More severe findings may include Handprints or oval fingertip marks caused by slapping or grabbing and shaking Long, bandlike ecchymoses caused by belt whipping Narrow arcuate bruises caused by extension cord whipping Multiple small, round burns caused by cigarettes Symmetric scald burns of upper or lower extremities or buttocks caused by intentional immersion Bite marks Thickened skin or scarring at the corners of the mouth caused by being gagged Patchy alopecia, with varying hair lengths, caused by hair pulling Fractures highly indicative of physical abuse include classic metaphyseal lesions (usually caused by shaking an infant or toddler), rib fractures, and spinous processes fractures.