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

Cultural Practices

Some cultural practices used to treat illness produce petechiae and purpura that can mimic abuse. Coining or Cao gio is a form of dermabrasion commonly used in Southeast Asian cultures to rid the body of "bad winds" by bringing bad blood to the surface (Davis, 2000). The process of Cao gio involves applying ointment to the skin and using a coin or spoon to firmly rub the skin until petechiae or purpura appear. The result is a distinct, symmetrical pattern of bruises typically on the back, shoulders, chest, temples, and forehead that resolve without residual effects (Figure 7).

Figure 7.

Typical coining lesions. This figure is available in color at

Cupping is another cultural practice used to treat illness. Cupping has been practiced by Russian, Asian, and Mexican cultures (Bays, 2001). A heated cup is applied to the skin, which creates suction on the skin, causing bruises that have been mistaken for abuse. Providers' knowledge of cultural practices along with a consistent history can aid in the diagnosis and avoid accusations of child abuse.


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