Which physical findings of bruising should raise suspicion of physical child abuse?

Updated: Apr 24, 2017
  • Author: Angelo P Giardino, MD, MPH, PhD; Chief Editor: Caroly Pataki, MD  more...
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Answer

Bruising over bony prominences is common in childhood, but patterns of bruising that raise the concern of possible abuse include the following:

  • Involvement of multiple areas of the body beyond bony prominences

  • Bruising of ears, facial cheeks, buttocks, palms, soles, neck, genitals (see images below)

  • Bruises at many stages of healing (see Bruising, in Pathophysiology)

  • Bruises in nonambulatory child

  • Patterned markings resembling objects, grab marks, slap marks, human bites, and loop marks (see images below)

  • Oral injury, lingular or labial frenula tears

    Inflicted pinch mark shaft. Image courtesy of Lawr Inflicted pinch mark shaft. Image courtesy of Lawrence R. Ricci, MD.
    Fingernail scratch in child with acute subdural wi Fingernail scratch in child with acute subdural with shift. Image courtesy of Lawrence R. Ricci, MD.
    Example of ear bruising. Ear bruising is a rare ac Example of ear bruising. Ear bruising is a rare accidental injury. This 10-month-old child was intubated for abusive head trauma (AHT) and spiral femur fracture and had this ear bruising in addition to other facial bruising.
    Linear inflicted bruising extending from arm to ba Linear inflicted bruising extending from arm to back, inflicted by a belt. Same child shown again with back bruising.
    Overlying linear inflicted marks, which the child Overlying linear inflicted marks, which the child disclosed came from a belt. Same child is shown in image of arm and back.
    Pattern bruising and extensive back bruising. The Pattern bruising and extensive back bruising. The 4-year-old child was found dead in his home and had no reported history. Autopsy revealed duodenal hematoma and perforation as cause of death.

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