This chapter was updated in July 2015 when a link to the Bruising in Babies flowchart was added.
Bruising is strongly related to mobility. This is reflected in both national evidence and the learning from local serious case reviews.
- Once children are mobile they sustain bruises from everyday activities and accidents;
- Bruising in a baby who is not yet crawling, and therefore has no independent mobility, is very unusual - 'Those that don't cruise rarely bruise';
- Only one in five infants who is starting to walk by holding on to the furniture has bruises;
- Most children who are able to walk independently have bruises;
- Bruises usually happen when children fall over or bump into objects in their way.
A bruise should never be interpreted in isolation and must always be assessed in the context of the child's medical and social history, developmental stage and explanation given. However, bruising in children who are not independently mobile including bruises in babies should raise concern about the possibility of physical child abuse and a bruise or suspicious mark in this group, however small, which does not have an adequate explanation of a significant event which fits with the child's developmental level, with appropriate parental/carer response should be referred to children's social care. The social worker should then arrange a strategy discussion with police and a consultant paediatrician to discuss the need for section 47 enquiries. This will usually involve arranging a medical examination.
In mobile children bruising that suggests the possibility of physical child abuse includes:
- Bruises that are seen away from bony prominences;
- Bruises to the face, back, abdomen, arms, buttocks, ears and hands;
- Multiple bruises in clusters;
- Multiple bruises of uniform shape;
- Bruises that carry an imprint – of an implement or cord;
- Bruises with petechiae (dots of blood under the skin) around them.