Child Physical Maltreatment

Is the child under the age of 2?

1. Yes
2. No

Was there an injury (including non-observable injuries marked by pain)?

1. Yes
2. No

Was the MOST SERIOUS injury in the incident any of the following:

• Loss of consciousness
• Loss of functioning (including, but not limited to, broken bones, detached retina, loose or chipped teeth)
• Heat stroke or heat exhaustion
• Damage to internal organs (including, but not limited to, internal bleeding or swelling)
• Disfigurement (including, but not limited to, scarring that is meaningful due to its size or location)
• Death

1. Yes
2. No

Which of the following was the MOST SERIOUS injury?

1. Damage to skin (cut/more than superficial scratch)
2. Welt
3. Swelling
4. Bruise
5. Pain
6. Damage to eye (cut/scratch)
7. Red marks
8. Scratch
9. Bloody nose
10. Cut inside the mouth
11. Burn
12. Physical impact not listed here

Which best describes the injury?

1. Direct pressure of longer than 10 minutes to stop bleeding
2. Direct pressure of less than 10 minutes to stop the bleeding
3. Superficial cut

Which best describes the injury?

1. Direct pressure of longer than 10 minutes to stop bleeding
2. Direct pressure of less than 10 minutes to stop the bleeding
3. Superficial cut

Which best describes the injury?

1. Welts with broken skin, blistering (or, for older injuries, scarring)
2. Welts where the skin is not broken or blistered (or, for older injuries, not scarred)
3. Superficial mark (e.g., red mark)

Which best describes the injury?

1. Welts with broken skin, blistering (or, for older injuries, scarring)
2. Welts where the skin is not broken or blistered (or, for older injuries, not scarred)
3. Superficial mark (e.g., red mark)

Which best describes the injury?

1. Swelling that significantly limits functioning (for example, swollen ankle that requires crutches, swollen eye that limits visual field)
2. Swelling that impacts but does not significantly limit functioning (for example, swollen ankle that causes limp, swollen eye that does not limit visual field)
3. Just noticeable swelling

Which best describes the injury?

1. Swelling that significantly limits functioning (for example, swollen ankle that requires crutches, swollen eye that limits visual field)
2. Swelling that impacts but does not significantly limit functioning (for example, swollen ankle that causes limp, swollen eye that does not limit visual field)
3. Just noticeable swelling

Which best describes the injury?

1. Bruising that covers a total area about the size of the victim’s hand (in one or multiple bruises)
2. Bruising that is painful in the course of normal activities
3. Non-superficial bruising (dark in color) that covers a total area half the size of the victim’s hand (in one or multiple bruises)
4. Non-superficial bruising (dark in color) that covers a total area less than the size of the victim’s hand (in one or multiple bruises)
5. Superficial (very light) bruising

Which best describes the injury?

1. Bruising that covers a total area about the size of the victim’s hand (in one or multiple bruises)
2. Bruising that is painful in the course of normal activities
3. Non-superficial bruising (dark in color) that covers a total area less than the size of the victim’s hand (in one or multiple bruises)
4. Superficial (very light) bruising

Which best describes the injury?

1. Pain that (a) significantly limits functioning in normal activities AND (b) lasts at least 24 hours
2. Pain that (a) impacts but does not significantly limit functioning AND (b) lasts at least 24 hours
3. Pain reported (a) that does not limit or impact functioning OR (b) lasts less than 24 hours

Which best describes the injury?

1. Notable damage to eye that significantly limits vision (for example, cut/scratch to the eye area that one cannot keep one’s eye open, or a patch is required while the cut/scratch heals)
2. Notable damage to eye that impacts but does not significantly limit vision (for example, cut/scratch to the eye but one can keep one’s eye open most of the time, it may hurt to blink)
3. Just noticeable damage to eye

Which best describes the injury?

1. (a) Third degree burn OR (b) burn that is very deep and marked by skin turning bright red, white, or black and leathery. Pain is typically not reported due to nerve damage.
2. (a) Second degree burn OR (b) a burn that is marked by redness, blisters, and pain.
3. (a) First degree burn OR (b) a burn that is marked by redness, occasional swelling, and some pain.

Which best describes the injury?

1. The nose was broken
2. There was swelling
3. The nose was broken AND there was swelling
4. Neither

Which best describes the injury?

1. Medical attention is required to stop the bleeding
2. Bleeding stopped without medical attention

The act(s) or pattern of acts:

1. extremely impacted physical functioning
2. highly impacted physical functioning
3. somewhat impacted physical functioning
4. did not impact physical functioning

Was there pain?

1. Yes
2. No

Which best describes the pain?

1. Pain that (a) significantly limits functioning in normal activities AND (b) lasts at least 24 hours
2. Pain that (a) impacts but does not significantly limit functioning AND (b) lasts at least 24 hours
3. Pain reported (a) that does not limit or impact functioning OR (b) lasts less than 24 hours

Was there reasonable potential for any of the injuries to occur? (Serious Injuries)

• Loss of consciousness
• Loss of functioning (including, but not limited to, broken bones, detached retina, loose or chipped teeth)
• Heat stroke or Heat exhaustion
• Damage to internal organs (including, but not limited to, internal bleeding or swelling)
• Disfigurement (including, but not limited to, scarring that is meaningful due to its size or location)

1. Yes
2. No

There was reasonable potential for one of these injuries:

• Loss of consciousness
• Loss of functioning (including, but not limited to, broken bones, detached retina, loose or chipped teeth)
• Heat stroke or Heat exhaustion
• Damage to internal organs (including, but not limited to, internal bleeding or swelling)
• Disfigurement (including, but not limited to, scarring that is meaningful due to its size or location)

How lucky was the person to have not sustained one of these injuries? In other words, what was the inherent dangerousness of the act?

1. Dangerous (less than 1 in 4 chance of happening)
2. Very dangerous (1 in 4 chance to 1 in 2 chance of happening)
3. Incredibly dangerous (more than 1 in 2 chance of happening)

The fear or anxiety caused or exacerbated by the incident:

1. extremely impacted the overall level of functioning
2. highly impacted the overall level of functioning
3. somewhat impacted the overall level or functioning
4. did not impact the overall level of functioning