g the arm to protect the face are also indications of physical abuse. Shaking a baby with the arms, legs, and head flailing back and forth can cause stress at the joints and result in metaphyseal or "corner chip" fractures. A piece of bone will pull off where the ligament is attached because the ligaments in a child are stronger than the bones. There may be rib fractures from the gripping force where the baby was held by the trunk.
Sexual abuse may be difficult to assess in children (Patterson, 1998, 51). The child may present with abnormal behavior such as highly seductive behavior, precocious knowledge of sexual acts, or concerns about pregnancy and other sexual subjects. Sexually abused children may display a distorted body image, shame, excessive guilt, or fear of the opposite sex. Personality changes, withdrawal, depression, regressive behavior, enuresis, encopresis, sleep changes, or changes in behavior and performance at school may also be indications of sexual abuse in children. Children may also present with evidence of sexually tran
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