Skin, Hair & Nail Health: Skin signs of physical abuse in children
May is Child Month and last month was observed as Child Abuse Prevention Month. Child abuse is a horrific problem worldwide and deserves attention all year round. It is still very under-reported and remains culturally acceptable and covered up by many persons in all socio-economic groups.
Child abuse may include physical abuse, sexual abuse, emotional abuse and/or neglect. The Office of the Children's Registry (OCR) in Jamaica defines physical abuse as any act, or failure to act, that leads to the non-accidental, physical harm of a child, or that places the child's physical well-being at risk.
It includes, but is not limited to, beating, burning, choking, kicking, punching, harmful restraint, and the use of a weapon or instrument. The OCR's website shows that 14,745 cases of physical abuse were reported between 2007 and 2014.
This is a very sensitive issue and we need to carefully differentiate between accidental injury, other medical conditions and non-accidental injury or physical abuse.
Here are some situations and signs which may suggest physical abuse and may warrant further investigation:
1 An unusual and unexplainable delay in seeking medical attention.
2 Unusual and excessive fear of a parent or caregiver, or on the other hand, a lack of concern by the person accompanying the child.
3 The child may report that the injury was deliberate and non-accidental.
4 Abnormal behaviour of the child, for example, extremely withdrawn, nervous, or unusual wariness of physical contact. This has to be taken in the context of the child's age and background, including any other mental or physical disorders, or other past traumatic experiences the child may have had.
5 The explanations of the causes of the injury don't make sense, change over time, or are not in keeping with the child's developmental stage.
6 Unexplained bruises, cuts, scratches and swellings at different stages of healing. These are often multiple and may be associated with multiple unexplained fractures and repeated head trauma.
7 Accidental bruises over bony areas are common, but unexplained bruises on ears, cheeks, buttocks and genitals may indicate physical abuse.
8 Some medical conditions may cause bruising and should be excluded. In addition, a common bluish discolouration, often in the lower back and buttocks, called Mongolian blue spot, should not be mistaken for physical abuse.
9 Prominent grab marks, slap marks, belt or cord marks, and human bites are signs of possible physical abuse. Adult bites are usually wider than three cm. There may be binding injuries where wrists or ankles were tied.
10 Cigarette burns, branding injuries in shape of the object, immersion burns in a 'stocking and glove' pattern of the arms or legs, or donut-shaped burns of buttocks are other signs of possible physical abuse. Some medical conditions may cause blistering of the skin and should be excluded where necessary.
We need to bring about meaningful social change and stop repeating mistakes of the past in the name of discipline. Children's lives and well-being are at stake. Child abuse is everybody's business.
- Dr Arusha Campbell-Chambers is a dermatologist and founder of Dermatology Solutions Skin Clinics & Medi-Spas; email: firstname.lastname@example.org