Physical Abuse

Physical abuse may involve hitting, shaking, throwing, poisoning, burning or scalding, drowning, suffocating or otherwise causing physical harm to a child. Physical harm may also be caused when a parent or carer fabricates the symptoms of, or deliberately induces, illness in a child (see Perplexing Presentations and Fabricated or Induced Illness Procedure).

Physical abuse can lead to physical injuries, neurological damage, disability and death and can produce emotional or behavioural disturbance in children such as aggressive behaviour.

The range of injuries which may be caused by the physical abuse of children is varied. One injury to a child is not in itself an indication of physical abuse, as many children sustain accidental injuries. Certain injuries are less likely to have an accidental cause, and it is important that an appropriate medical opinion or assessment is obtained where there is suspicion about the cause of an injury.

In Knowsley such medical assessment should be conducted by a paediatrician at the Rainbow Centre, Alder Hey Hospital (see Local Contacts).

A number of factors may give rise to suspicion about the cause of an injury, the most obvious being a statement by the child and/or another person, that the injury has been caused deliberately or not accidentally.

• In addition, professionals working with children and families should be alert to situations where a child is injured and:
• The explanation provided by the parent or carer is apparently incompatible with the physical injury;
• There are conflicting or different explanations provided;
• There is no explanation provided or a lack of awareness of how the injury occurred;
• There is a reluctance on the part of the parent or carer to provide information about the current or previous injuries;
• There is a reluctance to agree to medical assessment;
• There is a delay or failure to seek appropriate medical attention for an injury;
• There are frequent minor injuries or presentations of the child at Accident and Emergency Departments;
• The parent or carer is impatient, angry or aggressive towards the child;
• The parent or carer is under the influence of alcohol or another substance.

The presence of any of these factors does not indicate that Physical Abuse has occurred but does indicate that the possibility of Physical Abuse should be considered.