Skip to main content
SpringerLink
Log in

Blunt-Force Trauma: Bruises

  • Chapter
  • First Online:
Cutaneous Manifestations of Child Abuse and Their Differential Diagnosis

Abstract

In humans, the skin is the most visible organ, and it is also the most frequently damaged organ when children sustain injuries. The injuries most commonly seen are bruises and abrasions. These injuries are usually the result of everyday activities at home, including play, sports, or during participating in traffic. In most cases, a skin injury is the only abnormality. However, sometimes an external injury is an indication for more serious internal damage (the “tip of the iceberg” phenomenon).

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

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 159.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover 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

  • Bariciak ED, Plint AC, Gaboury I et al (2003) Dating of bruises in children: an assessment of physician accuracy. Pediatrics 112(4):804–807

    Article  PubMed  Google Scholar 

  • Becker S, Schneider W, Kreuz W et al (1999) Post-trauma coagulation and fibrinolysis in children suffering from severe cerebro-cranial trauma. Eur J Pediatr 158(Suppl 3):S197–S202

    Article  PubMed  Google Scholar 

  • Brenner JC (2004) Forensic science, an illustrated dictionary. CRC Press, Boca Raton

    Google Scholar 

  • Busuttil A (2004) Wonden en verwondingen. In: Cohen BAJ, Holtslag H, Smitshuijzen RPh (eds) Forensische geneeskunde, raakvlakken tussen geneeskunst, gezondheidszorg en recht. Van Gorcum, Assen, pp 247–268

    Google Scholar 

  • Busuttil A (2009) Chapter 16. Asphyxial death in children. In: Busuttil A, Keeling JW (eds) Paediatric forensic medicine & pathology. Hodder Arnold, London, pp 329–335

    Google Scholar 

  • Carpenter RF (1999) The prevalence and distribution of bruises in babies. Arch Dis Child 80(4):363–366

    Article  PubMed  CAS  Google Scholar 

  • Crimescope (2003). http://www.crimescope.com/march%2015/Applications.htm. Accessed on 2010

  • Damm D, White D, Brinker M (1981) Variations of palatal erythema secondary to fellatio. Oral Surg Oral Med Oral Pathol 52(4):417–421

    Article  PubMed  CAS  Google Scholar 

  • David TJ (2004) Avoidable pitfalls when writing medical reports for court proceedings in cases of suspected child abuse. Arch Dis Child 89(9):799–804

    Article  PubMed  CAS  Google Scholar 

  • David TJ (2005) Child abuse and paediatrics. J R Soc Med 98(5):229–231

    Article  PubMed  Google Scholar 

  • Davis HW, Carrasco MM (2002) Child abuse and neglect. In: Zitelli BJ, Davis HW (eds) Atlas of pediatric physical diagnosis. Mosby, St Louis, pp 153–222

    Google Scholar 

  • DiMaio VJ, DiMaio D (2001a) Chapter 2. Timing of death. In: DiMaio VJ, DiMaio D (eds) Forensic pathology, 2nd edn. CRC Press, Boca Raton, pp 21–41

    Google Scholar 

  • DiMaio VJ, DiMaio D (2001b) Chapter 4. Blunt trauma wounds. In: DiMaio VJ, DiMaio D (eds) Forensic pathology, 2nd edn. CRC Press, Boca Raton, pp 91–116

    Google Scholar 

  • Dimaio VJ, Dimaio D (2001c) Chapter 8. Asphyxia. In: Dimaio VJ, Dimaio D (eds) Forensic pathology, 2nd edn. CRC, Boca Raton, pp 229–277

    Google Scholar 

  • Downes AJ, Crossland DS, Mellon AF (2002) Prevalence and distribution of petechiae in well babies. Arch Dis Child 86(4):291–292

    Article  PubMed  CAS  Google Scholar 

  • Ellis PSJ (1997) The pathology of fatal child abuse. Pathology 29(2):113–121

    Article  PubMed  CAS  Google Scholar 

  • Ely SF, Hirsch CS (2000) Asphyxial deaths and petechiae: a review. J Forensic Sci 45(6):1274–1277

    Google Scholar 

  • Feldman KW (1992) Patterned abusive bruises of the buttocks and the pinnae. Pediatrics 90(4):633–636

    PubMed  CAS  Google Scholar 

  • Gavin L, Lanz M, Leung D (1997) Chronic subungual hematomas: a presumed immunologic puzzle resolved with a diagnosis of child abuse. Arch Pediatr Adolesc Med 151(1):103–104

    Article  PubMed  CAS  Google Scholar 

  • Gilbert-Barnes E, Debich-Spicer DE (2005) Chapter 20. Pediatric forensic pathology. In: Gilbert-Barnes E, Debich-Spicer DE (eds) Handbook of pediatric forensic pathology. Humana Press, Totowa, pp 471–498

    Chapter  Google Scholar 

  • Glasgow JFT, Graham HK (1997) Chapter 4. Bruising and abrasions. In: Glasgow JFT, Graham HK (eds) Management of injuries in children. BMJ Publishing Group, London, pp 89–112

    Google Scholar 

  • Griest KJ (2010) Timing of death and injuries in infants and young children. In: Griest KJ (ed) Pediatric homicide, medical investigation. CRC Press, Boca Raton, pp 197–228

    Google Scholar 

  • Griest KJ, Zumwalt RE (1989) Child abuse by drowning. Pediatrics 83(1):41–46

    PubMed  CAS  Google Scholar 

  • Hammond H (2009) Chapter 1. Clinical assessment in suspected child abuse cases. In: Busutill A, Keeling JW (eds) Paediatric forensic medicine & pathology. Hodder Arnold, London, pp 1–23

    Google Scholar 

  • Harris TL, Flaherty EG (2011) Chapter 29. Bruises and skin lesions. In: Jenny C (ed) Child abuse and neglect – diagnosis, treatment and evidence. Elsevier Saunders, St. Louis, pp 239–251

    Chapter  Google Scholar 

  • Herrmann B, Dettmeyer R, Banaschak S et al (2008) Kapitel 4. Hautbefunde. In: Herrmann B, Dettmeyer R, Banaschak S et al (eds) Kindesmisshandlung, Medizi­nische Diagnostik, Intervention und rechtliche Grund­lagen. Springer Medizin Verlag, Heidelberg, pp 51–71

    Google Scholar 

  • Hobbs CJ, Hanks HGI, Wynne JM (1999a) Chapter 4. Physical abuse. In: Hobbs CJ, Hanks HGI, Wynne JM (eds) Child abuse and neglect – a clinician’s handbook, 2nd edn. Churchill Livingstone, London, pp 63–104

    Google Scholar 

  • Hobbs CJ, Hanks HGI, Wynne JM (1999b) Chapter 9. Clinical aspects of sexual abuse. In: Hobbs CJ, Hanks HGI, Wynne JM (eds) Child abuse and neglect – a clinician’s handbook, 2nd edn. Churchill Livingstone, London, pp 191–272

    Google Scholar 

  • Hymel KP, Abshire TC, Luckey DW, Jenny C (1997) Coagulopathy in pediatric abusive head trauma. Pediatrics 99(3):371–375

    Article  PubMed  CAS  Google Scholar 

  • Jain V, Ray M, Singhi S (2001) Strangulation injury, a fatal form of child abuse. Indian J Pediatr 68(6):571–572

    Article  PubMed  CAS  Google Scholar 

  • Jenny C, Reece RM (2009) Cutaneous manifestations of child abuse. In: Reece RM, Christian CW (eds) Child abuse, medical diagnosis and management, 3rd edn. American Academy of Pediatrics, Elk Grove Village, pp 18–51

    Google Scholar 

  • Johnson CF (1996) Physical abuse: accidental versus intentional trauma in children. In: In the APSAC handbook on child maltreatment. Sage Publications, Thousand Oaks, pp 206–226

    Google Scholar 

  • Johnson CF, Showers J (1985) Injury variables in child abuse. Child Abuse Negl 9(2):207–215

    Article  PubMed  CAS  Google Scholar 

  • Kaplan JM (1986) Pseudoabuse – the misdiagnosis of child abuse. J Forensic Sci 31(4):1420–1428

    PubMed  CAS  Google Scholar 

  • Kellogg N (2005) American Academy of Pediatrics/American Academy of Pediatric Dentistry – clinical report: oral and dental aspects of child abuse and neglect. Pediatrics 116(6):1565–1568

    Article  PubMed  Google Scholar 

  • Knottenbelt JD (1994) Traumatic rhabdomyolysis from severe beating–experience of volume diuresis in 200 patients. J Trauma 37(2):214–219

    Article  PubMed  CAS  Google Scholar 

  • Kornberg AE (1992) Skin and soft tissue injuries. In: Ludwig S, Kornberg AE (eds) Child abuse – a medical reference, 2nd edn. Churchill Livingstone, New York, pp 91–104

    Google Scholar 

  • Kos L, Shwayder T (2006) Cutaneous manifestations of child abuse. Pediatr Dermatol 23(4):311–320

    Article  PubMed  Google Scholar 

  • Kuban K, Winston K, Bresnan M (1983) Childhood subgaleal hematoma following minor head trauma. Am J Dis Child 137(7):637–640

    PubMed  CAS  Google Scholar 

  • Kumar V, Abbas AK, Fausto N et al (2007) Robbins basic pathology, 8th edn. Saunders, Philadelphia, p 86

    Google Scholar 

  • Langlois NEI, Gresham GA (1991) The ageing of bruises: a review and study of the colour changes with time. Forensic Sci Int 50(2):227–238

    Article  PubMed  CAS  Google Scholar 

  • Lee ACW (2008) Bruises, blood coagulation tests and the battered child syndrome. Singapore Med J 49(6):445–450

    PubMed  CAS  Google Scholar 

  • Leung A, Robson L (1987) Myoglobinuria from child abuse. Urology 29(1):45–46

    Article  PubMed  CAS  Google Scholar 

  • Maguire S, Mann MK, Sibert J et al (2005a) Can you review bruises accurately in children? Arch Dis Child 90(2):187–189

    Article  PubMed  CAS  Google Scholar 

  • Maguire S, Mann MK, Sibert J et al (2005b) Are there patterns of bruising in childhood which are diagnostic or suggestive of abuse? A systematic review. Arch Dis Child 90(2):182–186

    Article  PubMed  CAS  Google Scholar 

  • Merck Manuals Online Medical Library (2007) Blunt injuries to the eye. http://www.merckmanuals.com/home/injuries_and_poisoning/injuries_to_the_eye/blunt_injuries_to_the_eye.html. Accessed on 2010

  • Minford AMB, Richards EM (2010) Excluding medical and haematological conditions as a cause of bruising in suspected non-accidental injury. Arch Dis Child Educ Pract Ed 95(1):2–8

    Article  PubMed  CAS  Google Scholar 

  • Mukherji SK, Siegel MJ (1987) Rhabdomyolysis and renal failure in child abuse. Am J Roentgenol 148(6):1203–1204

    CAS  Google Scholar 

  • Munang LA, Leonard PA, Mok JY (2002) Lack of agreement on colour description between clinicians examining childhood bruising. J Clin Forensic Med 9(4):171–174

    Article  PubMed  CAS  Google Scholar 

  • Nathanson M (2006) Chapter 11. The physically and emotionally abused child: In Mason JK, Purdue BN. The Pathology of Trauma, 3rd edn. Arnold, London, pp 155–175

    Google Scholar 

  • Nayak K, Spencer N, Shenoy M et al (2006) How useful is the presence of petechiae in distinguishing non-accidental from accidental injury? Child Abuse Negl 30(5):549–555

    Article  PubMed  Google Scholar 

  • Newson J, Newson E (1986) Findings on use of physical punishment on 1, 4, 7 and 11 year old children, together with some sequelae in later life. Child Development Research Unit. University of Nottingham, Nottingham (cited from Hobbs, 1999)

    Google Scholar 

  • Pascoe JM, Hildebrandt HM, Tarrier A et al (1979) Patterns of skin injury in nonaccidental and accidental injury. Pediatrics 64(2):245–247

    PubMed  CAS  Google Scholar 

  • Payne-James J (2003) Chapter 36. Assault and injury in the living. In: Payne-James J, Busuttil A, Smock W (eds) Forensic medicine: clinical and pathological aspects. Greenwich Medical Media Ltd, San Francisco, pp 543–564

    Google Scholar 

  • Pediatric Care Online (2009). http://www.pediatriccareonline.org/pco/ub/view/Point-of-Care-Quick-Reference/397100/1.2/Petechiae_and_Purpura. Accessed on 2011

  • Peebles J, Losek JD (2007) Child physical abuse and rhabdomyolysis: case report and literature review. Pediatr Emerg Care 23(7):474–477

    Article  PubMed  Google Scholar 

  • Plattner T, Bolliger S, Zollinger U (2005) Forensic assessment of survived strangulation. Forensic Sci Int 153(2):202–207

    Article  PubMed  CAS  Google Scholar 

  • Purdue BN (2000) Chapter 15. Asphyxial and related death. In: Mason JK, Purdue BN (eds) The pathology of trauma, 3rd edn. Arnold, London, pp 230–252

    Google Scholar 

  • Raimer BG, Raimer SS, Hebeler JR (1981) Cutaneous signs of child abuse. J Am Acad Dermatol 5(2):203–214

    Article  PubMed  CAS  Google Scholar 

  • RCPCH (Royal College of Paediatrics and Child Health) (2008a) The physical signs of child sexual abuse – an evidence-based review and guidance for best practice. RCPCH, London, pp 14–89

    Google Scholar 

  • RCPCH (Royal College of Paediatrics and Child Health) (2008b) The physical signs of child sexual abuse – an evidence-based review and guidance for best practice. RCPCH, London, pp 153–157

    Google Scholar 

  • Reece RM, Grodin MA (1985) Recognition of nonaccidental injury. Pediatr Clin North Am 32(1):41–60

    PubMed  CAS  Google Scholar 

  • Robertson I (1957) Antemortem and postmortem bruises of the skin: their differentiation. J Forensic Med 4:2–10

    Google Scholar 

  • Robinson S (2000) Chapter 10. The examination of the adult victim of assault. In: Mason JK, Purdue BN (eds) The pathology of trauma, 3rd edn. Arnold, London, pp 140–154

    Google Scholar 

  • Rosenberg HK, Gefter WB, Lebowitz RL et al (1983) Prolonged dense nephrograms in battered children. Suspect rhabdomyolysis and myoglobinuria. Urology 21(3):325–330

    Article  PubMed  CAS  Google Scholar 

  • Roy D, Al Saleem BM, Al Ibrahim A et al (1999) Rhabdomyolysis and acute renal failure in a case of child abuse. Ann Saudi Med 19(3):248–250

    PubMed  CAS  Google Scholar 

  • Saukko P, Knight B (2004a) Chapter 4. The pathology of wounds. In: Saukko P, Knight B (eds) Knight’s Forensic pathology, 3rd edn. Arnold Publications, London, pp 136–173

    Google Scholar 

  • Saukko P, Knight B (2004b) Chapter 14. Suffocation and ‘asphyxia’. In: Saukko P, Knight B (eds) Knight’s forensic pathology, 3rd edn. Arnold, London, pp 352–367

    Google Scholar 

  • Saukko P, Knight B (2004c) Chapter 26. Forensic dentistry for the pathologist. In: Saukko P, Knight B (eds) Knight’s forensic pathology, 3rd edn. Arnold Publications, London, pp 527–540

    Google Scholar 

  • Schmitt BD (1987) The child with nonaccidental trauma. In: Helfer RE, Kempe RS (eds) The battered child, 4th edn. University of Chicago Press, Chicago, pp 178–196

    Google Scholar 

  • Schwartz AJ, Ricci LR (1996) How accurately can bruises be aged in abused children? Literature review and synthesis. Pediatrics 97(2):254–257

    PubMed  CAS  Google Scholar 

  • Schwengel D, Ludwig S (1985) Rhabdomyolysis and myoglobinuria as manifestations of child abuse. Pediatr Emerg Care 1(4):194–197

    Article  PubMed  CAS  Google Scholar 

  • Simpson CK (1979) Forensic medicine, 8th edn. Edward Arnold, London

    Google Scholar 

  • Somers GR, Chiasson DA, Taylor GP (2008) Presence of periorbital and conjunctival petechial hemorrhages in accidental pediatric drowning. Forensic Sci Int 175(2–3):198–201

    Article  PubMed  Google Scholar 

  • Speight N (1997) Non-accidental injury. In: Meadow R (ed) ABC of child abuse, 3rd edn. BMJ Publishing Group, London, pp 5–8

    Google Scholar 

  • Stephenson T, Bialas Y (1996) Estimation of the age of bruising. Arch Dis Child 74(1):53–55

    Article  PubMed  CAS  Google Scholar 

  • Sugar NF, Taylor JA, Feldman KW (1999) Bruises in infants and toddlers: those who don’t cruise rarely bruise. Arch Pediatr Adolesc Med 153(4):399–403

    PubMed  CAS  Google Scholar 

  • Sussman SJ (1968) The battered child syndrome. Calif Med 108(6):437–439

    PubMed  CAS  Google Scholar 

  • Tardieu (1870) Etude medico-legale sur la pendaison, la strangulation, et la suffocation. Bailliere et fils. Paris

    Google Scholar 

  • Thomas AE (2004) The bleeding child: is it NAI? Arch Dis Child 89(12):1163–1167

    Article  PubMed  CAS  Google Scholar 

  • Tsokos M (2005) Postmortem changes and artifacts occurring during the early postmortem interval. In: Tsokos M (ed) Pathology reviews, vol 3. Humana Press, Totowa, pp 183–238

    Chapter  Google Scholar 

  • Vanezis P (1997) Ageing of bruises by colour photometry. Lecture at the autumn symposium of the association of police surgeons (quoted from Robinson 2000)

    Google Scholar 

  • Vogeley E, Pierce MC, Bertocci G (2002) Experience with Wood lamp illumination and digital photography in the documentation of bruises on human skin. Arch Pediatr Adolesc Med 156:265–268

    PubMed  Google Scholar 

  • Vu TT, Guerrera MF, Hamburger EK (2004) Subgaleal hematoma from hair braiding: case report and literature review. Pediatr Emerg Care 20(12):821–823

    Article  PubMed  Google Scholar 

  • Watson AA (1990) Letsels en verwondingen. Uit Cohen BAJ, Leliefeld HJ (eds) Inleiding tot de Forensische geneeskunde, 2e druk. Kerckebosch BV Zeist, pp 279–96

    Google Scholar 

  • Wheeler DM, Hobbs CJ (1988) Mistakes in diagnosing non-accidental injury, 10 years’ experience. Br Med J 296(6631):1233–1236

    Article  CAS  Google Scholar 

  • Wilson EF (1977) Estimation of the age of cutaneous contusions in child abuse. Pediatrics 60(5):750–752

    PubMed  CAS  Google Scholar 

  • Wynne J (2003) Chapter 30. The physical and emotional abuse of children. In: Payne-James J, Busuttil A, Smock W (eds) Forensic medicine, clinical and pathological aspects. Greenwich Medical Media Ltd, San Francisco, pp 469–485

    Google Scholar 

  • Yamamoto K, Hayase T, Yamamoto Y et al (2000) Application of the term ‘Tardieu’s Spots’ to postmortem developed petechiae. A literature survey. Res Pract Forensic Med 43:386–392

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Forensic Medicine, Netherlands Forensic Institute, The Hague, Netherlands

    Robert A. C. Bilo M.D.

  2. Department of Paediatric Dermatology, Erasmus MC - Sophia, Rotterdam, Netherlands

    Arnold P. Oranje M.D., Ph.D.

  3. Department of Dermatology, Henry Ford Hospital, Detroit, Michigan, USA

    Tor Shwayder M.D. (Director of Pediatric Dermatology)

  4. St. James’s University Hospital, Leeds, UK

    Christopher J. Hobbs M.D.

Authors
  1. Robert A. C. Bilo M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Arnold P. Oranje M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tor Shwayder M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Christopher J. Hobbs M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Bilo, R.A.C., Oranje, A.P., Shwayder, T., Hobbs, C.J. (2013). Blunt-Force Trauma: Bruises. In: Cutaneous Manifestations of Child Abuse and Their Differential Diagnosis. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-29287-3_3

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-29287-3_3

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-29286-6

  • Online ISBN: 978-3-642-29287-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation