About the review
Bruising is the most common injury in physical child abuse.
The number of bruises a child sustains increases as they get older and their level of independent mobility increases.
There can be difficulty in distinguishing abusive from non-abusive bruises and determining the age of the bruise when attempting diagnoses.
It aims to answer two clinical questions:
- Which patterns are suggestive of abuse?
- Can a bruise be accurately aged?
The key evidence statements, research implications and other useful references are included in the review.
- In the most recent update, two new studies relating to the pattern of bruises have been published that met the inclusion criteria. There is, however, an increasing body of literature addressing optimal imaging of bruises which is highlighted in the ‘other useful resources’ section. There is no change in the evidence that it is not possible to age a bruise based on a naked eye assessment.
- Bruising was the most common injury in children who have been abused and a common injury in non-abused children, the exception to this being in non-mobile infants where accidental bruising is rare (<1%). The number of bruises a child sustains through normal activity increases as they get older and their level of independent mobility increases.
- Further cases have been reported where bruising was a “sentinel injury” in children prior to the recognition of child abuse, highlighting the importance of recognising abnormal patterns of bruising in young infants, enabling detection as early as possible and potentially preventing escalation of abuse with avoidance of serious abusive injury or death.
- This review highlights the importance of recognising abnormal patterns of bruising in young infants to enable the correct identification of abuse.
Disclaimer: This is a summary of the systematic review findings up to the date of our most recent literature search. If you have a specific clinical case, we strongly recommend you read all of the relevant references as cited and look for additional material published outside our search dates
Original reviews and content © Cardiff University, funded by NSPCC
While the format of each review has been revised to fit the style of the College and amalgamated into a comprehensive document, the content remains unchanged until reviewed and new evidence is identified and added to the evidence-base. Updated content will be indicated on individual review pages.