Bruising in Infants and Children: Minor Skin Injuries Can Have Major Implications

Bruising is a common finding in children presenting to emergency departments and can result from either accidental or abusive trauma. In physically abused children, bruising often precedes other, more severe injuries. Key features can help distinguish normal childhood bruising from bruising concerning for physical abuse, which can guide an appropriate medical workup and help ensure child safety.

This review will cover bruising features associated with physical abuse. A child's age and developmental capabilities relate to the likelihood of bruising being due to physical abuse. Features specific to the bruising itself are also significant. Bruising location, as well as the pattern and number of bruises are relevant in assessing injury plausibility. A careful medical assessment with consideration of alternate diagnoses is critical in thoroughly evaluating the likelihood of abuse. Laboratory and radiographic studies can help identify potentially contributory underlying medical conditions as well as injuries that may not be apparent on physical examination.