Do you have one of those kids who always has bruises and injuries because no realistic amount of supervision will prevent them from attempting to fly by jumping off of tables and chairs or creating their own sled for the stairs?
Or, is there a kid you often see — maybe on playdates, or perhaps you babysit or notice at school events — whose bumps and bruises raise concerns for you?
How can you reasonably tell whether there’s genuine cause for concern or if you’re seeing the results of a very adventurous and ambitious child?
When Should You Intervene?
If you are a teacher or childcare provider, you’re likely a mandated reporter — someone who is legally required to inform authorities if you see signs of abuse. Other mandated reporters can include law enforcement, healthcare workers, social workers, and other professionals whose jobs involve regular interaction with children.
The requirement may be even broader. In my state, North Carolina, every adult is a mandated reporter. If you’re unsure of your responsibility, you’ll want to check your state’s laws.
Even if it’s not legally mandated, you may want to take steps if you believe a child is being abused.
The big question is, when are injuries a red flag for abuse?
Body Parts Likeliest To Suffer Accidental Injury
Joshua Terhune, a child therapist who also uses social media to spread information to parents and caregivers, recently released a video that can help identify the difference between common childhood injuries and signs of abuse.
One key to focus on is protruding parts like foreheads and limbs. Terhune says these are some of the most likely body parts to suffer injuries.
In other words, if you’re seeing bumped foreheads, skinned or bruised knees and shins, scraped-up hands, and ouches on elbows, the injuries are not likely signs of abuse. He says:
“Those will be kinda the bony parts of the body. The chin, the nose, things that stick out, like your forehead, back of the head, palms of the hands…elbows, knees, shins.”
Bandages on the child’s face and bumps to the head could all result from simple rough play and accidents, especially for a child prone to more exuberant play and/or still struggles with balance, proprioception, and awareness of his surroundings.
Injuries That Might Be More Suggestive Of Abuse
Almost any part of the body could be injured through play or ordinary circumstances in some cases, but some injuries are less likely to happen by accident.
Terhune says to notice injuries to soft parts of the body, including “cheeks, neck, ears, inner arms, inner thighs, soles of the feet, [and] genitalia.”
He says to pay particular attention to the back of the neck, to what he identifies as the ‘triangle of safety.’ He explains:
“If something happens there, that is very concerning, because that is one of the most vulnerable parts of the body, especially your spine and the base of your skull, and all of those arteries as well.”
He also warns against symmetrical injuries, such as if both ears or both cheeks are hurt, asking, “How can it be an accident if it’s on both sides?”
Look For Patterns & Delays In Treatment
What do the injuries look like?
Sometimes, there’s a clear pattern to the injury that suggests the implement that caused it. For example, bruises that look like fingers or scratches that look like they were made by fingernails rather than by falling and scraping one’s skin on rocks.
He lists other patterns that could be noticeable—marks that visibly seem to have been made by knuckles, belts, extension cords, fly swatters, or shoes.
The child therapist also notes that injuries caused by abuse might have delayed treatment, such as a broken arm that isn’t examined until two days after the injury occurred or if there’s no treatment at all for an injury severe enough to warrant it.
When In Doubt, Ask Questions
If the injuries raise questions for you, you may be able to satisfy your concerns by opening a dialogue.
Speaking to the child, you might say, “Oh! You have a big bruise there! How did that happen?”
Focus on speaking with curiosity, not judgment. You should not be digging for information; you should just express genuine concern for the child and invite him to tell a story.
Injuries tend to come with stories, at least from kids who are big enough to tell one. Most of the time (not always), kids can talk about how they got hurt.
Maybe it’s “I was running on the rocks and…” or “I jumped off the swing, but I was going too high,” or “I ran into the table again!”
A parent, Terhune says, should also usually have some idea of how an injury happened.
By contrast, for injuries caused by abuse, stories may not match up. He offers an example:
“Oh, you got two black eyes falling down the stairs? How does that happen?”
Check Out Mr. Joshua’s Advice In His Own Words
It should be noted that these are red flags for abuse and may not be definitive evidence. Individuals should use their best judgment to determine whether there is a valid reason to contact authorities and should never take enforcement into their own hands.
With that said, check out Joshua Terhune’s video below to see his advice and the charts that he uses to help show the difference between injuries that are likely to be accidental and those that could be signs of abuse.
