Physical abuse can be identified by bruises, bites, lacerations, burns, fractures, or intracranial injuries in locations not typical for accidental injury in children. Neglect can present as poor hygiene, malnutrition, or untreated medical issues. Sexual abuse may involve anogenital injuries, sexually transmitted infections, or pregnancy in young girls. Proper documentation and reporting to authorities is important for suspected cases of child abuse and neglect. A multidisciplinary approach is needed to manage cases and ensure children's safety and well-being.

1. Child abuse
and
Neglect

2. Epidemiology

4. Categories of Abuse
hysical Abuse
exual Abuse
hycological Abuse
eglect

6. Physical abuse

8. Physical features
ruises
• bruising in the shape of a hand, ligature, stick, teeth mark, grip or
implement.
• bruising in a child who is
• not independently mobile
• multiple bruises or bruises in clusters
• bruises of a similar shape and size
• bruises on any non-bony part of the body or face including the eyes, ears and
buttocks
• bruises on the neck that look like attempted strangulation bruises on the ankles
and wrists that look like ligature marks.

10. BITES
human bite mark that is
thought unlikely to
have been caused by a
young child.
onsider neglect if there
is a report or
appearance of an
animal bite on a child
who has been
inadequately
supervised.

11. Lacerations (cuts), abrasions and scars
n a child who is not independently mobile
hat are multiple
ith a symmetrical distribution
n areas usually protected by clothing (for example,
back, chest, abdomen, axilla, genital area)
n the eyes, ears and sides of face

13. THERMAL INJURY
n any soft tissue area that would
not be expected to come into
contact with a hot object in an
accident (for example, the backs of
hands, soles of feet, buttocks,
back) or
n the shape of an implement (for
example, cigarette, iron)
calds to buttocks, perineum and
lower limbs
calds to limbs in a glove or stocking
distribution
scalds to limbs with symmetrical
distribution

14. FRACTURES
hild has one or more fractures
in the absence of a medical
condition that predisposes to
fragile bones (for example,
osteogenesis imperfecta,
osteopenia of prematurity) or
if the explanation is absent or
unsuitable
• Presentations include:
• fractures of different ages
• X-ray evidence of occult fractures
(fractures identified on X-rays that
were not clinically evident). For
example, rib fractures in infants.

18. INTRACRANIAL INJURY
bsence of major confirmed
accidental trauma or known medical
cause, in one or more of the
following circumstances:
he explanation is absent or
unsuitable[4] the child is aged under
3 years ,there are also:
• retinal haemorrhages or
• rib or long bone fractures or other
associated inflicted injuries
here are multiple subdural
haemorrhages with or without
subarachnoid haemorrhage with or
without hypoxic ischaemic damage
(damage due to lack of blood and
oxygen supply) to the brain.

20. Visceral injury
child has an intra-
abdominal or
intrathoracic injury in
the absence of major
confirmed accidental
trauma and there is an
absent or unsuitable
explanatioN, or a delay
in presentation. There
may be no external
bruising or other
injury.

21. Clinical presentation
pparent life-threatening event
• repeated apparent life-threatening events, the onset is witnessed only by one parent or
carer and a medical explanation has not been identified.
• bleeding from the nose or mouth
oisoning
on-fatal submersion injury
abricated or induced illness
eported symptoms and signs only appear or reappear when the parent or carer is
present.
eported symptoms are only observed by the parent or carer.
n inexplicably poor response to prescribed medication or other treatment.
ew symptoms are reported as soon as previous ones have resolved.

22. Emotional, behavioral, interpersonal and social
functioning
motional and behavioural states
• recurrent nightmares containing similar themes extreme distress
• markedly oppositional behaviour
• withdrawal of communication
ehavioural disorders or abnormalities either seen or heard about Self-harm
• scratching, picking, biting or tearing skin to cause injury, pulling out hair or eyelashes
and
isturbances in eating and feeding behaviour
• repeatedly scavenges, steals, hoards or hides food with no medical explanation.
etting and soiling
exualised behaviour
• oral–genital contact with another child or a doll

23. Differential consideration

24. Differential consideration

25. Differential consideration

26. Differential consideration

27. investigation

28. management
ttend to serious or life-threatening injuries, such as significant head or
abdominal trauma,
tabilize the patient.
hysical problems requiring medical intervention, such as fractures,
lacerations, burns, or STIs
he precise recording of the pertinent history, particularly any
disclosure made by the child
areful documentation of the physical findings. Most states require the
completion of a specific child abuse reporting form as a means of
notifying the authorities about the suspected case of child abuse. In

29. MUNCHAUSEN SYNDROME BY PROXY
arent induces or fabricates an illness in a child to secure for himself or herself
prolonged contact with health care providers.
hildren may arrive at the ED with reported symptoms such as bleeding,
seizures, altered mental status, apnea, diarrhea, vomiting, fever, rash, or
multiple organ system involvement.
hese symptoms may result from administration of agents such as warfarin
or ipecac.
families frequently move from hospital to hospital, seemingly in search of
diagnosis.
ultiple unnecessary tests
he parent (the biologic mother in 98% of cases) encourages the staff to do
more diagnostic procedures and often seems uncharacteristically happy if a
test is positive.

30. Neglect

32. Fetal alcohol syndrome

33. Management

35. Sexual abuse

36. Ano-genital signs and symptoms

38. Clinical presentation
regnancy
• Be aware that sexual
intercourse with a child
younger than 13 years is
unlawful and therefore
pregnancy in such a child means
the child has been maltreated
• Consider sexual abuse if a
young woman aged 13 to 15
years is pregnant

40. Differential consideration

41. investigation
exual abuse requires
supportive sensitive and detailed history taking.
istory Taking
hysical Examination
aboratory Findings- It depends on the history and the
time since injury.
pecimens of offender blood, hair and the victim's nail
clipping and clothing.

45. When to suspect child maltreatment
When to suspect child maltreatment
Issued: July 2009 last modified: March 2013
NICE clinical guideline 89
guidance.nice.org.uk/cg89