Study summarised:

Skin Signs in Child Abuse

This is a review that discusses the signs of abuse that manifest on the skin of a child; it also outlines clues to help you determine whether bruising/marks are accidental or not, it is important to note though, in such cases, a thorough medical examination by dermatologists and GPs are always called for before you make final recommendations.

Significant findings of this study

  • Warning signs of abuse are listed in this article, such as vague explanations by caretaker for a child’s body marks/bruising, conflicting stories by two parents, a story that constantly changes, unjustified delay in taking the child to a doctor.
  • Cutaneous (skin) signs of abuse include bruising, erosions, bites, burns and traumatic alopecia (hair loss caused by an injury to the scalp).
  • Bruising is the most common sign of abuse seen on the skin: accidental bruising is normally on bony parts of the body, like knees, shins, elbows and forehead. Bruises found on soft areas like buttocks, back, arms, genitals, inner thigs, ears, cheeks and neck, might indicate abuse.
  • Because children younger than 9 months are unable to move around, bruises and bumps in them should be treated with serious suspicion.
  • The review explains what type of bruising would mean what, for instance finger edge (linear) bruises are typically found on cheeks when a child has been slapped.
  • Always consider the stage of healing of the bruise as this helps to distinguish between inflicted or unintentional bruising.
  • Several factors are listed to consider when assessing a bruise.
  • Human bite marks are cause for investigation; and the difference between these and animal bites is that animal bites are deeper and generally cause more damage. If the inter-canine distance is more than 3cm, it is indicative that the bite was probably caused by an adult. Bite marks are often associated with sexual abuse.
  • Children under the age of 3 years are mostly affected by burn wounds and tap water is the most common form of burn wound.
  • A table that explains aging of bruises is provided in this article, as well as a table outlining characteristics suggestive of burns.
  • Three classic signs of forced immersion in hot water is explained (stocking and glove burns, zebra stripe burns and doughnut hole burns).
  • Cigarette burns generally have a punched-out appearance, heal gradually and cause scarring.
  • A definition of physical neglect is offered, of which poor hygiene, inappropriate clothing, decreased subcutaneous tissue due to malnutrition, dermatitis (itchy, dry skin or a rash on swollen, reddened skin – skin that blisters, ooze, crust or flake off) [especially in diaper area], dry skin, unhealed injuries and parasite infections (lice) are signs.
  • Sexual abuse is not limited to penetration, and most children who are victims of sexual abuse do not have physical signs of such abuse.
  • Skin signs highly suggestive of sexual abuse include acute hymenal tears (the hymen is a thin membrane that surrounds the opening of the vagina) (partial or complete), ecchymosis (a collection of blood under the skin), absence of hymen tissue and recent scars in the posterior fourchette (a fork-shaped fold of skin at the bottom of the entrance to the vagina). Foul smelling vaginal discharge could be a sign of STDs and should be tested.
  • Genital warts (soft growths that appear on the genitals which can cause pain, discomfort, and itching) in children under the age of 3 years is normally caused by non-sexual transmission, but, children over the age of 5 years with genital warts could indicate sexual abuse.

How can you relate this to practise?

  • If you need a scientific article to support your recommendation that a child’s skin condition or marks/bruises should be further explored by a dermatologist, when you suspect possible abuse, you can reference this article in your court report.
  • When you investigate a case or even just work with a family, and you notice any skin bruising or skin conditions, read this article again and if you suspect that something might be suggestive of abuse, investigate and intervene. Always consider alternative explanations, look at the medical history and other contextual factors and involve medical experts such as dermatologists to help you draw conclusions.

Carefully summarised by: