Physical abuse involves causing or exacerbating physical harm through either action or inaction, so we need to be vigilant to signs and indicators of physical harm. However, this can be more difficult than it might at first appear. One of the reasons for this is that children and young people can have all manner of accidents that cause physical harm, but which are not the result of abuse. We are concerned about unexplained physical harm. By “unexplained” we mean that either no explanation is provided, or that the explanation is not plausible. This would include situations where incompatible or contradictory explanations are provided by different people, where the injury is incompatible with the explanation (e.g. the shape or size of the mark, or where the injury is in a position that is incompatible with the explanation.

It is important to remember that in safeguarding, context is critical. We are not trying to impose an explanation of abuse onto an accident. Where the explanation is reasonable and consistent we accept it, however, we still need to record it. Sometimes the explanation seems reasonable and consistent but the same injury recurs on numerous occasions, or on an ongoing basis. This may indicate neglect, or even that the explanation is untrue, but it is important to remember that the presence of these signs and indicators does not necessarily mean that abuse has occurred.

Signs and indicators of physical abuse

Physical signs would include:

• Bruises
• Broken or fractured bones
• Burns or scalds
• Bite, pinch or grab marks
• Cuts or lacerations
• Swelling and lumps

It could also include:

• Scarring
• The effects of poisoning or brain injury such as vomiting, drowsiness or seizures
• Breathing problems from drowning, suffocation or poisoning
• Untreated medical conditions
• Untraeated injuries (possibly resulting in infections
• Odours, rashes or other skin conditions
• Weight loss, hunger, or thirst

Behavioural indicators might include:

• Aggressive or violent behaviour
• Anger and threatening behaviour
• Withdrawn, fearful or anxious behaviour
• Hypervigilance, excessive startle or flinching
• Wearing extra layers of clothing, covering up and reluctance to undress

Babies (non-mobile children)

As a general rule, pre-mobile children shouldn’t bruise or have fractures or broken bones. Obviously, accidents can happen, particularly where there are siblings in the house, and as the child becomes more active, but if they are not able to move themselves, they are not going to fall or trip and require constant supervision while awake. As such, significant injuries to a pre-mobile child must be carefully considered.

A controversial subject when considering injuries to very young children is “Shaken Baby Syndrome”, sometimes referred to as “Abusive Head Trauma” or “Shaken Impact Syndrome”. Following a number of successful legal challenges to wrongful convictions, medical and scientific opinion is divided and there is now far less certainty about this that was previously thought to be the case. The case of Louise Woodward is one such example that has been the subject of a number of documentary programmes.