Bite Marks of Child Abuse
Information has been excerpted from VisualDx clinical decision support system as a public health service. Additional information, including symptoms, diagnostic pearls, differential diagnosis, best tests, and management pearls, is available in VisualDx.
Synopsis
Bite marks can be a form of abusive injury and are of particular concern because of their potential for infection. Various instruments have been used in child abuse and traditionally leave patterned imprints of their shape on the child’s skin. Bite marks should be suspected when ecchymoses, abrasions, or lacerations are found in an elliptical, ovoid, or semicircular pattern.
Common locations for bite marks are on “fleshy” body parts (thighs, buttocks, cheeks), but they can occur anywhere on the body. They have been reported as a form of sexual as well as physical abuse. Bite marks have been documented on both pediatric male and female genitalia but are more commonly found in males.
A human bite typically causes less tissue destruction than that from an animal but has greater potential for infection. Aerobic and anaerobic bacteria commonly colonize the mouth such as Staphylococcus, Streptococcus, and Clostridium. Bite infections are typically polymicrobial.
Childhood physical and sexual abuse is a problem of epidemic proportions affecting children of all ages and economic and cultural backgrounds. Approximately 3.9 million cases of child abuse were investigated in 2020, with victims of substantiated cases numbering approximately 618 000. Although awareness is increasing, it is often challenging to differentiate findings attributable to child abuse from those of other benign skin conditions.
Look For
Bite marks typically appear as a pair of semicircular ecchymotic patches with either of the following patterns: positive pressure from the closing of teeth with disruption of small vessels, or negative pressure caused by suction creating surrounding erythema and edema with occasional petechiae.
Adult bite marks can be differentiated from those of a child by a maxillary intercanine distance (the linear distance between the central points of the cuspid tips) of more than 3 cm and the tooth pattern.
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