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all blue marks, however, are bruises and "Mongolian Spots" (a blue birthmark over the
buttocks) are quite normal in a dark complexioned child.
Wheals are found when children have been sjambokked and are obvious. According
to Winship (1988) human bites should be measured. They are not all caused by other
children. Burns should be treated with suspicion.They are not all caused accidentally.
Particularly co=on are those caused by a hot cigarette end which can be recognised
as a deep ulcer. Less obvious are cigarette burns which only come to our attention
when they are infected, but a careful examination of one child revealed a healing ulcer
under the foot (Winship 1988 : 92-93).
Many children suffer scalds with hot water but no child will dip his hand up to the
wrist in hot water. This type of "dunking" burn may be seen on the feet or buttocks
where the straight line indicates that it is an inflicted, not an accidental injury.
Fractures of the limbs, particularly in the middle of the shaft of a long bone, rarely
occur in normal children under the age of three as a result of a fall. When they fall,
children sustain fractures near the joints. Midshaft fractures are caused by bending the
limb-often over a fulcrum such as a bar in a cot. Again there are inherited
abnormalities of bone -osteogenesis imperfecta (brittle bone disease) which must be
excluded before accusations ofabuse are made. Compression injuries, such as fractures
of the ribs, are caused by squeezing, not falling; and those like a ruptured liver or
bowel are likely to occur non-accidentally, except when a motor vehicle has been
involved (Winship 1988 : 93).
Head injuries insmall children should always be treated with suspicion unless the child
has been involved in a motor accident. Children do fall on their heads and simple
fractures may be acquired accidentally; but multiple fractures affecting more than one
of the bones of the skull can only be caused by the head being hit very hard either
with a blunt object or against something like a wall. Difficult to detect are brain
injuries caused by violent shaking.The brain is loose within the skull and infants are
unable to support their heads if shaken.The result is a whiplash injury of the brain
causing tearing of the fragile blood vessels on the surface or within the substance of