| Bruises |
- Any bruising in infants 4 months of age or younger
- More than 1 bruise in a pre-mobile infant and more than 2 bruises in a crawling child
- Bruises located on the trunk, ear, neck, jawline, cheek, or buttocks
- Bruises with a pattern of the striking object (eg, slap, belt, or loop marks; spoons; spatulas; or other objects)
- Human bite marks
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| Oral injuries |
- Lip lacerations or bruising, especially in nonambulatory infants
- Lingual or labial frenulum tears, especially in nonambulatory infants
- Tongue lacerations, especially in nonambulatory infants
- Bruising or wounds of the buccal mucosa, gums, or palate, especially in nonambulatory infants
- Missing or fractured teeth with an absent or implausible history
- Maxillary or mandibular fractures with an absent or implausible history
- Bruising, lichenification, or scarring at the corners of the mouth from being gagged
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| Burns |
- Scalds in children <5 years of age that do not fit an unintentional spill pattern
- Scalds from hot tap water due to immersion, demonstrating a sharp upper line of demarcation ("high tide mark"), affecting both sides of the body symmetrically or involving the lower extremities and/or perineum
- Burns that have a sharply demarcated edge in the shape of the burning object (eg, clothing iron, spatulas, spoons, grates, metal hairdryer grids, curling irons, or the metal tops of butane cigarette lighters)
- Cigarette burns that appear as discreet circular burns 8 to 12 mm in diameter and are deep (eg, third-degree burns)
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| Fractures |
- Metaphyseal corner fractures
- Rib fractures
- Fractures of the sternum, scapula, or spinous processes
- Long bone fracture in a nonambulatory infant
- Multiple fractures in various stages of healing
- Bilateral acute long bone fractures
- Vertebral body fractures and subluxations in the absence of a history of high-force trauma
- Digital fractures in children younger than 36 months of age
- Transphyseal fractures (sometimes called epiphyseal separations)
- Severe skull fractures in children younger than 18 months of age
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| Serious injury without explanation* |
- Subdural hematoma or retinal hemorrhage in a young child without a significant public trauma such as a fall out a tall building window or a car crash
- Other intracranial injury without a clear trauma history
- Abdominal injury (perforation or hematoma of the bowel, pancreas, or bladder; solid organ [eg, liver, spleen, or kidney] hematoma or laceration)
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