These four bruising signs help rule out physical child abuse

'Green flags' help families seeking care for accidental injuries

A new study into the characteristics of everyday child bruising provides evidence that helps rule out physical abuse, according to paediatricians.

band aid on injury

Clinicians from Cardiff University in the UK say their findings, derived from 559 accidental injuries in children under 13, provide an evidence-based guide to help establish the plausibility of explanations for child injuries provided by parents and caregivers.

While previous studies have focused on infrequent and unlikely patterns of bruising in children, the researchers have now compiled a list of unintentional injuries.

The four common bruise findings are:

  1. “One and done”: 82% of all incidents result in only one bruise. Three or more bruises is uncommon and more than five from a single incident brings plausibility into question
  2. “Once you cruise, you bruise”: 99% of bruises occur in mobile children and bruising in non-mobile infants is uncommon and has clear, plausible explanations
  3. “Bony areas bruise easily”: these include the forehead, cheek, chin, elbows, knees and shins
  4. “Forward falls are frequent”: most bruises occur on a child’s front (face, torso, legs). When multiple bruises occurred they were in the same body region and rarely on the front and back.

The new findings also reinforced previous 'red flag' bruising characteristics from physical abuse. From a single injury incident these include:

  • Posterior surface (torso, buttocks and legs)
  • Linear pattern
  • Multiple (four or five) bruises from a single incident
  • Bruising to front and back of body from a single incident
  • Petechial bruising
  • Ear, neck or genital bruise

Read the full study here