Burns and scalding, usually second or third degree, may result from immersion, non-accidental splashing of hot liquids, or contact with hot objects, e.g., irons, heaters, or cigarettes. Subdural, subarachnoid, and retinal hemorrhages with or without skull fractures that cannot be explained by history are most strongly suggestive of non-accidental trauma. A skeletal survey must be done in all suspected cases of child abuse and neglect in children less than two years old. These films should be read by a pediatric radiologist if at all possible. Child neglect is as lethal as physical abuse.
Some studies show that as many children die from neglect as from physical abuse.
These children often suffer frequent humiliation and scapegoating. Parents may show inconsistent or unrealistic expectations or both. Acute manifestations of emotional abuse include increased worries, fears, and phobias, somatic complaints, and nightmares. If emotional abuse becomes chronic, the child may exhibit failure to thrive, low self-esteem, poor peer relationship, impulse disorders, and school problems. Behavioral indicators of child sex abuse include shame or guilt, sexually explicit play, problems in school, enuresis and encopresis, nightmares, depression, and pseudomaturity.