NCJ Number
200934
Date Published
2003
Length
11 pages
Annotation
This chapter explains medical procedures for examining bruises on child patients to determine whether abuse may have occurred.
Abstract
The chapter lists questions and issues the medical practitioner should consider when taking a history of bruises observed on a child's body. Risk factors for abuse include an explanation for the bruise that is incompatible with the type or severity of the injury, contradictory or significant changes in the history on retelling, and multiple injuries of different ages that contradict the chronology and number of episodes recounted by the caretaker. In the context of the physical examination, the chapter advises the bruises should be carefully described, measured, located on body diagrams, and photographed when possible. An estimated age of the injuries should be made. Further, a developmental assessment of the injury and its history should be conducted. This involves assessing the child's capabilities for rolling over, sitting up, arm extension, crawling, walking, and running in relation to the opportunities for accidental injury. Another area of concern in the medical evaluation of bruises is the mechanisms of injury. The postulated mechanism of injury is critical to determining its cause and validation of the history. Considerations should include the direction and velocity of the object, whether the injury is penetrating, and damage to underlying tissues. One section of the chapter focuses on issues associated with the estimation of the age of bruises. A section on differential diagnosis addresses coagulation disorder; self-inflicted, accidental, and infectious disease; folk medical customs; and other skin conditions. A case vignette and its resolution are presented. 10 photographs, 9 tables, 24 references, and 4 suggestions for further reading