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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.


What patterns of bruising suggest physical child abuse?

  • Of 201 studies reviewed, 42 studies were included to address this question 1-42
  • Most information applied to children under 10 years of age
  • Two studies examined disabled children aged 2 to 20 years with accidental bruising 11,29
  • Bruising is the commonest injury in children who have been physically abused
  • Children also sustain bruises from every day play activities and accidents
  • Two comparative studies detail bruising patterns in children aged less than three years admitted to PICU 20,33


Influence of ethnicity and socio-economic group

  • There was very little information about bruising in different ethnic groups for non-abused children 38,40
  • White abused children are more likely to be bruised than black abused children 15
  • Patterns of bruising in non-abused children do not differ by socio-economic group 3,6,15,18,24,38,40,41

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  1. Atwal GS, Rutty GN, Carter N, Green MA. Bruising in non-accidental head injured children; a retrospective study of the prevalence, distribution and pathological associations in 24 cases. Forensic Science International. 1998;96(2):215-230 [Pubmed]
  2. Brinkmann B, Püschel K, Mätzsch T. Forensic dermatological aspects of the battered child syndrome. Aktuelle Dermatologie. 1979;5(6):217-232
  3. Carpenter RF. The prevalence and distribution of bruising in babies. Archives of Disease in Childhood. 1999;80(4):363-366 [Pubmed]
  4. 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]
  5. de Silva S, Oates RK. Child homicide - the extreme of child abuse. Medical Journal of Australia. 1993;158(5):300-301 [Pubmed]
  6. 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]
  7. Ellerstein NS. The cutaneous manifestations of child abuse and neglect. American Journal of Diseases of Children. 1979;133(9):906-909 [Pubmed]
  8. Feldman KW. Patterned abusive bruises of the buttocks and the pinnae. Pediatrics. 1992;90(4):633-636 [Pubmed citation only]
  9. Feldman KW. The bruised premobile infant; should you evaluate further? Pediatric Emergency Care. 2009;25(1):37-39 [Pubmed]
  10. Galleno H, Oppenheim WL. The battered child syndrome revisited. Clinical Orthopaedics and Related Research. 1982;162:11-19 [Pubmed]
  11. 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]
  12. Harper NS, Feldman KW, Sugar NF, Anderst JD, Lindberg DM. Additional injuries in young infants with concern for abuse and apparently isolated bruises.The Journal of Pediatrics. 2014;165(2):383-388 [Pubmed]

  13. Jappie F. Non accidental injuries in children. Australian Family Physician 1994;23(6):1144-1150 [Pubmed citation only]
  14. Johnson CF, Kaufman KL, Callendar C. The hand as a target organ in child abuse. Clinical Pediatrics. 1990;29(2):66-72 [Pubmed]
  15. Johnson CF, Showers J. Injury variables in child abuse. Child Abuse and Neglect. 1985;9(2):207-215 [Pubmed]
  16. 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]

  17. Kemp AM, Maguire SA, Nuttall D, Collins P, Dunstan F. Bruising in children who are assessed for suspected physical abuse. Archives of Disease in Childhood. 2014;99(2):108-113 [Pubmed]

  18. Labbé J, Caouette G. Recent skin injuries in normal children. Pediatrics. 2001;108(2):271-276 [Pubmed]
  19. Leavitt EB, Pincus RL, Bukachevsky R. Otolaryngologic manifestations of child abuse. Archives of Otolaryngology - Head & Neck Surgery. 1992;118(6):629-631 [Pubmed]
  20. Lopez MR, Abd-Allah S, Deming DD, Piantini R, Young-Snodgrass A, Perkin R, Barcega B, Sheridan-Matney C. Oral, jaw, and neck injury in infants and children: From abusive trauma or intubation? Pediatric Emergency Care. 2014;30(5):305-310 [Pubmed]

  21. Lynch A. Child abuse in the school-age population. Journal of School Health. 1975;45(3):141-148 [Pubmed citation only]
  22. Lyons TJ, Oates RK. Falling out of bed: a relatively benign occurrence. Pediatrics. 1993;92(1):125-127 [Pubmed]
  23. McMahon P, Grossman W, Gaffney M, Stanitski C. Soft-tissue injury as an indication of child abuse. The Journal of Bone and Joint Surgery (American volume). 1995;77-A(8):1179-1183 [Pubmed]
  24. Mortimer PE, Freeman M. Are facial bruises in babies ever accidental? Archives of Disease in Childhood. 1983;58(1):75-76 [Pubmed]
  25. Mosqueda Peña R, Ardura García C, Barrios López M, Casado Picón R, Palacios Cuesta A. Lesiones equimóticas en miembro superior [Spanish]. Ecchymotic injuries in upper extremity. Acta Pediátrica Española. 2008;66(4):198-200
  26. Murty OP, Ming CJ, Ezani MA, Yan PK, Yong TC. Physical injuries in fatal and non-fatal child abuse cases: A review of 16 years with hands on experience of 2 years in Malaysia. International Journal of Medical Toxicology and Legal Medicine. 2006;9(1):33-43
  27. Naidoo S. A profile of the oro-facial injuries in child physical abuse at a children's hospital. Child Abuse and Neglect. 2000;24(4):521-534 [Pubmed]
  28. 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]
  29. 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]
  30. Patno K, Jenny C. Who slapped that child? Child Maltreatment. 2008;13(3):298-300 [Pubmed]
  31. Peters ML, Starling SP, Barnes-Eley ML, Heisler KW. The presence of bruising associated with fractures. Archives of Pediatrics & Adolescent Medicine. 2008;162(9):877-881 [Pubmed]
  32. Petska HW, Sheets LK, Knox BL. Facial bruising as a precursor to abusive head trauma. Clinical Pediatrics. 2013;52(1):86-8 [Pubmed citation only]

  33. 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]
  34. Pierce M, Smith S, Kaczor K. Bruising in infants: those with a bruise may be abused. Pediatric Emergency Care. 2009;25(12):845-847 [Pubmed]
  35. Schultes A, Lackner K, Rothschild MA. "Scalping": A possible indicator for child abuse [German]. Rechtsmedizin. 2007;17(5):318-320 [Abstract from Springer]
  36. Seifert D, Puschel K. Subgaleal hematoma in child abuse. Forensic Science International. 2006;157(2):131-133 [Pubmed]
  37. Smith SM, Hanson R. 134 battered children: a medical and psychological study. British Medical Journal. 1974;3(5932):666-670 [Pubmed]
  38. 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]
  39. Sussman SJ. Skin manifestations of the battered-child syndrome. Journal of Pediatrics. 1968;72(1):99-101 [Pubmed citation only]
  40. Tush BAR. Bruising in healthy 3-year-old children. Maternal-Child Nursing Journal. 1982;11(23):165-179 [Pubmed citation only]
  41. Wedgwood J. Childhood bruising. The Practitioner. 1990;234(1490):598-601 [Pubmed citation only]
  42. 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]


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