Child abuse (skin signs)

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Injuries to the skin are one of the most common signs that a child is being physically abused. These injuries may be in the form of burns and bruises. Injuries which are done on purpose usually are found on certain parts of the body, and often have patterns and shapes that are different than injuries that happen by accident. Knowing how to tell the difference between injuries that happen by accident and injuries that are done to a child on purpose is an important part of helping to protect children from harm.[1]

Bruises[change | change source]

Location[change | change source]

  • Bruises a child gets by accident are usually found on the ankles, shins, hips, lower arms, elbows and under the chin.
  • Bruises a child gets because somebody hurt them on purpose are usually found on the upper arms, the buttocks face, neck and ears. Bruises in areas such as the cheeks, abdomen, upper thighs and private parts are usually caused by child abuse.[2]

Types[change | change source]

This piece of wood has a rectangular shape. Being hit with something that has a rectangular shape may cause a tramline bruise, or worse, bone fracture.
This is a rod. A rod has a cylindrical shape. Being hit with something cylindrical like this may also cause a tramline bruise or (more seldom) bone fracture.
  • Tramline bruise: two line-shaped bruises separated by a wider line-shaped area of skin which has little or no bruising. This is usually caused by being hit with a rectangular or cylindrical object.[3][4]This kind of bruise is called tramline because of the two bruises with a space in between kind of looks like the tracks from a tram or train tracks.
  • Linear bruising the slap of an open hand may leave parallel linear bruises on the cheek or elsewhere; bruises may also be caused by objects such as a stick, rod etc.[5]
  • Pinch mark: two oval-shaped bruises, with one bruise - caused by the thumb - larger than the other, separated by an area of relatively unbruised skin. Depending upon the amount of pressure applied a hematoma may be present within the area between the two bruises. Curve-shaped cuts caused by the fingernails may be present in one or both of the two bruised areas; usually these happen in smaller pinch marks where the skin is pinched between the fingernails.[6]
  • Fingertip bruising caused by grabbing or squeezing the skin appear as oval shaped bruises, with the bruise caused by the thumb some distance away. Not all of the fingers may leave a bruise as a result of uneven pressure being applied.[7]
  • Pattern shaped bruise: when something is used to hit a child, the bruise that happens after being hit may have the same shape as the thing they were hit with, like a paddle.

References[change | change source]

  1. Swerdlin A, Berkowitz C, Craft N. Cutaneous signs of child abuse. J Am Acad Dermatol. 2007 Sep;57(3):371-92. PMID 17707148
  2. Enid Gilbert-Barness, Diane E. Debich-Spice: Handbook of Pediatric Autopsy Pathology. p.483 Humana Press; (2004) ISBN 158829224X
  3. Danielson L., Rasmussen O V. Dermatological Findings After Alleged Torture. pp.109-112 [1]
  4. Krishnan Vij: Textbook Of Forensic Medicine And Toxicology: Principles And Practice. p.287 (Elsevier India) (2011) ISBN 9788131226841
  5. Child Abuse and Neglect: Guidelines for Identification, Assessment, and Case Management. editors: Marilyn Strachan Peterson, Michael Durfee, Kevin Coulter; p. 26 Volcano Press (2003) ISBN 1884244211
  6. U.K. Department of Health: Child Protection and the Dental Team
  7. American Academy of Pediatrics, American College of Emergency Physician: The Pediatric Emergency Medicine Resource p.328; Jones and Bartlett Publishers; 4 edition (2006) ISBN 076374414X