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Patterns and sites – non-abused

The following is a summary of the systematic review findings up to the date of our most recent literature search. If you have a specific clinical case, we strongly recommend you read all of the relevant references as cited and look for additional material published outside our search dates.

 

Bruising in non-abused children

 

Gender

  • There is no difference in bruising patterns between boys and girls 1,2,4-7

 

Trends in accidental bruising

  • Increased accidental bruising was noted in the summer months 1,2 and with increased family size 1-3
  • Children sustain more bruises as they become older 1,2,5,6,8
  • Bruising is strongly related to mobility 1,2,5,6,8
  • Bruising in a baby who is not yet crawling and therefore has no independent mobility is very uncommon 1,2,5,6,8
  • Approximately 17% of infants who are cruising have bruises (range 1-5 bruises) 1,5,6,8
  • 52%-87% of children who are walking have bruises (range 1-27 bruises) 1,2,5,6,8

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References

  1. Carpenter RF. The prevalence and distribution of bruising in babies. Archives of Disease in Childhood. 1999;80(4):363-366 [Pubmed]
  2. Kemp AM, Dunstan F, Nuttall D, Hamilton M, Collins P, Maguire S. Patterns of bruising in preschool children - a longitudinal study. Archives of Disease in Childhood. 2015;100(5):426-31 [Pubmed]

  3. Labbé J, Caouette G. Recent skin injuries in normal children. Pediatrics. 2001;108(2):271-276 [Pubmed]
  4. Nayak K, Spencer N, Shenoy M, Rubithon J, Coad N, Logan S. How useful is the presence of petechiae in distinguishing non-accidental from accidental injury? Child Abuse and Neglect. 2006;30(5):549-555 [Pubmed]
  5. Pierce M, Kaczor K, Aldridge S, O'Flynn J, Lorenz D. Bruising characteristics discriminating physical child abuse from accidental trauma [published erratum appears in Pediatrics 2010;125(4):861]. Pediatrics. 2010;125(1):67-74 [Pubmed]
  6. Sugar NH, Taylor JA, Feldman KW. Bruises in infants and toddlers; those who don't cruise rarely bruise. Puget Sound Pediatric Research Network. Archives of Pediatrics and Adolescent Medicine. 1999;153(4):399-403 [Pubmed]
  7. Tush BAR. Bruising in healthy 3-year-old children. Maternal-Child Nursing Journal. 1982;11(23):165-179 [Pubmed citation only]
  8. Wedgwood J. Childhood bruising. The Practitioner. 1990;234(1490):598-601 [Pubmed citation only]

The sites and characteristics of bruising in non-abused children

  • In mobile children the commonest sites of bruising are the shins and the knees 4,6-8
  • In slips, trips and falls the commonest sites of bruising are the back of the head and the front of the face, including the T of the forehead, nose, upper lip and chin 2,4
  • Less than 5% of accidental bruising was on the cheeks and less than 6% around the eyes 2,4
  • Most accidental bruises occur over bony prominences and are commonly seen on the front of the body. These correspond to the sites that are bumped in falls 1,2,4,6
  • Children who are pulling to stand may bump their head and sustain bruising to the head, usually occurring on the forehead 1,2,6
  • There were areas of the body where bruising was uncommon. These sites include the back, buttocks, forearm, face, neck, ears, abdomen or hip, upper arm, posterior leg, foot or hands 1-8
  • Children who sustain fractures rarely have a bruise overlying the fracture when they present to hospital 9

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References

  1. Carpenter RF. The prevalence and distribution of bruising in babies. Archives of Disease in Childhood. 1999;80(4):363-366 [Pubmed]
  2. Chang L-T, Tsai M-C. Craniofacial injuries from slip, trip, and fall accidents of children. Journal of Trauma - Injury, Infection, and Critical Care. 2007;63(1):70-74 [Pubmed]
  3. Dunstan FD, Guildea ZE, Kontos K, Kemp AM, Sibert JR. A scoring system for bruise patterns: a tool for identifying abuse. Archives of Disease in Childhood. 2002;86(5):330-333 [Pubmed]
  4. Kemp AM, Dunstan F, Nuttall D, Hamilton M, Collins P, Maguire S. Patterns of bruising in preschool children - a longitudinal study. Archives of Disease in Childhood. 2015;100(5):426-31 [Pubmed]

  5. Pierce M, Kaczor K, Aldridge S, O'Flynn J, Lorenz D. Bruising characteristics discriminating physical child abuse from accidental trauma [published erratum appears in Pediatrics 2010;125(4):861]. Pediatrics. 2010;125(1):67-74 [Pubmed]
  6. Sugar NH, Taylor JA, Feldman KW. Bruises in infants and toddlers; those who don't cruise rarely bruise. Puget Sound Pediatric Research Network. Archives of Pediatrics and Adolescent Medicine. 1999;153(4):399-403 [Pubmed]
  7. Tush BAR. Bruising in healthy 3-year-old children. Maternal-Child Nursing Journal. 1982;11(23):165-179 [Pubmed citation only]
  8. Wedgwood J. Childhood bruising. The Practitioner. 1990;234(1490):598-601 [Pubmed citation only]
  9. Worlock P, Stower M, Barbor P. Patterns of fractures in accidental and non-accidental injury in children: a comparative study. British Medical Journal (Clinical Research Edition). 1986;293(6539):100-102 [Pubmed]

Bruising in disabled children

  • Bruising patterns in disabled children showed the feet, knees and thighs as a frequent site of accidental bruising 1,2
  • Lower legs, ears, neck, chin, anterior chest and genitalia were rarely bruised accidentally 1,2
  • Bruising to the hands, arms and abdomen were significantly commoner in disabled than able bodied children 1,2
  • With data stratified into categories of unrestricted walker, restricted walker and wheelchair dependent, bruising increased with increasing independent mobility (p=0.001) 2
  • Causes of injury varied by mobility with falls predominating in the walkers in comparison to equipment usage and self-infliction for wheelchair users (p<0.001) 2

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References

  1. Goldberg AP, Tobin J, Daigneau J, Griffith RT, Reinert SE, Jenny C. Bruising frequency and patterns in children with physical disabilities. Pediatrics. 2009;124(2):604-609 [Pubmed]
  2. Newman C, Holenweg-Gross C, Vuillerot C, Jeannet P, Roulet-Perez E. Recent skin injuries in children with motor disabilities. Archives of Disease in Childhood. 2010;95(5):387-390 [Pubmed]

 

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