Physical findings, patient history, laboratory data, and your observations of the child may indicate that the child has been abused.

a. Physical Findings. Look for the following:

(1) Multiple fractures of the extremities. Fractures of the arms and/or legs in different stages of healing usually indicate that the child has been abused. A radionuclide bone scan should be done to detect recent fractures.

(2) Multiple bruises and abrasions. Look especially around the child’s trunk and buttocks. Be particularly suspicious if there are old bruises in addition to fresh ones. Also, check the child’s head and face because 50 percent of physical child abuse injuries are to the head and face.

(3) Multiple soft tissue injuries. A child who has had a bottle forced into its mouth will have multiple soft tissue injuries around the mouth. There will be bruises around the child’s mouth.

(4) Burns. Look for the round circles made by cigarette burns. Hot water poured on infants will cause scald burns.

b. Child’s Medical History. A child who has been in several emergency rooms recently for related complaints may be a victim of abuse. In a military hospital, check the child’s medical records. Additionally, a child brought in for treatment of an injury which occurred several days ago may have been abused.

c. Laboratory Reports for the Child. A complete physical examination containing laboratory tests and reports will sometimes provide the first medical evidence that an unreported injury has occurred to the child in the past. For instance, if you suspect that a child under 3 years of age has been abused, a nuclear scan of the child’s bones may be revealing. X-ray films may not reveal recent injuries which have begun to heal. A nuclear scan of the child’s bone structure will show such injuries. CT scans are usually taken for children with head injuries. Conventional X-ray films should also be taken of the head because CT scans may miss skull fractures.

d. Your Observations. Observe the child carefully. The person who brings in a physically abused child rarely gives a clear and honest explanation of the acts that produced the injury. Additionally, the adult who brings the child in may have either waited several days or taken the child to other medical facilities for treatment. Since what you are told about how the injury happened may not be correct and since the injury may not have just occurred, it is very important for you to observe the child. Your detection of the nature of the child’s injuries is vital in starting proper treatment.