Bites: systematic review

Child Protection Evidence is a resource for clinicians across the UK and internationally to inform clinical practice, child protection procedures and professional and expert opinion in the legal system.

Children and young people who attend child protection medical assessments may present with a variety of injuries or physical findings. One such finding may be a bite mark, or a mark that is it thought could be due to a bite. Human bites are always inflicted which may or may not be abusive. There is the potential for the perpetrator to be identified from the injury itself if salivary DNA is present. Rarely, clear dental characteristics may also assist. Bite marks may be human or animal in origin, and it is possible to differentiate between these as well as between bites inflicted by an adult and a child.

This systematic review evaluates the scientific literature on abusive bites in children published up until May 2024 and reflects the findings of eligible studies.

The review aims to answer the following clinical question:

• What features are suggestive of a human bite mark on a child in abuse?

For more information on how to safely assess possible bite marks, please visit the Child Protection Companion 

Key findings:

• The lack of quality papers on bite marks in children is a significant constraint. Future studies should include more detail on diagnostic criteria.
• Findings of this systematic review are limited due to the lack of good quality studies where the bite mark is confirmed by a forensic odontologist.
• Evidence suggests that human bite marks can present as an arc shape or two opposing arc shaped bruises or marks on the skin.
• It can be possible to identify a perpetrator through careful analysis of bite marks, but this requires the expertise of forensic odontologists as well as adequate photography, the details of which go beyond the scope of this review.