Skin lesions in 397 children referred for forensic medical examination on suspicion of physical abuse

INTRODUCTION. Physical child abuse is a well-known global health problem. Considerable efforts have been devoted to identifying predictors of physical abuse. METHODS. This study included all 397 cases in the cohort of children aged 0-18 years referred to the Department of Forensic Medicine, Aarhus University, Denmark, between 2000 and 2020 on suspicion of exposure to physical abuse. The number, character and location of skin lesions were described. Bone fractures were recorded. A total of 59 cases involving weapons and sharp force violence related to attack or fighting between young people were assessed as a separate group. RESULTS. The annual number of cases referred increased. The male-to-female ratio in the cohort was 6:4. Bruising was the most common skin manifestation in the blunt force violence (BFV) group; 72.2% of the individuals had skin lesions on the head and neck, thus visible on a normally dressed child. Lesions on the hands and arms were present in 69.8% of the BFV cases and may partially reflect defensive reactions. One or more bone fractures were recorded in 19.5% of the BFV group. Occult fractures were observed in 40% of the children in the BFV group = 2 years of age. CONCLUSIONS. More than 70% of the children in the BFV group had lesions on the head and neck visible on a normally dressed child. Skin lesions on hands and arms, which are visible on a lightly dressed child, were just as frequent. Persons with close relation to children should be aware of this opportunity to spot non-accidental skin injuries.