Patterns of bruising in preschool children—a longitudinal study

Abstract

IntroductionThis study aims to identify the prevalence and pattern of bruises in preschool children over time, and explore influential variablesMethodsProspective longitudinal study of children (<6 years) where bruises were recorded on a body chart, weekly for up to 12 weeks. The number and location of bruises were analysed according to development. Longitudinal analysis was performed using multilevel modelling.Results3523 bruises recorded from 2570 data collections from 328 children (mean age 19 months); 6.7% of 1010 collections from premobile children had at least one bruise (2.2% of babies who could not roll over and 9.8% in those who could), compared with 45.6% of 478 early mobile and 78.8% of 1082 walking child collections. The most common site affected in all groups was below the knees, followed by ‘facial T’ and head in premobile and early mobile. The ears, neck, buttocks, genitalia and hands were rarely bruised (<1% of all collections). None of gender, season or the level of social deprivation significantly influenced bruising patterns, although having a sibling increased the mean number of bruises. There was considerable variation in the number of bruises recorded between different children which increased with developmental stage and was greater than the variation between numbers of bruises in collections from the same child over time.ConclusionsThese data should help clinicians understand the patterns of ‘everyday bruising’ and recognise children who have an unusual numbers or distribution of bruises who may need assessment for physical abuse or bleeding disorders.

Childhood bruising distribution observed from eight mechanisms of unintentional injury

“…This prospective cross-sectional study was conducted in two settings: the emergency department (ED) of the University Hospital of Wales, Cardiff (ED cohort), and children in the community whose injuries were not medically attended (community cohort)13 (see online supplementary appendix 1). …”

“…For the community cohort, flyers were distributed to playgroups, and primary and secondary care clinics to invite parents of children aged <6 years to participate in a longitudinal study of bruising patterns from 2005 to 2011 (details in Kemp et al 2015) 13. An amendment to the ethical approval of this study allowed collection of data on the cause of injury where known for phase 213(2008–2011).…”

“…An amendment to the ethical approval of this study allowed collection of data on the cause of injury where known for phase 213(2008–2011). A cross section of data on children in this study,13 who had a bruise of known origin , was extracted for further analysis. These children did not sustain any serious injuries, and thus did not require medical attendance.…”

“…In the ED, bruises were examined and recorded by the researchers. In the community cohort, parents were trained to record site and cause of bruising on their child, which they did weekly for up to 12 weeks, with a random sample of 40 data collections from 40 different children independently verified by the research nurse to validate the quality and consistency of recording 13. The presence of petechiae was recorded for the ED cohort only, as this was considered difficult for parents to identify.…”

Families Affected by Parental Substance Use

“…It is far less common for children to have bruising over posterior surfaces, the chest, the face (except for forehead), the buttocks, or hands. 68,69 Bruising in these areas as well as protected areas, such as the abdomen, genitalia, and ears, in infants and toddlers, although still nonspecific, is suspicious for inflicted trauma. 68 -70 Patterned bruises might suggest a device or implement was used to cause the injury.…”