Physical Abuse

Physical abuse involves the intentional harming of a child, resulting in injuries such as fractures, cuts, bruises, or burns. It may arise from actions including hitting, throwing objects, shaking, poisoning, burning or scalding, drowning, suffocating, or otherwise causing physical injury to a child or young person. In some cases, parents or carers may also fabricate symptoms or deliberately induce illness.

Signs of physical abuse

Babies and young children
The following signs may indicate physical abuse in babies and very young children:

Any bruising to a baby who is not yet walking
Bruising to soft areas of the body in a child who is not independently mobile or only just becoming mobile

Bruising in non-mobile children
Bruising in children who are not yet mobile is uncommon. When it does occur, there is a significant possibility that it may be the result of abuse or neglect. Nationally and locally, there have been instances where such bruising has not been appropriately recognised or acted upon by health professionals, including Health Visitors, GPs, and doctors. This has led to missed opportunities to identify abuse, placing children at ongoing risk and, in some cases, resulting in serious incidents and reviews.

The Bruising in Non-Mobile Children Protocol has been developed to address this issue. It requires that all professionals refer any bruising in non-mobile children for assessment by a Consultant Paediatrician and Children’s Social Care.

Bruising in Children who are Not Independently Mobile...

Children and young people
Other signs that may indicate physical abuse in children and young people include:

Multiple bruises on different parts of the body
Bruising that appears to have the shape or outline of an object or a hand
Bruising in areas less likely to be injured during normal play, such as the back of the legs, abdomen, or groin
Bite marks — it can sometimes be difficult to distinguish between bites from a child and those from an adult
Fractures or broken bones — these may be suspected where a child has pain, swelling, or discolouration around a bone or joint
Burns or scalds — while it can be challenging to distinguish between accidental and non-accidental injuries, burns or scalds with clear or defined edges may be a cause for concern

ICON programme
Research shows that persistent crying in babies can be a trigger for some parents or carers to lose control and shake a baby. Evidence also indicates that around 70% of babies who are shaken are shaken by men. Prevention programmes should therefore include male caregivers and make use of opportunities to engage them, while also supporting all parents and carers with information about infant crying and coping strategies.

Intervention points
The ICON parenting support programme is delivered at five key stages:

Following birth, in hospital or at home, before discharge
Within the first 10 days at home (community midwife)
Within the first 14 days at home (health visitor)
At around three weeks (health visiting team)
During the routine 6–8 week check at the GP surgery

For further detail, see ICON guidance for professionals Professionals - ICON: Babies cry, you can cope