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Bruising characteristics from unintentional injuries in children: the ‘green flag’ study
  1. Mary Clyde Pierce
  1. Correspondence to Dr Mary Clyde Pierce, Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, USA; MPierce{at}luriechildrens.org

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Bruising in young children is probably the most overlooked or underappreciated injury prior to a child being severely injured or killed at the hands of their caregiver/s. In fact, 28%–64% of children who sustained subsequent severe physical abuse injuries had prior ‘sentinel’ bruising that was overlooked or dismissed as insignificant by a professional providing care for the child.1 2 This harm-causing oversight is likely driven by several factors: (1) bruising in and of itself rarely needs an intervention or treatment, and in medicine, we focus on findings (signs and symptoms) that need our immediate attention or add to our understanding of the patient’s condition. Thus, we overlook what does not register as important. (2) Bruising is common, ubiquitous and, for the most part, an inconsequential finding on active toddlers and older children, and (3) even if the bruise is noticed, the clinician may not feel comfortable concluding whether a bruise is or is not likely to occur from any one stated cause. In the spirit of being ‘non-accusatory with families’, the clinician is more likely to give the family the ‘benefit of the doubt’ and not make judgements about the bruising and injury ‘plausibility’.

Common trauma mechanisms that result in bruising include falls from standing or sitting, running/falling into an object (such as the edge of a coffee table), short falls of around 1 m (3.28 feet) (eg, fall off of furniture including a couch, bed, …

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