Child Protection Evidence A SUMMARY

'Child Protection Evidence' is a series of 15 systematic reviews to help clinicians identify the signs of physical abuse and neglect in children
The reviews include the latest evidence on a series of areas including burns, bruises and fractures...


Scald burns are the most common burn type in children who have been abused and the most common causative agent is tap water. Abusive scalds tend to be distributed on the buttocks, perineum, and lower extremities, with clear upper limits and scald symmetry especially when present on the lower extremities. In non-scald abusive burns contact burns are the most common. These burns tend to be distributed on the back, shoulders, and buttocks, with clearly demarcated edges often matching the object used.


The head is by far the commonest site of bruising in child abuse. Other commonly bruised sites in abuse include the ear, neck, trunk, buttocks, thighs, and arms. A bruise must never be interpreted in isolation and must always be assessed in the context of medical and social history, developmental stage, explanation given, full clinical examination and relevant investigations.


Fractures have been recorded in as many as 55% of young children who have been physically abused, 18% of whom have multiple fractures. Fractures in physical child abuse denote severe assault and it is essential that they are identified if present. In children less than four years of age rib fractures were more commonly found in those abused than those accidentally injured.
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Created with images by Free-Photos - "hands baby child" • MelSi - "stethoscope blood pressure heart" • LunaSun - "recreation court child" • 304cina62 - "faucet cleaning water" • S Pallavicini - "Bruises" • congerdesign - "joint fracture gypsum fracture"

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