Bruises in Infants and Toddlers

Injuries Suggestive of Physical Abuse in Young Children With Subconjunctival Hemorrhages

“…Indeed, this subset of children had similar rates of fractures and TBI as children with SCHs and bruises. The fact that these children were significantly younger than children with bruising with a mean age of younger than 5 months is consistent with previous data showing high rates of occult injury among children younger than 6 months with sentinel injury 21,24,25 …”

Validation of a Clinical Decision Rule to Predict Abuse in Young Children Based on Bruising Characteristics

“…Some bruises may have been missed, but the screening process was standardized. The finding of overall prevalence of bruising (14%) is higher than our previously published results of 3.5% and results from other studies in infants . Enrollment in pediatric emergency departments vs primary care clinics and an enriched sampling of potential abuse patients may account for this difference.…”

“…Consistent with the study findings, forces applied to the body from physical assault of a child (eg, grabbing the torso, neck, or face) would be expected to result in bruising to regions of the body that differ from those associated with nonabusive injury (eg, falling forward onto the ground or falling off furniture). Several other studies also found bruising to the regions in the BCDR to be highly associated with abuse. Notably, bruising to the ears, neck, angle of the jaw, cheeks (fleshy), frenulum, and buttocks were seen most often in abuse cases and rarely in nonabuse cases.…”

Bruising in children who are assessed for suspected physical abuse

“…Thus, not every bruise on a child who has been physically abused is necessarily abusive in aetiology. Previous studies have shown that unintentional bruises occur over the front of the body12 13 and on bony prominences: the facial T is a typical location for facial injuries after slips, trips and falls 14. In our study, bruises over the forehead, nose, mouth and chin were common in abused children as well as in those where abuse was excluded; some of these may represent bruises sustained from unintentional injury in the abused children.…”