- Where is the injury?
Certain locations on the body are more likely to sustain accidental injury: knees, elbows, shins, the forehead; all are parts of the body which can be injured during an accidental fall or bump. Protected or nonprotuberant parts of the body, such as the back, thighs, genital area, buttocks, back of the legs, or face, are less likely to accidentally come into contact with objects which could cause injury. For example, bruised knees and shins on a toddler are likely to be the result of normal age-related activity; bruises on the lower back are less likely to have been inflicted nonaccidentally.
- How many injuries does the child have? Are there several injuries occurring at one time over a period of time?
The greater the number of injuries, the greater the cause for concern. Unless involved in a serious accident, a child is not likely to sustain a number of different injuries accidentally. Injuries in different stages of healing can suggest a chronological pattern of occurrence.
- What are the size and shape of the injury?
Many nonaccidental injuries are inflicted with familiar objects: a stick, a board, a belt, a hair brush. The marks which result bear strong resemblance to the object which was used. For example, welts caused by beating a child with an electrical cord might be loop shaped; a belt might cause bruises in the shape of a buckle. Accidental marks resulting from bumps and falls usually have no defined shape.
- Does the description of how the injury occurred seem likely?
If an injury is accidental, there should be a reasonable explanation of how it happened which is consistent with its severity, type, and location. When the description of how the injury occurred and the appearance of the injury do not seem related, there is cause for concern. Could a fall off a chair onto a rug produce bruises all over the body?
- Is the injury consistent with the child's developmental capabilities?
As a child grows and gains new skills, he increases his ability to engage in activities which can cause injury. A toddler trying to run is likely to suffer bruised knees and a bump on the head before the skill is perfected. He is less likely to suffer a broken arm than is an eight-year-old who has discovered the joy of climbing trees. A two-week-old infant does not have the movement capability to self-inflict a bruise.
- Accidents do happen.
Parents are not perfect. Injuries occur which may have been avoided. Still, accidents of this nature should not happen repeatedly.
