Aims: To investigate what patterns of bruising are diagnostic or suggestive of child abuse by means of a systematic review.
Methods: All language literature search 1951–2004. Included: studies that defined patterns of bruising in non-abused or abused children <18 years. Excluded: personal practice, review articles, single case reports, inadequate confirmation of abuse. Two independent full text reviews using standardised data extraction and critical appraisal forms. Studies ranked by study design and definition of abuse used.
Results: Twenty three studies included: seven non-abusive bruising, 14 abusive bruising, and two both. Non-abusive: The prevalence, number, and location of bruises is related to increased motor development. Bruising in non-independently mobile babies is very uncommon (<1%). Seventeen per cent of infants who are starting to mobilise, 53% of walkers, and the majority of schoolchildren have bruises. These are small, sustained over bony prominences, and found on the front of the body. Abuse: Bruising is common in children who are abused. Any part of the body is vulnerable. Bruises are away from bony prominences; the commonest site is head and neck (particularly face) followed by the buttocks, trunk, and arms. Bruises are large, commonly multiple, and occur in clusters. They are often associated with other injury types that may be older. Some bruises carry the imprint of the implement used.
Conclusion: When abuse is suspected, bruising must be assessed in the context of medical, social, and developmental history, the explanation given, and the patterns of non-abusive bruising. Bruises in non-mobile infants, over soft tissue areas, that carry the imprint of an implement and multiple bruises of uniform shape are suggestive of abuse. Quality research across the whole spectrum of children is urgently needed.
- physical abuse
- child abuse
Statistics from Altmetric.com
The appendices are available as a downloadable PDF (printer friendly file).
If you do not have Adobe Reader installed on your computer,
you can download this free-of-charge, please Click here
Files in this Data Supplement:
- [View PDF] -
Box 1 Search Criteria
Figure 1 Ranking used for study type and abuse definitions
Table A Summary of papers detailing bruising in non-abused children
Table B Papers comparing bruising patterns in abused and non abused children
Table C Summary of papers detailing bruising in abused children
- [View PDF] -
Competing interests: none declared
Welsh Child Protection Systematic Review Group: M Barber, P Barnes, R Brooks, M James-Ellison, N John, A Maddocks, A Naughton, C Norton, H Payne, L Price, B Ranton, C Woolley
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.