Child Abuse Recognition & Reporting

A toddler presents with bilateral symmetric burns on both feet. The caregiver says the child "stepped in hot water" — but the pattern tells a different story. Can you read it?

Child abuse recognition hinges on pattern recognition: injuries that don't match the developmental stage or the stated mechanism. Bruises in non-mobile infants (babies who can't cruise don't bruise), injuries in various stages of healing, burns with clear demarcation lines (stocking-glove pattern from forced immersion), and spiral fractures in non-ambulatory children are classic red flags. Retinal hemorrhages and subdural hematomas in infants suggest abusive head trauma (formerly called shaken baby syndrome). Behavioral indicators include extreme withdrawal, inappropriate sexual knowledge for age, or a child who doesn't cry during painful procedures. Nurses are mandatory reporters in all 50 states — you report reasonable suspicion, not confirmed abuse. You do NOT need proof, parental consent, or provider approval. Report directly to your state's child protective services or designated hotline. Document objective findings using exact quotes and body maps. Never use subjective language like "the child was abused." Describe what you see: size, shape, color, and location of injuries. Failure to report carries legal consequences for the nurse.

Key Distinctions

Don't confuse mandatory reporting (based on suspicion) with investigation (that's CPS/law enforcement — not the nurse's role). Students think they need definitive evidence before calling — you don't; suspicion alone triggers the legal duty. Distinguish accidental bruising locations (shins, foreheads, bony prominences in mobile children) from suspicious locations (trunk, ears, neck, buttocks, genitalia).

Clinical Pearl

TEN-4 rule: bruising on the Torso, Ears, or Neck in a child under 4 — or ANY bruise in an infant under 4 months — demands investigation.