Some patterns and locations of bruising are suggestive of abuse and warrant further investigation, researchers in Wales report.

Bruising is the commonest feature of physical abuse in children, Dr. A. Kemp and colleagues at Cardiff University point out, but it’s difficult to distinguish such bruises from those that are due to normal play activities or accidents.

To look into this issue, the team reviewed medical articles that defined patterns of bruising in abused or non-abused children. According to their report in the Archives of Disease in Childhood, 23 studies were identified, 7 of which discussed non-abusive bruising, 14 that addressed abusive bruising, and 2 that compared both.

Bruises in non-abused children tend to be small, occurring on the front of the body, most commonly over bony prominences such as the knees, shins and forehead. Bruising is rare in babies and in children who are not independently mobile.

Bruises that result from abuse tend to be larger; are more common on the face, back, abdomen, arms, buttocks, ears and hands - and often occur in clusters, Kemp’s team reports. Several studies found that the head was the most common site.

Bruises that result from abuse often carry the imprint of the implement used, such as rod-like instruments, electrical cords or belt buckles.

“A bruise must never be interpreted in isolation, and must always be assessed in the context of medical and social history, developmental stage, explanation given, full clinical examination, and relevant investigations,” Kemp’s team concludes.

Nonetheless, the patterns they describe should be enough to raise the possibility of abuse.

SOURCE: Archives of Disease in Childhood, February 2005.