PHYSICAL ABUSE a form of abuse which may involve hitting, shaking, throwing, poisoning, burning or scalding, drowning, biting, suffocating or otherwise causing physical harm to a child. physical harm may also be caused when a parent or carer fabricates the symptoms of, or deliberately induces, illness in a child.

If you are presented with a child who has some kind of injury, always: ask the child how the injury was caused. ask the carer how the injury was caused (if you feel that asking the carer might put the child at further risk, omit this question) note the replies in your records, trying to record the exact words used.

SIGNS OF A NON-ACCIDENTAL INJURY:
There may be a delay by parents or carers seeking medical help or medical help may not have been sought at all.
The account of the accident may be vague or may vary from one telling to another. someone reliving a genuine accident will usually tell a detailed and vivid story that remains consistent.

there may be no explanation for the injury.

The child may not be allowed to tell you the story.

There may be discrepancies between the injuries and the story given.

parents or carers may be preoccupied by their own problems, rather than the childs injuries, may be hostile and may curtail discussions abruptily.

The interaction between child and parents and/or carer may not be usual, the child being sad, afraid or withdrawn. CAUTION - some abused children may relate to their parents or carers remarkably well.

if a child is going home with parents or a carer, they may be unwilling to say what has happened for fear of repercussions.

BRUISING PATTERNS:

Fingertip brusing - on the upper arms or chest wall may suggest that the child has been tightly help. in this situation, the delicate blood vessels in the eyes and on the brain surface might also have been damaged.

Slap marks - large areas of the perichial haemorrhage, often with dense parallel lines within them, occur after hard slaps, particularly on the buttocks or cheeks.
The left cheek is most commonly affectes since a right-handed adult, facing the child, slaps the left cheek.

Imprint of a weapon

Site of bruising:

- Most accidental injuries occur on parts of the body where the skin passes over a bony protuberance, for example the shin or forehead.
- Bruises to dark skin may not be easily seen. other indicators could be swelling, or the child indicating skin is painful and tender.
- Although a single bruised eye can be accidental or an indication of abuse, two simultaneous bruised eyes, without accompanying bruising to the forehead, are rarely accidental.

Bruising to the outer ear is inherently suspicious and is usually caused when the ear is pinched or boxed.

Damage to the frenulum can be caused by a blow to the mouth, or a feeding bottle being forced into a babys mouth. it is important to remember that this can also be caused accidentally.

BURNS AND SCALDS:
Neglected children - are more prone to accidental burns or scalds.
Abused children - may be deliberately burned or scalded.

Contact Burns:
- are often uniform in density.
- May follow the shape of the 'branding' object, for example a hotplace, the bars