This is an extremely common area of injury and one that often leads to the involvement of children’s services where they occur in children who are not yet considered to be mobile or when an explanation is not consistent with the injury observed.
When a child is non mobile bruising is suspicious as they could not cause the injury to themselves without a carer having observed the cause and also, they do not have the required physical force to cause this to themselves. Therefore, caution calls into question whether they could have been inflicted upon them.
With mobile children the issue is whether the bruises are of a ‘normal’ childhood injury occurring in normal handling and normal play. However, children who present with excessive bruising or unexplained bruising causes concern.
Bruises are observed in a number of way from individual marks to patterns of marks. Some have formed the typical hand/grab mark pattern with the linear distinction of the fingers and ‘classic’ palm-print area. Some present as finger tip bruising. Others may be circular in appearance. Sometimes there are petichae markings which are minute red/ purple spots on the surface of the skin as a result of tiny bleeds of the blood vessels under the skin. Sometimes bruising may be caused through an impact injury with an object whether yielding or unyielding or handling that is considered beyond normal. Bruises come in all shapes and sizes and also colours. This causes concerns from professionals involved with children.
Bruising can occur on all parts of the body, it is not specific. However, there are some areas which are more alerting than others for example, genital bruising, bruising to the pinnae of the ears, the fleshy parts of the cheek, the back, abdomen etc.
It is important when considering bruising to a child whether there may be some underlying reason/ cause which may pre-dispose a child to bruise easier than a normal child. Therefore, clotting tests should be done at the hospital to rule out coagulation disorders. A haematologist may be instructed to assist on such matters to establish if there is any abnormality with the blood.
It is also important to remember that some medical conditions have symptoms associated with easy/ spontaneous bruising such as Ehlers Danlos Syndrome.
There some medical conditions which can mimic bruising such as Acute Haemorrhagic Odema of Infancy and Phytophotodermalitis which can present with bruise like pigmentation of the skin. There are also Mongolian Blue Spots to be considered which are sometimes mistaken for bruising.