• Do they seem to be in pain as they walk into your room or climb into the dental chair? Children whose ribs have been injured or whose bones have been fractured, for instance, may exhibit hindered movement or walk with a limp.
   
• Do they appear uncomfortable as they sit down? This may indicate sexual abuse. Is your young, female patient pregnant? This may be an additional indicator of sexual abuse.
   
• Check for facial symmetry - are there swellings, bruises or other types of injuries from trauma?
   
• Observe their hands. Are there burns from cigarettes, lighters or "glove-like" burns from immersion in a hot liquid? Do the hands exhibit the effects of trauma - injuries from being slammed in a car door, or rope marks from being bound? Injuries to the dorsal surface of the hand may indicate non-accidental trauma, as this is not a typical exploring surface like the palm is.
    
• Carefully observe the child's head. Are there any swellings of the scalp from trauma or fracture? You may need to palpate the head to determine whether swelling is present. Are there bald spots where hair was traumatically removed? If this is the case, there will be no loose hairs at the periphery of the bald area and no inflammation or scaling of the scalp associated with hair loss due to disease. Also, there may be a few petechiae present at the hair roots.
    
• Does the child's neck appear to have rope burns or hand marks from choking or strangling? Bruises on the back of the neck may result from the child having been shaken.
    
• Does the child have several bruises in various stages of resolution? Different colored bruises may indicate chronic abuse over several days or weeks?
    
• Are there elliptical or oval ecchymoses, abrasions or lacerations that indicate the child has been bitten? Individual marks where the incisal or occlusal surfaces of the teeth may be apparent may allow an observer to identify the exact teeth used to bite the child. For example, if the intercuspid space can be measured, and this distance is greater than three centimeters, the bite probably was caused by an adult. Bite mark analysis can provide an important link between a victim and the suspected perpetrator of the crime. Particular characteristics of a bite mark, such as rotated, fractured, or missing teeth; or diastemas can be consistent or inconsistent with the suspected abuser. A forensic odontologist may possibly be able to match up casts made of the suspect with casts made of the bite mark itself.
    
• Are there lesions on their ears that may indicate blows, punching, slapping, pulling, twisting or pinching? It has been noted that lesions on the ears, particularly if they are on both ears, are rarely accidental in nature.
    
• Does their nose appear broken or are there blood clots in the nostrils?
    
• Does the child have a deviated gaze, black eye, drooping eye lid, pupils of unequal size, or scleral hemorrhage from trauma?
    
• Does the child appear "overdressed" for the climate, in other words, are they wearing long sleeves, a turtleneck sweater, long pants and other heavy clothing in the heat of the summer? This may suggest a conscious attempt to hide bruises or injuries on arms or legs.
    
• Is the child clean, tidy and apparently well nourished, or dirty, disheveled and gaunt from neglect and malnourishment?
    
• If the child was brought in for treatment of an oral injury that seems to be abuse related, does it appear there was an obvious delay in seeking treatment?

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