Bruising in children who are assessed for suspected physical abuse
Open Access
- 16 September 2013
- journal article
- research article
- Published by BMJ in Archives of Disease in Childhood
- Vol. 99 (2), 108-113
- https://doi.org/10.1136/archdischild-2013-304339
Abstract
Objective To describe the characteristics of bruising and mode of presentation of children referred to the paediatric child protection team with suspected physical abuse (PA), and the extent to which these differ between the children where abuse was confirmed and those where it was excluded. Design Cross-sectional study. Setting and patients 519 children, <6 years, referred to two paediatric child protection teams. Main outcome measures The mode of presentation, number, anatomical distribution, size and appearance of bruises according to whether PA was confirmed or excluded. ORs with 95% CI were calculated where relevant. Results PA was confirmed in 69% of children; the rate varied from 84% when abuse was witnessed, admitted, alleged or where explanation for injury was absent or implausible, to 50% where there was a concerning history. Significantly more children with PA had bruises (89.4%) than PA-excluded (69.9%) and had significantly more sites affected (p<0.001). The odds of a PA child having bruising to: buttocks/genitalia (OR 10.9 (CI 2.6 to 46), left ear (OR 7.10 (CI 2.2 to 23.4), cheeks (Left (OR 5.20 (CI 2.5 to 10.7), Right OR 2.83 (CI 1.5 to 5.4)), neck (OR 3.77 (CI 1.3 to 10.9), trunk (back (OR 2.85 (CI 1.6 to 5.0) front (OR 4.74 (CI 2.2 to 10.2), front of thighs (OR2.48 (CI 1.4 to 4.5) or upper arms (OR 1.90 (CI 1.1 to 3.2) were significantly greater than in children with PA-excluded. Petechiae, linear or bruises with distinct pattern, bruises in clusters, additional injuries or a child known to social services for previous child abuse concerns were significantly more likely in PA. Conclusions Features in the presenting history, the extent and pattern of bruising differed between children with confirmed PA and those where abuse was excluded. These findings can provide a deeper understanding of bruising sustained from PA.Keywords
This publication has 14 references indexed in Scilit:
- Bruising Characteristics Discriminating Physical Child Abuse From Accidental TraumaPediatrics, 2010
- Who Slapped That Child?Child Maltreatment, 2008
- Craniofacial Injuries From Slip, Trip, and Fall Accidents of ChildrenJournal Of Trauma-Injury Infection and Critical Care, 2007
- How useful is the presence of petechiae in distinguishing non-accidental from accidental injury?Child Abuse & Neglect, 2006
- Are there patterns of bruising in childhood which are diagnostic or suggestive of abuse? A systematic reviewArchives of Disease in Childhood, 2005
- A scoring system for bruise patterns: a tool for identifying abuseArchives of Disease in Childhood, 2002
- Bruises in Infants and ToddlersArchives of Pediatrics & Adolescent Medicine, 1999
- Mother‐child play interaction in neglecting and non‐neglecting mothersEarly Child Development and Care, 1993
- The Cutaneous Manifestations of Child Abuse and NeglectArchives of Pediatrics & Adolescent Medicine, 1979
- Skin manifestations of the battered-child syndromeThe Journal of Pediatrics, 1968