Child Abuse Detection, Reporting and Treatment > Chapter 3 - Signs of Physical Abuse

Chapter 3: Signs of Physical Abuse

Physical abuse is the most visible form of child maltreatment. Sexual abuse and emotional abuse are certainly visible to those who are actively seeking it such as physicians, nurses, and law enforcement personnel, but they don't "show" as clearly as physical abuse. In fact, the signs of physical abuse can be hidden by clothing or can be reasonably explained as non-abusive. For example, a school nurse may ask a boy how he got such a severe black eye. The boy, in a calculated but nonchalant way replies in the manner that he has been told, warned, or threatened; "Oh, it's no big deal. I just caught a baseball with my face. My mom's been putting an ice pack on it and says she'll take me to the doctor if it isn't better in a couple of days." Sounds reasonable. Boys and baseballs collide with each other frequently. Mom's doing the right thing with the ice packs and will take the boy to the doctor if needed. What the nurse does not know is that the boy's black eye was actually caused by a hard blow with his stepfather's fist. What the nurse cannot see is that the boy has linear bruises on his buttocks where his stepfather beat him with a belt. Thus, one injury is reasonably explained, and another injury is hidden by the boy's clothing.

Signs of physical abuse include:

  • The child has unexplained burns, bites, bruises, broken bones, or black eyes.
  • The child has fading bruises or healing lacerations noticed after an absence from school.
  • The child appears frightened of the parent(s) and protests or cries when it is time to go home.
  • The child seems afraid at the approach of an adult.
  • The child reports being injured by a parent or another adult caretaker.
  • The parent gives conflicting, unconvincing, or no explanation for the child's injury.
  • The parent seems unconcerned about the child's injury.
  • The parent describes the child as being "bad" or "evil", or in some other negative way.
  • The parent uses harsh physical discipline with the child.
  • The parent has a history of physical abuse as a child.
Case Vignette

"When I was about six, I didn't do something the way my dad wanted – I don't remember what it was. He picked me up by one ankle and started swinging me around, hard. He deliberately crashed me into the wall several times. I was so scared, I peed in my pants. That made him even madder. He threw me down on the floor and kicked me on my butt at least ten times, maybe more. I had to sleep in my pee-soaked pants. I was in the first grade, and when I finally got permission to change my clothes to go to school, I saw that I had these huge bruises on my butt, all black and blue. I had to make sure nobody saw them. I could barely sit down in my seat at school. I think the worst thing was that while he was beating me, my mother was there and she never said a word or tried to stop him. She knew that if she did, she'd be next."


This patient's childhood abuse was well hidden by his clothing. Comparing this story with the fictional story about the boy with the black eye, we find that they are opposites: in the factual vignette, the boy's injuries were hidden by his clothing. In the fictional story, the boy gave a reasonable explanation of how he received the injury. Some forensic behavioral analysts theorize that a parent who regularly physically abuses a child does so in a deliberate manner so that either the physical injuries inflicted upon the child are not visible or if visible, the injury is reasonably explained by either the child or the parent. The abuser, in other words, knows how to not be caught.

The factual vignette reveals another component commonly associated with child abuse. In a home where the father or other adult male is the abuser of the child, it is likely that he also abuses his spouse or female partner. The child's mother is afraid to protest the abuse of her child out of fear that the abuser will severely hurt, or even kill, her if she attempts to intervene. Only by staying alive and "whole" does she have any hope of taking the child and fleeing from the abuser. The child, on the other hand, willingly endures the abuse so that his/her mother will not be beaten as well. The child hopes to hold the abuser's focus until his violent rage subsides, thus keeping the mother safe. This convoluted and pathological pattern of family dysfunction is not unusual in homes where domestic violence is prevalent.

Case Vignette

“I was in the eighth grade, and was constantly failing math. Since testing showed that I was in the upper range of intelligence, my parents couldn’t understand why I was making A’s and B’s in everything else, but failing math. This was long before we knew about specific kinds of learning disabilities; today I would be in a special program for kids who were learning disabled in math. But back then, my parents thought I was failing math on purpose. I never figured out what kind of gain I would have gotten by doing this; I was always grounded and had no privileges. I was the “family failure.” One day I brought home my report card with the usual “F” in math, and my Dad just went crazy. He told me to lie down on the couch for a belt whipping. When I said no, I wasn’t just going to set myself up to get hit, he threw me down on the couch and started hitting my back, butt and upper thighs with his belt – hard. Afterwards, my Mom came in the room and sat down beside me, between me and Dad. They lectured me about my math grades. Then my Dad said he was going to whip me again. My mother intervened, placing herself literally between my father and me, preventing him from whipping me again. Later, as I was taking a bath, my Mom saw that I had lots of ugly red marks – some were even bleeding – on my back, butt and thighs; she started to cry a little and told me that my father never meant to do that to me, that he just lost his infamous Irish temper and hurt me out of impulsive anger. He really loved me, she said, but his temper and frustration got the better of him. Nothing like this had ever happened before to me or my sisters, and nothing like it ever happened again. My Dad never said he was sorry, but I know he was. Today, he’d have been arrested. Back then, discipline was a family matter. I never knew what my mother said to my father about what happened, but knowing her, I’m sure she made it exceedingly clear that what he did was not okay, and that it had better never happen again.”


To end this chapter on a very realistic and common note, the discovery of child abuse often occurs accidentally. For example, a mother brings a four-year-old child into the emergency room with a suspected broken arm. The mother tells the ER physician that the little girl was playing on her swing set but fell out of the swing, breaking her arm. The physician orders an X-ray to confirm the fracture and discovers that the child has a "spiral" break; he immediately suspects that the child's arm was broken due to physical abuse. Why? Because the mother's story of how the child's arm was broken is not consistent with the injury. If the child had fallen off the swing and broken her arm, the fracture would be a "clean" break, like snapping a twig into two pieces. A spiral break is the result of the child's arm being pulled and twisted, giving the break an uneven spiral pattern. Based upon his suspicions of child abuse, the ER physician orders a complete bone scan on the child, which results in the revelation of two more healed spiral fractures. In only four years, this child's arms and legs were broken three times. Convinced by medical evidence that this little girl has been severely abused, the ER physician immediately contacts the local child protection agency and law enforcement.
 
Child Abuse Detection, Reporting and Treatment > Chapter 3 - Signs of Physical Abuse
Page Last Modified On: September 6, 2014, 10:01 PM