Child Protection Evidence - Bruising

Child Protection Evidence is a resource for clinicians across the UK and internationally to inform clinical practice, child protection procedures and professional and expert opinion in the legal system. This systematic review evaluates the scientific literature on abusive and non-abusive bruising.

About the review

Bruising is the commonest 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.

This systematic review evaluates the scientific literature on abusive and non-abusive bruising in children published up until February 2016.

It aims to answer two clinical questions:

  • Which patterns are suggestive of abuse?
  • Can a bruise be accurately aged?

The implications for practice and research and other useful references are included in the review.

Key findings

  • In the most recent update, no new studies relating to the pattern or aging of bruises have been published that met the inclusion criteria.
  • However, there is an increasing body of literature addressing optimal imaging of bruises.

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.

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
Published by RCPCH July 2017

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.