skin (petechiae).1

References

Royal College of Paediatrics and Child Health (RCPCH) (2020) Bruising: systematic review. [Accessed 08/12/2025]

Fractures in babies, infants and children

The majority of fractures in children over 5 years of age are accidental. But fractures can also be caused by child abuse. Any bone in the body can be broken as a result of abuse, and abusive fractures indicate a child has experienced a serious assault.

When to worry about a fracture

The signs that a fracture may be caused by abuse include:

  • fractures to the ribs or the leg bones in babies
  • multiple fractures or breaks at different stages of healing.2

In very young children, fractures are sometimes only revealed by x-ray or other tests. If you have any concerns about a child that has experienced a fracture, whether recently or not, you should follow your safeguarding procedures.

References

Royal College of Paediatrics and Child Health (RCPCH) (2020) Fractures: systematic review [Accessed 08/12/2025]

Burns and scalds on babies, infants and children

Burns include scalds from hot liquids, as well as contact burns from hot objects or those caused by flames, chemicals and electrical burns.

Burns can happen when a child reaches out and touches a hot object, like hair straighteners, or pulls on the cord of an iron causing it to fall on them.

Accidental scalds usually happen as “spill injuries”, such as a toddler reaching out and pulling a hot drink or cooking liquid over themselves, or when a child turns on a very hot tap in a sink or bath.

When to worry about burns and scalds

Indicators that burns or scalds are intentional include:

  • multiple burns and scalds
  • a clear edge to the burn or scald
  • burns and scalds on the back, shoulders, buttocks and both legs or arms
  • burns in the shape of an implement – for example, a circular cigarette burn. 3

Intentional burns and scalds may also be accompanied by other non-accidental injuries or signs of neglect.

References

Royal College of Paediatrics and Child Health (RCPCH) ( (2020) Burns: systematic review [Accessed 08/12/2025]

Bite marks on babies, infants and children

Bite marks on children can be made by humans or animals. They may or may not indicate abuse. Bite marks:

  • usually form an arc shape or two opposing arc shapes
  • often show clear teeth marks.4

References

Royal College of Paediatrics and Child Health (RCPCH) (2020) Bites: systematic review [Accessed 08/12/2025]

Responding to and reporting concerns

If you think a child is in immediate danger, contact the police on 999. If you're worried about a child but they are not in immediate danger, you should share your concerns.

  • Follow your organisational child protection procedures. Organisations that work with children and families must have safeguarding policies and procedures in place.
  • Contact the NSPCC Helpline on 0808 800 5000 or by emailing help@nspcc.org.uk. Our child protection specialists will talk through your concerns with you and give you expert advice.
  • Contact your local child protection services. Their contact details can be found on the website for the local authority the child lives in.
  • Contact the police.

Services will risk assess the situation and take action to protect the child as appropriate either through statutory involvement or other support. This may include making a referral to the local authority.

> See our information about recognising and responding to abuse

If your organisation doesn't have a clear safeguarding procedure or you're concerned about how child protection issues are being handled in your own, or another, organisation, contact the Whistleblowing Advice Line to discuss your concerns.

> Find out about the Whistleblowing Advice Line on the NSPCC website

When you're not sure

The NSPCC Helpline can help when you're not sure if a situation needs a safeguarding response. Our child protection specialists are here to support you whether you're seeking advice, sharing concerns about a child, or looking for reassurance.

Whatever the need, reason or feeling, you can contact the NSPCC Helpline on 0808 800 5000 or by emailing help@nspcc.org.uk

Our trained professionals will talk through your concerns with you. Depending on what you share, our experts will talk you through which local services can help, advise you on next steps, or make referrals to children's services and the police.

> Find out more about how the NSPCC Helpline can support you

More guidance and resources

Protecting children from physical abuse

Explains what physical abuse is, the impact it can have on different age groups, signs and indicators to look out for and what next steps to take if you're concerned.

NSPCC Helpline

The NSPCC Helpline can help with safeguarding situations you could face at work. If you need advice and support, or some simple reassurance on a current safeguarding incident, we're here to help.

Introduction to safeguarding and child protection training

Increase your confidence in identifying and responding to possible signs of child abuse and neglect with our introductory online, live virtual and face-to-face training courses.

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