Facial Surgeon:Look Beyond the Obvious for Telltale Signs of Child Abuse

'Your face is as a book where men may read strange matters'
-- Shakespeare, Macbeth

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American Association of Oral and Maxillofacial Surgeons
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CHICAGO, Sept. 10, 1997 -- The eyes may be the window to the soul, but the face offers the most telling glimpse behind the closed doors of child abuse.

In a comprehensive study of 371 children who were suspected of being abused, injuries to the head and face accounted for 28% of 892 soft-tissue injuries. Among infants, 49% of the 61 soft-tissue injuries were found on the head or face.

Perhaps the most notable finding was that most of these children did not exhibit the "classic" signs of child abuse, i.e., fractures or severe bruises. In fact, very few of the 266 children who were three years or older had been severely battered.

Clearly, the tens of millions of healthcare professionals, teachers, social workers and others who work with children every day should be able to recognize the more subtle signs of child abuse. Dr. Daniel Laskin, Editor of Journal of Oral and Maxillofacial Surgery, who has been involved with this issue for more than two decades, writes that "the prime requisite for the successful recognition and further prevention of child abuse is still a high index of suspicion."

In addition to the obvious signs such as jaw fractures or facial bruises, Dr. Laskin cites the following oral and maxillofacial injuries as possible indicators of child abuse:

• Bruised or swollen lips
• Loose teeth
• Lacerations of the tongue and lips caused by forced feeding
• Abrasions of the corners of the mouth from the use of a gag
• Evidence of hair pulling
• Hematomas, i.e., localized masses of blood outside the blood vessels, especially in infants
• Tearing of the tympanic membrane in the ear

Dr. Laskin emphasizes that these conditions by themselves are not conclusive proof of abuse, but they should arouse suspicion if accompanied by one or more of the following factors:

• Multiple, anatomically unrelated injuries that can't be explained by the parent
• Evidence of physical or emotional neglect
• Malnourishment or malnutrition
• Scars from previous injuries or injuries in various stages of healing

Another important consideration is the emotional makeup of the parent or primary caregiver. While abusive parents can vary greatly in terms of education and economic status, many share certain characteristics, e.g.:

• Immaturity
• Poor impulse control
• Low tolerance of frustration
• Tendency to establish inappropriately rigid behavioral standards
• Perceive themselves as under considerable emotional stress

More than 3.1 million cases of child abuse or neglect were reported in the U.S. in 1996, a 45% increase since 1987. Everyone who comes in contact with children should be aware that the signs of abuse are not always readily apparent. By keeping a constant vigil for the related indicators of abuse, caregivers will be better able to bring these secrets out of the dark and begin to cultivate in each child, as Shakespeare also wrote, "a garden in her face where roses and white lilies grow."

For More Information

Readers interested in knowing more about facial trauma and child abuse can write or call the American Association of Oral and Maxillofacial Surgeons, 9700 Bryn Mawr Avenue, Rosemont, IL, 60018-5701, 800-467-5268. The organization offers a free copy of Dr. Laskin's editorial, "The Recognition of Child Abuse," as well as a list of resources.

CONTACT: Jan Shulman or Judy Horak for AAOMS, 312-649-0371