Physical Features

Alerting features that should prompt you to CONSIDER child maltreatment:

• Any serious or unusual injury with an absent or unsuitable explanation.

• Cold injuries (for example, swollen, red hands or feet) in a child, with no medical explanation.

• Hypothermia in a child, with an unsuitable explanation.

• Oral injury in a child, with an absent or unsuitable explanation.

Alerting features that should prompt you to SUSPECT child maltreatment:

• Bruising in the shape of a hand, ligature, stick, teeth mark, grip or an implement.

• Bruising or petechiae (tiny red or purple spots) not caused by a medical condition (for example, a coagulation disorder), with an unsuitable explanation, including those:

  • in a child who is not independently mobile

  • that are multiple or in clusters

  • of similar shape and size

  • on non-bony parts of the face or body, including the eyes, ears and buttocks

  • on the neck that look like attempted strangulation

  • on the ankles and wrists that look like ligature marks.

• Human bite mark thought unlikely to have been caused by a young child.

• Lacerations, abrasions or scars on a child that have an unsuitable explanation, including those:

  • on a child who is not independently mobile

  • that are multiple or have a symmetrical distribution

  • on areas usually protected by clothing, or the eyes, ears and sides of face

  • on the neck, ankles and wrists that look like ligature marks.

• Burn or scald injuries on a child:

  • with an absent or unsuitable explanation or

  • who is not independently mobile or

  • on soft tissue areas not expected to accidentally come into contact with a hot object (for example, backs of hands, soles of feet, buttocks, back) or

  • in the shape of an implement (for example, cigarette or iron) or

  • that indicate forced immersion (for example, scalds to buttocks, perineum and lower limbs, to limbs in a glove, stocking or symmetrical distribution or with sharply delineated borders).

• One or more fractures in a child if there is no medical condition that predisposes to fragile bones (for example, osteogenesis imperfecta or osteopenia of prematurity), or if the explanation is absent or unsuitable, including:

  • fractures of different ages

  • X-ray evidence of occult fractures (for example, rib fractures in infants).

• Intracranial injury in a child if there is no major confirmed accidental trauma or known medical cause in one or more of the following circumstances:

  • there is an absent or unsuitable explanation

  • the child is aged under 3 years

  • there are also other inflicted injuries, retinal haemorrhages, or rib or long bone fractures

  • there are multiple subdural haemorrhages with or without subarachnoid haemorrhage with or without hypoxic ischaemic damage to the brain.

• Retinal haemorrhages or injury to the eye in a child if there is no major confirmed accidental trauma or medical explanation, including birth-related causes.

• Signs of spinal injury (injury to vertebrae or within the spinal canal; for example, cervical injury with inflicted head injury, or thoracolumbar injury with focal neurology or unexplained kyphosis) in a child if there is no major confirmed accidental trauma.

• Intra-abdominal or intrathoracic injury in a child if there is no major confirmed accidental trauma, with an absent or unsuitable explanation, or with a delay in presentation. There may be no external bruising or other injury.