CHILD PHYSICAL ABUSE
- bruises – on non contact areas – or the face and neck
- bruises in suspicious locations - such as small of the back, neck, area behind the ear, earlobe or genitals
- bruising to buttocks, face and upper lip are seen in children who are kicked or punched
- multiple bruises particularly if varying degrees of healing
- bruises in suspicious shapes or shapes of objects- fingertip bruising, tramline/track bruising, pinch marks, slap marks, implement bruising- ie. shape of a leather belt or electric cord, or a ligature
- bruises on an infant are suspicious as babies aren't normally able to accidentally bruise themselves until they become mobile
It’s perfectly normal for children to sustain bruising during normal play activities or whilst learning to walk and run - 52% of children who are walking will have bruises. Bruising on bony areas like knees, shins and forehead are often part of normal activity. So what’s suspicious bruising?
Bruising on non-contact areas such as the small of the back, the neck, the area just behind the ear, the earlobe or the genitals should be treated as suspicious without credible explanation. A twisted ear is guaranteed to bruise behind the ear.
Bruising to the buttocks, face and upper lip should also be questioned as these are common landing places for kicks and punches.
Multiple bruises in various stages of healing should also be looked into. So should bruises that have a linear appearance that would be left by a stick or piece of wood.
Ligatures can leave long bruises around the circumference of the wrists, ankles or the neck, a leather belt will usually leave a V shaped bruise whilst an electric cord will leave a U shaped mark with a tear drop shaped bruise.
Generally speaking, any bruising on an infant is suspicious. Until they are mobile they shouldn’t be able to cause bruising to themselves.
It is important, however, to be aware with infants generally of African or Asian background, and/or with dark skin, that they may have Mongolian blue spots which may resemble bruising. Appearing at birth or in the first few weeks of life on the skin of infants, they are most commonly found at the base of the spine, on the buttocks, back, and down the back of the legs of healthy infants. These spots typically disappear spontaneously within 4 years but can persist for life. However, if you were not aware of these spots when the child’s enrolment begins, and then see some bruise-like markings, it is important to consider whether they could be bruises and of concern.