Bruising as an indicator of child abuse: when should I be concerned?

Bruising remains the most common finding in abused children of all ages. While in itself it may not cause long-term sequelae, it may be the injury which prompts recognition of abuse, and affords the opportunity to intervene to protect the child from further abuse. It is clear that, at present, we are missing these opportunities – despite increased awareness and public campaigns, the number of children killed in the UK has remained constant for the past 28 years, at 79 per year. Of children attending Accident and Emergency or trauma centres, it is estimated that between 7% and 30% have an abusive injury, the higher figures being from paediatric hospitals. The highest prevalence of abuse is in the youngest children, where up to 40% of trauma in children less than 4 years of age may be due to abuse, falling to less than 10% of 10–14 year olds.This article will review the features of abusive childhood bruises in comparison to accidental ones, examine issues surrounding ageing of bruises, highlight important features on history or examination, and look at investigations that need to be considered in children with bruising that causes concern.