| Physical Abuse | Sexual Abuse |
|---|
- Pattern of bruises/welts
- Burns (e.g., from cigarettes, scalds)
- Lesions resembling bites or fingernail marks
- Unexplained fractures or dislocations, especially in child younger than 3 y
- Areas of baldness from hair pulling
- Injuries in various stages of healing
- Other injuries or untreated illness, unrelated to present injury
- X-rays revealing old fractures
| - Signs of genital irritation, such as pain or itching
- Bruised or bleeding genitalia
- Enlarged vaginal or rectal orifice
- Stains and/or blood on underwear
- Unusual sexual behavior
|
| Signs Common to Both |
- Signs of “failure to thrive” syndrome
- Details of injury changing from person to person
- History inconsistent with developmental stages
- Parent blaming child or sibling for injury
- Parental anger toward child for injury
- Parental hostility toward health-care workers
| - Exaggeration or absence of emotional response from parent regarding child’s injury
- Parent not providing child with comfort
- Toddler or preschooler not protesting parent’s leaving
- Child showing preference for health-care worker over parent
|
Adapted from Myers RNotes 5th ed., 2018, with permission.
Child Abuser Characteristics 
Characteristics associated with those who may be child abusers:
- In a stressful situation, such as unemployed
- Poor coping strategies; may be suspicious or lose temper easily
- Isolated; few support systems or none
- Do not understand needs of children, basic care, or child development
- Expect child perfection, and child behavior blown out of proportion (Murray & Zentner 1997)
[Outline]