Physicians must maintain a high index of suspicion, particularly when the history of an injury is inconsistent with physical findings. Physical abuse most often is a pattern of repeated behavior, with bruises and welts being the most frequent evidence of such. Human bite marks leave concentric bruises that contain individual teeth marks. Dating bruises is also important, and multiple colors suggest multiple times of injury. Between days 1-5, a combination of colors can be seen, being red, blue, or purple.
Child abuse is a common cause of burns.
Scald or immersion burns are the most common, bearing the characteristic glove or stocking pattern that is observed on physical examination. With a water temperature of 145 degrees or greater, an almost instantaneous full-thickness burn will occur. With a water temperature of 130 degrees, it takes approximately 30-45 seconds. Contact burns from a hot metal object or cigarette are another type of burn seen with child abuse. Head injuries are the most common cause of death from child abuse.