Skip to main content

Bruising in Infants and Children

  • Chapter
  • First Online:
Pediatric Forensic Evidence
  • 592 Accesses

Abstract

Bruises may be accidental, inflicted or the result of an underlying medical disorder. They are commonly accidental but also the commonest manifestation of inflicted injury with 90% of victims sustaining skin injury.

A bruise is the escape of blood from ruptured blood vessels caused by blunt trauma damaging underlying skin and blood vessels. Blood leaks from the capillaries and larger vessels into unbroken skin. Swelling is due to blood or fluid leakage into the bruise.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Maguire S, Mann MK, Sibert J, Kemp A. Are there patterns of bruising in childhood which are diagnostic or suggestive of abuse? A systematic review. Arch Dis Child. 2005;90(2):182–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Carpenter RF. The prevalence and distribution of bruising in babies. Arch Dis Child. 1999;80(4):363–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Sheets LK, Leach ME, Koszewski IJ, Lessmeier AM, Nugent M, Simpson P. Sentinel injuries in infants evaluated for child physical abuse. Pediatrics. 2013;131(4):701–7.

    Article  PubMed  Google Scholar 

  4. Thomas A. The bleeding child: is it NAI. Arch Dis Child. 2004;89(12):1163–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Bays J. Conditions mistaken for child abuse. In: Reece RM, editor. Child abuse: medical diagnosis and management. Philadelphia: Lea & Febiger; 1994. p. 358–85.

    Google Scholar 

  6. O’Hare AE, Eden OB. Bleeding disorders and non-accidental injury. Arch Dis Child. 1984;59(9):860–4.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Sussman SH. Skin manifestations of the battered child syndrome. J Pediatr. 1968;72:99–101.

    Article  CAS  PubMed  Google Scholar 

  8. Chang LT, Tsai MC. Craniofacial injuries from slip, trip, and fall accidents of children. J Trauma – Inj Infect Crit Care. 2007;63(1):70–4.

    Article  Google Scholar 

  9. Kemp AM, Dunstan F, Nuttall D, Hamilton M, Collins P, Maguire S. Patterns of bruising in preschool children. A longitudinal study. Arch Dis Child. 2015;100(5):426–31.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Kemp A, Maguire S, Nuttall D, Collins P, Dunstan F. Bruising in children who are assessed for suspected physical abuse. Arch Dis Child. 2014;80(4):363–6.

    Google Scholar 

  11. Brinkman B, Puschel K, Matzsch T. Forensic dermatological aspects of the battered child syndrome. Act Dermatolol. 1979;5:217–32.

    Google Scholar 

  12. Pascoe JM, Hildebrandt HM, Tarrier A, Murphy M. Patterns of skin injury in non-accidental and accidental injury. Pediatrics. 1979;64:245–7.

    CAS  PubMed  Google Scholar 

  13. Johnson CF, Showers J. Injury variables in child abuse. Child Abuse Negl. 1985;9:207–15.

    Article  CAS  PubMed  Google Scholar 

  14. Pierce M, Kaczor K, Aldridge S, et al. Bruising characteristics discriminating physical child abuse from accidental trauma. Pediatrics. 2010;125:67–74.

    Article  PubMed  Google Scholar 

  15. 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 Negl. 2006;30(5):549–55.

    Article  PubMed  Google Scholar 

  16. Dunstan FD, Guildea ZE, Kontos K, Kemp AM, Sibert JR. A scoring system for bruise patterns: a tool for identifying abuse. Arch Dis Child. 2002;86(5):330–3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Petska HW, Sheets LK, Knox BL. Facial bruising as a precursor to abusive head trauma. Clin Pediatr (Phila). 2013;52(1):86–8.

    Article  Google Scholar 

  18. Harper NS, Feldman KW, Sugar NF, Anderst JD, Lindberg DM. Examining siblings to recognize abuse investigators. Additional injuries in young infants with concern for abuse and apparently isolated bruises. J Pediatr. 2014;165(2):383–388.e1.

    Article  PubMed  Google Scholar 

  19. Ellerstein NS. Cutaneous manifestations of child abuse and neglect. Am J Dis Child. 1979;133:906–9.

    CAS  PubMed  Google Scholar 

  20. Bariciak ED, Plint AC, Gaboury I, Bennett S. Dating of bruises in children: an assessment of physician accuracy. Pediatrics. 2003;112(4):804–7.

    Article  PubMed  Google Scholar 

  21. Stephenson T, Bialas Y. Estimation of the age of bruising. Arch Dis Child. 1996;74(1):53–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Carpenter RF. The prevalence and distribution of bruising in babies. Archives of Disease in Childhood. 1999;80(4):363–366.

    Google Scholar 

  23. McCann J, Miyamoto S, Boyle C, Rogers K. Healing of non-hymenal genital injuries in pre-pubertal and adolescent girls: a descriptive study. Pediatrics. 2007;120(5):1000–11.

    Article  PubMed  Google Scholar 

  24. Johnson CF. Inflicted injury versus accidental injury. Pediatr Clin North Am. 1990;37:791–814.

    Article  CAS  PubMed  Google Scholar 

  25. Richardson AC. Cutaneous manifestations of abuse. In: Reece RM, editor. Child abuse: medical diagnosis and management. Philadelphia: Lea & Febiger; 1994. p. 167–84.

    Google Scholar 

  26. Barsley RE, West MH, Fair JA. Forensic photography. Ultraviolet imaging of wounds on skin. Am J Forensic Med Pathol. 1990;11(4):300–8.

    Article  CAS  PubMed  Google Scholar 

  27. Hempling SM. The applications of ultraviolet photography in clinical forensic medicine. Med Sci Law. 1981;21(3):215–22.

    Article  CAS  PubMed  Google Scholar 

  28. Peel M, Hughes J, Payne-James JJ. Post-inflammatory hyperpigmentation following torture. J Clin Forensic Med. 2003;10(3):193–6.

    Article  PubMed  Google Scholar 

  29. Hughes VK, Ellis PS, Burt T, Langlois NE. The practical application of reflectance spectrophotometry for the demonstration of haemoglobin and its degradation in bruises. J Clin Pathol. 2004;57(4):355–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Patno K, Jenny C. Who slapped that child? Child Maltreat. 2008;13(3):298–300.

    Article  PubMed  Google Scholar 

  31. Kemp A, Maguire SA, Sibert J, Frost R, Adams C, Mann M. Can we identify abusive bites on children? Arch Dis Child. 2006;91:951.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Sweet D, Lorente M, Lorente JA, Valenzuela A, Villanueva E. An improved method to recover saliva from human skin: the double swab technique. J Forensic Sci. 1997;42(2):320–2.

    Article  CAS  PubMed  Google Scholar 

  33. Gold MH, Roenigk HH, Smith ES, Pierce LJ. Human bite marks. Differential diagnosis. Clin Pediatr (Phila). 1989;28(7):329–31.

    Article  CAS  Google Scholar 

  34. Kornberg AE. Skin and soft tissue injuries. In: Ludwig S, Kornberg AE, editors. Child abuse: a medical reference. 2nd ed. New York: Churchill Livingstone; 1992. p. 91–104.

    Google Scholar 

  35. Reece RM, Ludwig S. Child abuse: medical diagnosis and management. 2nd ed. Philadelphia: Lippincott Williams and Wilkins; 2001.

    Google Scholar 

  36. Chiaviello CT, Christoph RA, Bond GR. Stairway-related injuries in children. Pediatrics. 1994;94(5):679–81.

    CAS  PubMed  Google Scholar 

  37. Docherty E, Hassan A, Burke D. Things that go bump…bump…bump: an analysis of injuries from falling down stairs in children based at Sheffield Children’s Hospital. Emerg Med J. 2010;27(3):207–8.

    Article  PubMed  Google Scholar 

  38. Joffe M, Ludwig S. Stairway injuries in children. Pediatrics. 1988;82(3):457–61.

    CAS  PubMed  Google Scholar 

  39. Hobbs CJ, Osman J. Genital injuries in boys and abuse. Arch Dis Child. 2007;92(4):328–31.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Yeatman GW, Dang VV. Cao Gío (coin rubbing). Vietnamese attitudes toward health care. JAMA. 1980;244(24):2748–9.

    Article  CAS  PubMed  Google Scholar 

  41. Sandler AP, Haynes V. Non-accidental trauma and medical folk belief: a case of cupping. Pediatrics. 1978;61(6):921–2.

    CAS  PubMed  Google Scholar 

  42. Clements J, Zarkowska E. Behavioural concerns and autistic spectrum disorders: explanations and strategies for change. London: Jessica Kingsley Publishers; 2000.

    Google Scholar 

  43. Minshawi NF, Hurwitz S, Fodstad JC, Biebl S, Morriss DH, McDougle CJ. The association between self-injurious behaviors and autism spectrum disorders. Psychol Res Behav Manag. 2014;7:125–36.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Hyman SL, Fisher W, Mercugliano M, Cataldo MF. Children with self-injurious behavior. Pediatrics. 1990;85(3 Pt 2):437–41.

    CAS  PubMed  Google Scholar 

  45. 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):604–9.

    Article  PubMed  Google Scholar 

Further Reading

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing Switzerland

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Robinson, D.L. (2017). Bruising in Infants and Children. In: Pediatric Forensic Evidence. Springer, Cham. https://doi.org/10.1007/978-3-319-45337-8_2

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-45337-8_2

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-45335-4

  • Online ISBN: 978-3-319-45337-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics