n, 1998, 50). Bruises over multiple body areas such as the trunk, buttocks, waists, ankles, ears, neck, or around the mouth indicate the possibility of physical abuse. Other indications are loop arks from cord whippings, hand marks or finger prints, bruising of the genitalia, punching or bite marks, and symmetric marks such as those produced by shock sticks. Soft tissue bruising may indicate internal injuries. Immersion injuries occur in glove and stocking patterns, or in the diaper area if the child could have been dipped in hot water. Contact burns such as cigarette or lighter burns present as circular scars, and flexion burns and splash burns in which a hot liquid has spilled on the child may or may not be accidental.
Children commonly present with fractures, either accidentally occurring or from abuse (Patterson, 1998, 50). Long bone fractures are more common in older children, and multiple, metaphyseal, and rib fractures are seen more commonly in infants. Most abuse fractures are seen in children under the age of five years, particularly in those less than one year of age. Fractures in children under one year of age, spiral fractures from torsion or twisting, an unwitnessed or unexplained fracture, a fracture healing over, a fracture that does not fit the explanation of the injury, and a history of fractures in a child or their siblings are all indications of child abuse. Direct blows will cause transverse fractures and bruising of soft tissue. Metaphyseal and rib fractures are rarely seen in children except in cases of physical abuse.
Other fractures typical in abused children include fractures of the scapular, distal clavicle, fractures of the humerus in children under age three, vertebral fractures and subluxations, finger injuries in non-ambulating infants, bilateral fractures, and two or more fractures in a child (Patterson, 1998, 50). Complex skull fractures and fractures of the midshaft ulnar from raisin...