What are the key clinical signs and symptoms that may indicate a non-accidental injury in children?

Suspect child maltreatment if a child has bruising in the shape of a hand, ligature, stick, teeth mark, grip or implement ¹.

Suspect child maltreatment if there is bruising or petechiae that are not caused by a medical condition and if the explanation for the bruising is unsuitable ¹.

Suspect child maltreatment if a child has an intracranial injury in the absence of major confirmed accidental trauma or known medical cause, especially if there are retinal haemorrhages, rib or long bone fractures, or other inflicted injuries ¹.

Suspect physical abuse if a child presents with signs of spinal injury (such as cervical injury or thoracolumbar injury) in the absence of confirmed accidental trauma ¹.

Consider child maltreatment if a child has intra-abdominal or intrathoracic injuries without a suitable explanation or with delayed presentation, especially if there is no external bruising ¹.

Consider child maltreatment if a child has oral injuries with an absent or unsuitable explanation ¹.

Consider child maltreatment if there is no suitable explanation for serious or unusual injuries ¹.

Suspect sexual abuse if a girl or boy has genital, anal or perianal injury (bruising, laceration, swelling or abrasion) with an absent or unsuitable explanation ¹.

Suspect sexual abuse if a girl or boy has persistent or recurrent genital or anal symptoms (such as bleeding or discharge) with no medical explanation and associated behavioural or emotional changes ¹.

Suspect sexual abuse if an anal laceration is present and causes have been excluded, such as constipation or Crohn's disease ¹.

Consider sexual abuse if an anus shows dynamic dilation during examination without a medical explanation ¹.