Recognising physical abuse
Bumps and bruises don’t necessarily mean a child is being physically abused – all children have accidents, trips and falls. These injuries tend to affect bony areas of the body such as elbows, knees and shins and aren’t usually a cause for concern.
However, some injuries are more likely to indicate physical abuse. Some of these signs are more obvious or common, or appear differently, for younger children.
Signs and indicators in children
Bruises
Potentially concerning signs include:
- commonly on the head but also on the ear, neck or soft areas (abdomen, back and buttocks)
- defensive wounds commonly on the forearm, upper arm, back of the leg, hands or 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 (babies who cannot crawl, cruise, bottom shuffle or roll over)
- bruises with dots of blood under the skin (petechiae).
(Royal College of Paediatrics and Child Health (RCPCH), 2020).
> See the Bruises on children: core info leaflet
Burns or scalds
Burns or scalds can be from hot liquids, hot objects, flames, chemicals or electricity. Signs to look out for include:
- can be from hot liquids, hot objects, flames, chemicals or electricity
- these may be on the hands, back, shoulders or buttocks. Scalds in particular may be on lower limbs, both arms and/or both legs
- a clear edge to the burn or scald
- sometimes in the shape of an implement – for example, a circular cigarette burn
- multiple burns or scalds.
> See the Thermal injuries on children: core info leaflet
Bite marks
Signs include:
- usually oval or circular in shape
- visible wounds, indentations or bruising from individual teeth.
Fractures or broken bones
Indicators include:
- fractures to the ribs or the leg bones in babies
- multiple fractures or breaks at different stages of healing.
> See the Fractures in children: core info leaflet
Behavioural changes
As well as physical signs of abuse, it’s important to be aware of behavioural indicators, including:
- fear of specific individuals
- flinching when approached or touched
- reluctance to get changed in front of others or wearing long sleeves or trousers in hot weather
- depression or withdrawn behaviour.
Some signs are more obvious or common, or appear differently, for younger children.
Signs and indicators in babies and young children
Certain injuries such as bruises and fractures are more likely to be intentional rather than accidental in babies and very young children, especially when they are non-mobile.
Deliberate shaking or impact can cause serious head injuries.
Signs of non-accidental head injuries can include:
- visible signs such as swelling, bruising or fractures
- unusual behaviour – being irritable, lethargic, unresponsive or not wanting to feed
- seizures
- vomiting
- respiratory problems
- being comatose.
Not all head injuries are caused by abuse. There are also other medical reasons a baby may have these symptoms.
> See the Head and spinal injuries in children: core info leaflet
> Read our Why language matters blog on using ‘non-accidental head injury’ instead of ‘shaken baby syndrome’
> Take our Preventing non-accidental head injury training
Risks and vulnerability factors
Physical abuse can happen in any family. But babies and children who have a disability are at a higher risk of suffering physical abuse (Jones et al, 2012).
> Find out more about safeguarding d/Deaf children and children who have disabilities
Some parents may also struggle to provide their children with safe and loving care if they are facing difficulties such as:
- poverty
- poor housing
- substance misuse
- relationship problems
- domestic abuse
- the effects of childhood abuse or neglect.
If parents are isolated and don’t get enough support, things can become even more challenging. The more of these problems a family is facing, the harder it can be to cope – and the greater the risk of harm to children.
Challenges parents or carers may face
Adults who physically abuse children may have:
- emotional or behavioural problems – such as difficulty controlling their anger
- health issues which make it difficult for them to cope
- family or relationship problems
- experienced abuse as a child (Miller-Perrin and Perrin, 2013).
