User:Fordcar4/sandbox

Signs of Psychical Abuse in a Child Physical:

Any injury to a child who is not crawling yet Visible and severe injuries Injuries at different stages of healing On different surfaces of the body Unexplained or explained in a way that doesn’t make sense Distinctive shape Frequency, timing and history of injuries (frequent, after weekends, vacations, school absences) [3] Behavioral:

Aggression toward peers, pets, other animals Seems afraid of parents or other adults Fear, withdrawal, depression, anxiety Wears long sleeves out of season Violent themes in fantasy, art, etc. Nightmares, insomnia Reports injury, severe discipline Immaturity, acting out, emotional and behavior extremes Self-destructive behaviors or attitudes[4] Different Skin Signs of Abuse[edit source | edit] Bruises[edit source | edit] Physical abuse is frequently identified by bruising, which may be multiple and in different stages of healing. The location of the bruised area may be suspicious. Whereas bruising from accidental trauma is usually over bony prominences (e.g. knees, elbows, shins, forehead), intentional injury often leads to bruising on the softer regions of the thighs, abdomen, buttocks, cheeks, neck and anogenital regions.

Bruises may have a particular pattern or shape indicative of how they were inflicted. Examples include hand-shaped bruises, the imprint from a belt buckle, linear bruising from being struck by a rod or stick, and curvilinear loop marks caused by striking with a cable or cord.

Other signs of violent physical trauma can accompany bruising. These may include haematomas, traumatic hair loss and traumatic fractures of bone.[5]

Why Bruises Occur[edit source | edit] "Bruising of the skin occurs after blunt trauma, which disrupts underlying blood vessels and causes leaking and collection of blood in the dermal layers."[6] Thermal burns[edit source | edit] Burning is an especially traumatic form of abuse for children. Typically, cigarette burns can often be suspected where there are one or more rounded ulcers or erosions. There may also be singed vellus hairs.

Branding injuries may be caused by contact with heated metal objects such as spoons or forks and may represent the shape of the object.

Immersion burns of the buttocks and extremities are caused by dunking a child into scalding water. They tend to be sharply demarcated in a “glove and stocking distribution”, with a uniform depth of burn. “Donut-type sparing” may occur on the buttocks where the buttocks are pressed against the bottom of the tub while the surrounding immersed skin is scalded.[5]

Bites[edit source | edit] Human bites leave an indentifying mark on the victim, so it is particularly important to photographically record them if possible. If the distance between the marks from the canine teeth is greater than 3 cm, the perpetrator possesses adult dentition. Human bites tend to cause a crush injury rather than puncture wounds. Animal bites may be distinguished by the narrower puncture marks and different spacing.[5]

Binding Injuries[edit source | edit] Binding injuries occur when the wrists and ankles are tied. Acute injuries may present with soft-tissue swelling, redness, warmth or abrasions around the wrists and ankles. Older, healed injuries may present with post-inflammatory pigment change circumferentially around the wrists or ankles.[5]

Signs of Neglect[edit source | edit] Physical neglect may be present with a combination of poor hygiene, malnutrition, and sometimes untreated illness, which could include dermatitis or infestations of the skin (scabies) and hair (head lice). A neglected child that has not received the usual childhood immunisations may present with infections such as measles.[5]

Differential Diagnosis[edit source | edit] Dermatologists are responsible for distinguishing skin lesions caused by abuse from skin conditions, benign or otherwise, that can mimic abuse. The most common markings confused with bruises by physicians who are not dermatologists are Mongolian spots[7],which are frequently found on the buttocks and the back. Unlike bruises, however, these spots are not painful and their appearance does not change significantly over days or weeks.[8]

A complete coagulation study should be ordered in children with multiple bruises to rule out an underlying blood disorder (mainly hemophilia, von Willebrand disease, idiopathic thrombocytopenic purpura, and vitamin K deficiency). Idiopathic thrombocytopenic purpura and leukemia must be considered in children with petechiae and multiple hematomas. Patients with coagulation factor deficiencies typically have deep circular bruises with indurated centers. When such a deficiency is suspected, it is essential to take a personal and family history of bruising and tendency to bleed.

Certain forms of vasculitis that typically present in childhood (eg, Schönlein-Henoch syndrome and acute hemorrhagic edema of infancy) can occasionally cause purple erythematous, edematous plaques that can mimic inflicted injuries. Children with Schönlein-Henoch syndrome often have lesions on the legs and buttocks, frequently in association with a previous infection and abdominal and joint pain.[8]

"Various conditions, including perniosis, erythema nodosum, and hemangiomas, have been confused with physical abuse. Blisters can also mimic burns in the following disorders: staphylococcal scalded skin syndrome, bullous impetigo, linear IgA dermatosis, and fixed drug eruption. Finally, infections such as erysipelas and ecthyma as well as certain forms of dermatitis (phytophotodermatitis, contact dermatitis, and diaper rash) should also be considered in the differential diagnosis of a child with burn-like marks."[9]

Original Lead: Injuries to the skin are amongst the most common indicators that a child has been physically abused. These injuries include burns and bruises. Intentionally inflicted injuries are often in characteristic locations, patterns, and shapes that help differentiate them from accidental injury. The ability to recognize these types of inflicted injuries, as well as the various differential diagnoses—medical conditions that mimic cutaneous signs of abuse—is key to child protection.[2]

My Lead that I would like to add to the original.

Child abuse is the mistreatment of a child by a parent or guardian, including neglect, beating, and sexual molestation. Child Abuse is a serious manner and there is different skin signs to show that the a child is suffering from abuse.The different types of abuse through physical and sexual show different injuries and marks on the child's body. The ability to recognize the different skin signs through pictures and definitions. The signs are able to be noticed through the location, patterns, and shapes of the injuries on the child's body. The pattern of how child abuse is different through age groups by looking at the different types of abuse occur within different age groups. Through visual culture there will be different pictures and diagrams for an audience to look at and see the different signs to be able to differentiate the child playing and abuse. Using visual culture with definitions and pictures to get a better visual view on what child abuse skin sign look like.

Combination: Child abuse is the mistreatment of a child by a parent or guardian, including neglect, beating, and sexual molestation. Child Abuse is a serious manner and there is different skin signs to show that the a child is suffering from abuse. Injuries to the skin are amongst the most common indicators that a child has been physically abuses. These injuries include burns and bruises. The abuse can also include sexual and neglect that will also show skin marks.

Intentionally inflicted injuries are often in characteristic locations, patterns, and shapes that help differentiate them from accidental injury. The pattern of how child abuse is different through age groups. By being able to identify the different abuse throughout different age groups will help to diagnose the abuse that is taking place. The pictures and diagrams will add to help differentiate the different types of skin signs that occur within the abuse that is taking place in that age group. The ability to recognize these types of inflicted injuries will help determine the different cutaneous signs of abuse and how to help protect the child from further abuse taking place.

Through Visual culture there will be different pictures and diagrams for an audience to be able to reference and see the different signs of child abuse and help differentiate what is actual abuse and what is not. The definitions of the different aspects of child abuse skin sign will go hand in hand to be able to perceive the correct observation when identifying the skin signs of child abuse. Visual culture will be a large help in people to perceive the correct idea of the marks on a child’s body.

Changes to the original lead:

I would like to add more about the definition of child abuse and why it is such a serious issue. Also, I would like to tie in visual culture because as of right now the current article does not have any images to refer to the different skin signs that occur when child abuse happens. Also, I want to add the definition of visual culture and different definitions of the different times of child abuse that occurs. I think that the article can be really well developed with right information and sources that people can refer to this wiki page when they are questioning different signs of child abuse.