Indicators of Inflicted Injury (Abuse)

Indicators of Inflicted Injury (Abuse)

The indicators of injury listed here are not all-inclusive nor are they conclusive. Some of these indicators can exist in situations where abuse has not occurred. These indicators mean more when they are found as part of a pattern than when isolated. They are signals or suggestions of abuse or mistreatment that require further investigation. It is up to the professional to weigh these signs, investigate and form an expert judgment.

Please share this information with families and appropriate staff; including medical personnel, investigators, incident review committee members, administrators, program managers, service coordinators, direct support professionals and any others with responsibilities for program implementation and incident management

Injuries of one or more of the following characteristics may be inflicted, rather than accidental. If you are investigating an injury to a person that has one or more of these characteristics, you should consider the possibility that the person was abused as you conduct the investigation. The injury itself is not proof of abuse. Conduct a careful investigation and base your conclusion on all of the evidence.


Accidental injury: This happens casually and by chance.

Inflicted injury: This is caused by a conscious act of another person.

Indicators of Inflicted Injury: General • Injuries that are unexplained or are inconsistent with the caretaker’s explanation. • Bilateral injuries. Accidents usually cause injuries on only one side. • Clustered injuries (group of injuries in the same area). • Patterned injuries, such as the outline of a belt. • Grab marks on the upper extremities. • Human bites. • Injuries that are consistently noticed after the person’s absence from the residence (e.g., after a home visit or stay at camp). • Internal injuries, such as bleeding or liver damage. • Delay in seeking medical attention. • Significant abdominal injuries (e.g., perforated small intestine).

Indicators of Inflicted Injury: Fractures • More than one fracture in various stages of healing. • Multiple or repeated fractures to the same bone or the same area. • Injury is “accidentally” discovered during an exam. • Posterior (back) rib fractures are most likely due to inflicted injury.

Indicators of Inflicted Injury: Burns • Delay in obtaining treatment. • Cigar or cigarette burns. • Immersion burns (e.g., sock-like and/or glove-like). • Burn patterns that correspond to heated objects, such as a cigarette or iron and/or are sharply outlined. • Burns in areas that are not within the victim’s reach (e.g., back, behind the knees, bottoms of feet, back of hands).

Indicators of Inflicted Injury: Bruises • Bruised in areas not usually visible. • Black eyes that are bilateral or with no injury to the nose. • Patterned bruises. • Multiple bruises in various stages of healing.

Indicators of Inflicted Injury: Sexual Abuse • Difficulty walking or sitting. • Torn, stained or bloody underclothing. • Genital or anal pain, irritation, bleeding, swelling or redness. • Bruises on external genitalia or inner thighs. • Sexually transmitted diseases. • Inappropriate, unusual or aggressive sexual behavior. • Frequent urinary tract infections in women.