Ensure child abuse cases are recognized, diagnosed, and reported as soon as practical by telephone and followed up with a written report.
The following signs and symptoms of abuse and neglect should be identified by the physician:
•Physical abuse – Physical injury inflicted on a child by another person by other than accidental means.
•Bruises or welts that have a regular pattern resembling the shape of an article which might have been used to inflict the injury.
•Burns that appear to be from a cigar or cigarette, especially on the soles of the feet, palms, back or buttocks, patterned burns, and immersion burns.
•Abrasions such as rope burns or lacerations especially on the wrist, ankles, torso, palate, mouth, gums, lips, eyes, ears, or external genitalia.
•Fractures, many times at different stages of healing, to the skull, ribs, or long bones.
•Injuries to the abdomen, kidney, bladder, or pancreas, intestinal perforation, ruptured liver, spleen, or blood vessels, or intramural hematoma of the duodenum or proximal jejunum.
•Symptoms of suffocation or chemical abuse.
•Indicators pointing to Munchausen syndrome by proxy.
•Sexual abuse – Includes both sexual assault and sexual exploitation.
•Bruises or abrasions to the inner thighs or external genitalia.
•Attenuation or distortion of the hymen.
•An alternation of anorectal tone.
•Evidence of sexually transmissible disease.
•Pregnancy (although pregnancy alone is not sufficient to constitute the basis of a reasonable suspicion of sexual abuse).
•Willful cruelty or unjustifiable punishment of a child.
•Unlawful corporal punishment or injury.
•Neglect – Negligent treatment or maltreatment of a child by a person responsible for the child’s welfare where harm to the child’s health or welfare is indicated or threatened.
•History of lack of appropriate well-child care.
•Failure of a child to thrive.
•Malnutrition, untreated medical conditions, poor hygiene, or rampant dental caries.
•Behavioral indicators such as anxiety, depression, sleep disturbances, enuresis, excessive masturbation, aggressive behavior, or excessive household responsibilities for age, including child care, poor school performance, discipline problems, and impaired personal problems.
•Abuse in Out of Home Care – All cases of abuse as defined above in a childcare, school, or other agency or institutional setting.