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Implications for practice

  • A bruise must never be interpreted in isolation and must always be assessed in the context of medical and social history, developmental stage, explanation given, full clinical examination and relevant investigations 

Patterns of bruising that are suggestive of physical child abuse:

  • Bruising in children who are not independently mobile 
  • Bruising in babies 
  • Bruises that are seen away from bony prominences
  • Bruises to the face, back, abdomen, arms, buttocks, ears, neck, and hands 
  • Multiple bruises in clusters
  • Multiple bruises of uniform shape 
  • Bruises that carry the imprint of implement used or a ligature 
  • Bruises that are accompanied by petechiae, in the absence of underlying bleeding disorders


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