The sexually abused battered child.
A total of 130 children were identified in whom both evidence of sexual abuse and non-accidental, non-genital physical injuries (bruises, fractures, scratches, burns and scalds, including failure to thrive) were found. There were 77 girls and 53 boys with mean ages 5.7 and 6.8 years respectively and the peak age between the second and seventh birthdays; this reflects previous reports indicating that physical and sexual abuse predominantly involves young children. Patterns of injury that suggested sexually motivated assault included bruises, scratches, and burns around the lower trunk and genitalia, thighs, buttocks, and upper legs including knees. Pinch and grip marks were found where the child was held. The sexual abuse often involved attempted or achieved penetration of mouth, vagina, or anus, and physical signs were seen relatively more often than in sexually abused children as a whole. Four children died and sexual aggression and child death in the domestic setting may be linked. One in six of 769 physically abused children (16.9%) and one in seven of 949 sexually abused children (13.6%) have suffered both forms of abuse.