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What Is Physical Abuse?
Statutory definition — Working Together to Safeguard Children 2026:
"Physical abuse is a form of abuse which may involve hitting, shaking, throwing, poisoning, burning or scalding, drowning, suffocating or otherwise causing physical harm to a child. Physical abuse can also be caused when a parent or carer fabricates the symptoms of, or deliberately induces, illness in a child."
Working Together to Safeguard Children 2026, Annex B
Physical abuse is defined by the intentional causing of physical harm. Accidents happen to children — the key question is whether an injury is consistent with the explanation given, with the child's developmental stage, and with the pattern of previous presentations. It is the job of a paediatrician, not a teacher or social worker, to determine whether an injury is non-accidental. The practitioner's role is to notice, record, and refer — not to diagnose.
Forms of Physical Abuse
H Hitting, Slapping and Beating
The most common form of physical abuse — including smacking, punching, kicking, hitting with objects, and beating. In England, the law on "reasonable punishment" was strengthened by the Children Act 2004 and further consolidated: any corporal punishment that causes reddening of the skin, bruising, swelling, or mental harm constitutes assault. Many cases of physical abuse involve punishment that escalates over time.
S Shaking
Shaking is particularly dangerous in infants and young children. The brain sits loosely within the skull in infancy; violent shaking causes the brain to move back and forth, tearing blood vessels and causing intracranial haemorrhage. Abusive Head Trauma (AHT) — formerly known as "shaken baby syndrome" — is the leading cause of child fatality from maltreatment in children under one.
- Presenting features include unexplained vomiting, seizures, bulging fontanelle, unconsciousness
- Retinal haemorrhage on ophthalmological examination is a key diagnostic indicator
- There is often no external evidence of injury — bruising may be absent entirely
- Parents may present saying the baby "just went limp" with no account of trauma
B Burning and Scalding
Deliberate burning with cigarettes, irons, lighters, or hot objects, or scalding with hot water. Burn injuries are among the most significant indicators of physical abuse — accidental burns have particular features (splash patterns, irregular edges); inflicted burns tend to be more uniform, patterned, or in atypical locations.
- Circular cigarette burns — especially multiple, or in clusters
- Glove or stocking pattern scalds (immersion burns) — a very distinct waterline
- Burns on feet, buttocks, genitalia, or other areas unlikely to be accidentally touched
- Burns of uniform depth (accidental splashes are irregular; deliberate contact burns are uniform)
P Poisoning
Deliberately administering harmful substances — prescription medication, alcohol, recreational drugs, salt, household chemicals — to a child. Poisoning is often linked to Fabricated or Induced Illness (FII) and may be very difficult to identify without toxicological testing.
- Recurrent unexplained acute illness — particularly vomiting, unconsciousness, or seizures
- Symptoms present only in the care of one specific parent or carer
- Symptoms that resolve immediately when the child is removed from the home
- Toxicology screens revealing substances not prescribed to the child
Su Suffocating and Drowning
Deliberate suffocation (smothering) or holding a child underwater. Suffocation may leave no physical mark and can be presented as an apparent life-threatening event (ALTE), a seizure, or an unexplained collapse. It may be associated with factitious illness presentations.
- Recurrent ALTEs — apparent life-threatening events — particularly where the parent is always the sole witness
- Petechiae (small red spots from burst blood vessels) around the eyes, face, or neck
- Near-miss drowning incidents with an explanation inconsistent with the child's supervision level
Bruising Guidance: The Key Rules
Bruising is the most common presentation of physical abuse. These evidence-based principles are used by paediatricians and child protection practitioners to determine whether bruising is likely to be non-accidental. They do not replace medical assessment — but they guide when to refer.
⚠ The "TEN-4 FACES" Rule (adapted for UK practice)
Bruising in any of the following locations in a child under 4 years old should be considered potentially non-accidental until a medical opinion establishes otherwise:
- Torso — chest, back, abdomen, buttocks
- Ears — particularly pinna (ear flap)
- Neck
- Frenulum (inside the mouth)
- Angle of jaw
- Cheeks
- Eyelids / periorbital region
- Soft areas of the face
⚠ Any bruise on a non-mobile baby is significant
A child who cannot yet pull to stand, crawl, or cruise cannot generate the force necessary to bruise themselves through accidental contact. Any bruise on a pre-mobile infant — however small, wherever it is — is an indicator for urgent paediatric assessment and a safeguarding referral. This is one of the most important rules in paediatric safeguarding.
Other bruising features that raise concern
- Patterned bruising — an outline consistent with an object (belt buckle, cord, implement)
- Bilateral bruising — same injury on both sides of the body simultaneously (accidental impacts are typically unilateral)
- Multiple bruises in clusters, or at different healing stages, suggesting repeated episodes
- Bruising inconsistent with the explanation — e.g. a fall "down three steps" causing extensive bruising over multiple body parts
- Delayed presentation — parent seeking help significantly later than the alleged time of injury
- Explanation that changes between different tellings, or between different professionals
Bruising that is more likely to be accidental
Not all bruising in children is a cause for concern. Mobile children commonly bruise on:
- Shins and lower legs (from running, falling, furniture impact)
- Foreheads and fronts of knees
- Bony prominences — elbows, hipbones
Context matters enormously. A single shin bruise on an active five-year-old is unremarkable. The same bruise on a six-month-old who has never been to A&E before, with a parent who cannot explain it, is not.
Warning Signs by Age Group
0-4 Infants and Under-5s
- ● Any bruising on a pre-mobile baby — refer immediately
- ● Unexplained injuries — fractures, burns, head injuries — presented late or with changing explanation
- ● Recurrent presentations to A&E or the GP with injuries
- ● Flinching or freezing when an adult raises their hand or voice
- ● Reluctance to be changed or examined — protecting part of the body
- ● Watchful, hypervigilant behaviour — scanning for threat
5-10 Primary School Age
- ● Injuries inconsistent with the child's account, or explanation that changes
- ● Wearing long sleeves in warm weather — concealing arms or legs
- ● Reluctance to take part in PE or activities that involve undressing
- ● Arriving at school very early, very reluctant to go home
- ● Flinching at sudden movement or loud voices
- ● Disclosing that a parent "lost their temper" or describing being hit
11-15 Secondary School Age
- ● Visible injuries attributed to fighting, sports, or self-harm — consider whether the explanation fits
- ● Disclosures minimised as "it's fine, it's just discipline"
- ● Increased aggression or significantly withdrawn behaviour
- ● Describing extreme physical punishments as normal
- ● Running away from home; reporting fear of returning
All Signs in the Carer
- ● Explanation of injury changes between tellings or between professionals
- ● Delay in seeking medical attention
- ● Dismissive or hostile reaction to concern being raised
- ● Blaming the child for the injury ("she always does silly things")
- ● Only one carer present at all medical and professional contacts
⚠ Do not attempt to examine injuries yourself
If you see or suspect a physical injury, do not remove clothing to examine it. Note what you can observe, ask the child open-ended questions if appropriate ("I can see you've hurt your arm — how did that happen?"), record exactly what you see and hear, and refer. Medical examination should be conducted by a paediatrician — unnecessary examination by non-medical staff can compromise evidence and the child's dignity.
Fabricated or Induced Illness (FII)
WT2026 definition:
"Although rare, there may be times when a parent or carer presents a child as ill or more unwell/more disabled than the child actually is. This is known as perplexing presentations or fabricated or induced illness."
FII sits within the category of physical abuse because inducing illness in a child involves deliberately causing physical harm. It is among the most serious and difficult-to-identify forms of maltreatment. The majority of perpetrators are mothers, and the majority of victims are children under five.
Fabricated (presentation without illness)
- Parent reports symptoms the child does not have
- Test results and observed findings do not match the reported history
- Parent insists the child is more seriously ill than professionals can verify
- Child is described as unable to walk, eat, or function in ways that observations contradict
Induced (causing genuine illness)
- Administering medication or substances to provoke genuine symptoms
- Tampering with medical samples
- Restricting diet or fluids to create a verifiable medical condition
- Suffocating to produce apnoeic episodes
Guidance for Schools & DSLs
Do not delay — refer the same day
Physical abuse — particularly in young children — can escalate quickly. KCSIE 2025 is explicit: where there is a concern about a child's safety, the DSL must refer without unnecessary delay. Do not wait until the end of the week. Do not try to gather more evidence first. If you see something that concerns you, report it to the DSL immediately.
Record what you see, in writing, with a timestamp
Write exactly what you observed — not your interpretation. "Child had a 3cm circular bruise on the inside of the left upper arm, with a lighter centre, consistent with a cigarette burn. Child said 'Mum was cross.' Time: 9:14am." Do not wash injury sites, apply cream, or allow anyone to handle the injury in a way that may affect evidence.
Do not tell the parent you are referring
Where there is a concern that a parent may destroy evidence, interfere with witnesses, or place the child at greater risk, do not inform the parent prior to the referral. KCSIE 2025 is clear: the child's safety is paramount. Speak to your MASH or social care duty team if you are unsure whether to notify the parent.
PE, swimming, and changing room observations
Schools have a unique opportunity to observe injuries through PE and swimming. Staff should be aware that children with physical abuse histories may be reluctant to change, or may change hurriedly. Injuries observed in this context should be handled sensitively — the child should never be made to undress for examination, but what can be naturally observed should be recorded and reported.
Guidance for Parents & Carers
If you are struggling with your temper or your child's behaviour
Many parents who physically harm their children do not set out to do so. Stress, financial pressure, domestic abuse, and mental health difficulties can push parents to a breaking point. If you recognise yourself in that situation, support is available before things escalate.
- Family Lives: 0808 800 2222 — free, confidential parenting support line
- NSPCC parenting helpline: 0808 800 5000
- Your GP can refer you to parenting programmes, anger management support, and mental health services
- Many local authorities offer Triple P, Incredible Years, or PAMS parenting programmes — ask your health visitor or children's centre
If a child discloses to you
If a child tells you they are being hurt at home: listen calmly, do not promise to keep it secret, tell them it is not their fault, and report what they have said to their school DSL, the NSPCC (0808 800 5000), or children's services. You can make a referral anonymously if you choose.
How to Refer
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Immediate danger: call 999
If a child is injured or at immediate risk of harm, call 999 before anything else. Do not attempt to manage the situation alone.
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Inform your DSL (schools) or line manager
Pass your written record of observations to the DSL immediately. If the DSL is unavailable, go to the deputy DSL or designated governor. The concern should not wait.
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Contact your local MASH
Find your local MASH contact at our MASH finder. Report the concern clearly: child's name, age, the injury observed, the explanation given, and why it is concerning.
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Arrange urgent medical assessment where needed
For visible injuries, MASH will advise whether the child should attend A&E or see a paediatrician. Do not delay medical care if the child appears to need it — call 999 or 111 as appropriate.
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Confirm in writing within 24 hours
Follow up any verbal referral in writing. Keep a copy in the child's confidential safeguarding record. Record the date, time, who you spoke to, and what action was agreed.