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THe issues
Physical Abuse of Children
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Kids are kids, and sometimes their activities result in minor scrapes, bruises, and injuries that are not suggestive of abuse. However, a non-accidental injury to a child, which may include beating, burning, biting, or shaking is what we define as Physical Abuse. While you may be familiar with the obvious bodily signs of physical abuse, it is important to be familiar with the more subtle signs of physical abuse as well.

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Physical abuse is generally defined as "any nonaccidental physical injury to the child" and can include striking, kicking, burning, or biting the child, or any action that results in a physical impairment of the child.

  • In about 42 States and American Samoa, Guam, the Northern Mariana Islands, Puerto Rico, and the Virgin Islands, the definition of abuse also includes acts or circumstances that threaten the child with harm or create a substantial risk of harm to the child's health or welfare.

  • In 15 States, the crime of human trafficking, including labor trafficking, involuntary servitude, or trafficking of minors, is included in the definition of child abuse.

Physical Indicators:
  • Bruising: Bruises resulting from abuse are found on multiple surfaces of the body, particularly the buttocks, back, genitals, and face. The bruises might appear in a characteristic pattern (such as an outline of hand or paired bruises from pinching), or they may clearly resemble an impression of an item of jewelry (a ring), or a disciplinary imprint (a paddle, switch, or coat hanger). Linear bruise marks, strap marks, or loop marks going around a curved body surface are almost always evidence of abuse. Any bruising in any location on a child who is not walking or pulling up yet is always cause for concern.

  • Abrasions/Lacerations: Similar to bruising, the amount and location of the wounds should be considered. For example, lacerations under the tongue could be caused by falling with an object in the mouth or by the use of excessive force during feeding, which is a suspicious injury when the victim is an infant who is still unable to stand. Whipping a child with a belt buckle or belts or cords that are looped may cause lacerations resembling a “C” or “U” shape or other wounds with distinctive shapes.

  • Bite Marks: Bite marks may be found on any part of a child’s body. They may appear to be doughnut shaped, double horseshoe shaped, or oval in configuration. Individual teeth or a blurry area with varying colorations may be observed, depending on the age of the bite mark lesion.

  • Burns: The location of a burn and its characteristics (shape, depth, margins, etc.) may indicate abuse. It is important to keep in mind that children instinctively withdraw from pain. Burns, without some evidence of withdrawal, are highly suspect because a child will usually try to escape, which will result in splashes, uneven burns, and sometimes burns on the hands. Scalding a child with hot liquid is the most common abuse burn. Young infants are commonly scalded by immersion, and older children by having liquids thrown or poured on them. Other types of burns can include branding, cigarette burns, and rope burns.

  • Internal Injuries: Blunt blows to the body can cause serious internal injuries to the liver, spleen, pancreas, kidneys, and other vital organs and occasionally can cause shock and result in death. Internal injuries are the second leading cause of death for victims of child abuse. Detectable surface evidence of such trauma is present only about half the time. Physical indicators of serious internal injuries may include distension of the abdomen, blood in the urine, vomiting, and abdominal pain.

  • Head Injuries: Head injuries are the most common cause of child abuse related deaths and an important cause of chronic neurological disabilities. Whenever abuse or neglect is suspected, a careful examination of the child’s eyes and nervous system should be performed to look for signs of intracranial injury, as well as a psychological evaluation.

  • Abusive Head Trauma: Abusive head trauma (Shaken Baby Syndrome) describes a constellation of signs and symptoms resulting from violent shaking or shaking and impacting of the head of an infant. For more information, check out our Shaken Baby Syndrome program.

  • Fractures: Any unexplained fracture in an infant or toddler is cause for additional inquiry or investigation. Rib fractures, especially of back ribs, are the most common fractures found in abused children and are caused from either blunt force (hit) or compression (squeezed). Fractures are most suspicious for inflicted trauma when there are multiple lesions, they are in different stages of healing, and there are unsuspected lesions.

Behavioral Indicators:

While every child is different, there may also be behavioral indicators that a child is being abused. Here are some examples:

  • Is wary of adults or of a particular individual

  • Is violent to animals or other children or young people

  • Is dressed inappropriately to hide bruises or other injuries

  • May be extremely aggressive or extremely withdrawn

  • Cannot recall how the injuries occurred or gives inconsistent explanations

Parent or caregiver

Signs of child abuse may not always be observed in children. Sometimes, adults or caretakers display behaviors that could put a child at risk. The warning signs listed below might suggest an adult or caretaker needs help if they:

  • See the child as worthless or a burden

  • Seem secretive or isolate the child

  • Often blame, belittle, or insult the child

  • Deny any problems at school or at home

  • Avoid discussing the child's injuries or give conflicting explanations for them

  • Depend on the child for emotional support

  • Use harsh physical discipline

  • Blame accidents on a sibling, friend, relative or the injured child

  • Is aggressive towards a child in front of others

  • Delay seeking medical attention for a child

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Health care professionals and concerned individuals need to increase awareness for and education in child abuse in the community and among parents. Secondly, parents and guardians need to be encouraged to develop strong attachments with their children and learn to express warmth and positive regard for them. Finally, families must be encouraged to form relationships with support systems available to them.

  • Discipline your children thoughtfully. Never discipline your child when you are upset. Give yourself time to calm down. Remember that discipline is a way to teach your child. Use privileges to encourage good behavior and time-outs to help your child regain control.

  • Examine your behavior. Abuse is not just physical. Both words and actions can inflict deep, lasting wounds. Be a nurturing parent. Use your actions to show children and other adults that conflicts can be settled without hitting or yelling.

  • Educate yourself and others. Simple support for children and parents can be the best way to prevent child abuse. After-school activities, parent education classes, mentoring programs, and respite care are some of the many ways to keep children safe from harm. Be a voice in support of these efforts in your community.

  • Teach children their rights. When children are taught they are special and have the right to be safe, they are less likely to think abuse is their fault, and more likely to report an offender.

  • Know what child abuse is. Physical and sexual abuse clearly constitute maltreatment, but so does neglect, or the failure of parents or other caregivers to provide a child with needed food, clothing, and care. Children can also be emotionally abused when they are rejected, berated, or continuously isolated.

  • Know the signs. Unexplained injuries aren't the only signs of abuse. Depression, fear of a certain adult, difficulty trusting others or making friends, sudden changes in eating or sleeping patterns, inappropriate sexual behavior, poor hygiene, secrecy, and hostility are often signs of family problems and may indicate a child is being neglected or physically, sexually, or emotionally abused.

  • Report abuse. If you witness a child being harmed or see evidence of abuse, make a report to your state's child protective services department or local police.

  • Invest in kids. Encourage leaders in the community to be supportive of children and families. Ask employers to provide family-friendly work environments. Ask your local and national lawmakers to support legislation to better protect our children and to improve their lives.

How you can help:

What should you do if you suspect that a child has been abused? Or if a child confides in you? Child abuse is a difficult subject to talk about and can be hard to accept, for both you and the child. When talking with a child who is reporting abuse, the best thing you can provide is unconditional support and calm reassurance. Remember, do not interrogate or ask leading questions, do not deny that the abuse occurred, and reassure the child that they did nothing wrong.

It is the caregiver’s responsibility to report and not investigate suspicions of child abuse. It is the child protection agency’s responsibility to investigate reports of any type of abuse. A careful evaluation of those involved and the sources of stress should be completed by appropriate and skilled professionals. Usually, a team consisting of a child protection worker, a physician, a psychiatrist or psychologist, a public health nurse, a childcare staff, and a teacher will become involved.

Helping a Child Heal:

Children who have been abused need the support and validation of others to help build their self-esteem, and to teach them how to form healthy and appropriate relationships. Friends and family can help by:

Modeling appropriate behaviors

Reminding the child that he/she is important and deserves love

Listening to the child and making him or her feel respected

Engaging the child in activities he or she is good at and enjoys

Helping the child meet and make friends with other children his or her own age


Child Welfare Information Gateway: promotes the safety and well-being of children, teens, and families and provides links, including to family support services.

Child Matters: educating to prevent child abuse.

American Society for the Positive Care of Children: the voice for children in America.

National Child Abuse Hotline can be reached 24/7 at 1-800-4-A-CHILD   (1-800-422-4453) for information on free help in your area.

  • 1-800-25-ABUSE (1-800-252-2873)

  • If you suspect a child is in immediate danger or harm, call 911 first.

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