Distinguishing Abuse from Accident

Children are curious and fearless. They run, climb, jump, and explore. The very nature of childhood invites accidents. A child’s motor skills usually outpace cognitive skills, allowing the child to approach danger without recognizing it. Thus, it can be difficult to distinguish abuse from an accident.

When observing injury you suspect might be the result of abuse, consider:

• Where is the injury? Certain locations on the body are more likely to be injured during an accidental fall or bump, including knees, elbows, shins, and the forehead. Protected parts of the body, such as the back, thighs, genital area, buttocks, back of the legs, or face, are less likely to accidentally come into contact with objects which could cause injury. It is important to remember to look for other indicators.
• How many injuries are on the child? Are there several injuries occurring at one time or over a period of time? The greater the number of injuries, such as bruises on a single surface that are clustered, the greater the cause for concern. Unless involved in a serious accident, a child is not likely to sustain a number of different injuries accidentally. Injuries in different stages of healing can suggest a pattern of occurrence.
• What is the size and shape of the injury? Many non-accidental injuries are inflicted with familiar objects: a stick, a board, a belt, a hair brush, etc. The resulting marks bear strong resemblance to the object which was used. For example, welts caused by beating a child with an electrical cord might be loop-shaped; a belt might cause bruises in the shape of the buckle. Accidental marks resulting from bumps and falls will not normally have a defined shape.
• Does the description of how the injury occurred seem likely? If an injury is accidental, there should be a reasonable explanation of how it happened which is consistent with its severity, type and location. When the description of how the injury occurred and the appearance of the injury do match up, there is cause for concern. It is also important to check for discrepancies between the injury and the history provided by the caretaker and others.
• Is the injury consistent with the child’s developmental capabilities? As a child grows and gains new skills, he increases his ability to engage in activities which can cause injury. For example, an infant does not have the movement capability to self-inflict a bruise. A toddler trying to run is likely to suffer bruised knees and a bump on the head before the skill is perfected. However, the child is less likely to suffer a broken arm than is an eight-year-old who has discovered the joy of climbing trees.

Source: Kansas Department for Children and Families.