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]