Bruises in Children: Normal or Child Abuse?

Tomika S. Harris, DNP, MSN, CPNP


J Pediatr Health Care. 2010;24(4):216-221. 

In This Article

Abstract and Introduction


Bruises in active children are common and often are considered "normal" childhood injuries. However, bruises also may be the result of physical abuse or other conditions. The evaluation of a child with bruising should include a thorough history and physical examination to determine the cause. When abuse is suspected, prompt reporting is necessary to protect the child from further injury. This article provides information intended to assist nurse practitioners and other pediatric health care providers in their decision making when assessing a child with bruises.


Bruising is common in active, healthy children. However, bruises are also a common finding in abused children (Thompson, 2005). Distinguishing between normal and abnormal bruising can be challenging and requires careful assessment by the practitioner. Physical abuse and mimickers of abuse should be included in the differential when evaluating a child with bruises.

In 2006, child protective service agencies in the United States received an estimated 3.3 million referrals concerning the welfare of 6 million children (Child Welfare Information Gateway, 2008). Nearly two thirds of the referrals were accepted for investigation. Approximately 905,000 children were verified victims of abuse in 2006. More than half the referrals alleging abuse and neglect were made by professionals, including health care providers, educators, law enforcement, and social service personnel.

Primary care providers are increasingly relied upon by child protective services to determine whether an injury is the result of abuse (Mudd & Findlay, 2004). Determining the cause of a bruise in a child can be a challenge. A misdiagnosis of child abuse can have serious consequences for a child and family. However, a child who is the victim of unreported abuse is at risk for further abuse and even death (American Academy of Pediatrics [AAP], 2002). Given these serious implications, when performing an assessment on a child who presents with bruises, providers must obtain a careful history and perform a thorough physical examination prior to arriving at conclusions.


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