Clinical Case Database / Category: Patient Management

An approach to abnormal bruising in the child for the junior doctor

Publication details

Dr Richard Screen, Dr Gyan Sinha, Dr Alexander Lalayiannis
Foundation Years Journal, volume 8, issue 6, p.10 (123Doc Education, London, June 2014)

Abstract

Dermatological injuries, particularly bruising, are the earliest and most common findings in cases of physical child abuse. (1-3) When accidental bruising is so common in children, how can the junior doctor recognise pathological bruising and differentiate between accidental and non-accidental bruising? This article presents the case of a seven-year-old boy with bilateral bruising to the ears: a pattern highly suggestive of non-accidental injury. The importance of a systematic and unbiased history is emphasised, and a list of key questions to ask is provided. The reader is also made aware of some additional history taking goals and documentation requirements in such cases. On a practical note, the distinguishing features of accidental and non-accidental bruises are explained, and a list of differential diagnoses for bruising is provided. The article concludes with a guide on choosing appropriate initial investigations and summarises the outcome of the clinical case.

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Authors

Dr Richard Screen (Corresponding author)

Foundation Year 1 doctor in Colorectal Surgery/Paediatrics/Cardiology
Walsall Manor Hospital
Moat Road
Walsall
WS2 9PS
richard.screen@nhs.net

Dr Gyan Sinha

Consultant Paediatrician
Walsall Manor Hospital
Moat Road
Walsall
WS2 9PS
gyan.sinha@walsallhealthcare.nhs.uk

Dr Alexander Lalayiannis

Specialty Trainee in Paediatrics
Birmingham Women’s Hospital
Mindelsohn Way
Birmingham
B15 2TG
alex.lalayiannis@doctors.org.uk

References

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3.  Ellerstein NS. The cutaneous manifestations of child abuse and neglect. Am J Dis Child 1979, 9:906-909.

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16.  Brinkmann B, Püschel K, Mätzsch T. Forensic dermatological aspects of the battered child syndrome. Aktuelle Derm 1979, 5:217-232.

17.  Nayak K, Spencer N, Shenoy M, Rubithon J, Coad N, Logan S. How useful is the presence of petechiae in distinguishing non-accidental from accidental injury? Child Abuse Negl 2006, 30:549-555.

18.  Hayward, CP. Diagnosis and management of mild bleeding disorders. Hematology Am Soc Hematol Educ Program 2005, 423-8.

19.  General Medical Council [Internet] 0-18 Years Guidance: Principles of confientiality. 2007 pages 18-22 [cited 2014, 23rd March]. Available from: http://www.gmc-uk.org/guidance/ethical_guidance/children_guidance_46_sharing_info_without_consent.asp.

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T​he Foundation Years Clinical Cases Database is​ a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.

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