A bite with an intercanine diameter greater than 3 cm is probably made by an adult. Oral trauma includes labial and lingual frenulum tears from forced feeding or sexual penetration, burns from hot food, and lacerations or bruises at the corners of the mouth from being gagged. Accidental liquid burns in children usually result from their pulling down hot liquids and are characterized by splatter marks, usually starting from the chest down. Burns elsewhere or without splatter marks are suspicious. Accidental contact burns are usually on the palm of the hand, while intentional burns, seen on the dorsum of the hand or elsewhere, are often clearly demarcated.
Cigarette burns are highly suspicious.
3 Retinal hemorrhage due to abusive head trauma. Munchausen's Syndrome by Proxy is rare, and may occur through strangulation, poisoning or other bizarre mechanisms. A parent repeatedly brings the child to medical attention for illness brought on by the parent. The parent frequently has a medical background, is very friendly with medical staff and is very involved in the child's treatment. Periocular, orbital and sub-conjunctival hemorrhages can be seen, though corneal damage and other signs of direct eye trauma are less common.