Bruising
Bruising is the most common manifestation of physical abuse, occurring in one study in 52% of abused children.
Developmental Milestones
- 3-4 months – rolling over
- 6 months – sitting up
- 8-9 months – crawling
- 9-12 months – cruising
- >12 months – crashing
Pattern of bruises may be suggestive of abuse:
- multiple bruises in various stages of healing, especially on the trunk
- any bruising in a non-ambulatory baby
- hand prints or oval finger marks
- belt marks - long broad band ending with horseshoe shape or puncture from buckle
- loop pattern from cord, rope or wire that has been doubled up
- petechiae or instrument pattern on buttocks from paddling, severe spanking
- ligature pattern on neck, wrists, ankles
- gag pattern on corners of the mouth
- color of bruises is not reliable for dating, but documentation of colors is important
Location of bruises may be suggestive of abuse:
- upper thighs, especially inner thighs
- trunk, buttocks
- upper arms
- sides of face, ears, neck
- genitalia
Mimics of abusive bruising:
- drug ingestion, such as salicylates
- bleeding disorders
- infectious, inflammatory, or autoimmune disorders
- birthmarks
- cultural treatments such as cupping or coining
For more complete discussion of abuse mimics, see differential diagnosis table from e-book by Dr. Botash
[From Maguire S Are there patterns of bruising in childhood which are diagnostic or suggestive of abuse? A systematic review.Arch Dis Child. 2005 Feb;90(2):182-6 and
Sugar NF, Bruises in infants and toddlers Arch Pediatr Adolesc Med 1999;153(4):399]
Sugar NF, Bruises in infants and toddlers Arch Pediatr Adolesc Med 1999;153(4):399]