Bruising in non-mobile babies presenting to the ED

Warning
  1. Pre-mobile baby presents to the ED with a bruise (see National child protection guidance for clinical assessment and bruising features.)
  2. Ensure senior doctor review and consider any immediate necessary investigations or treatment.
    • Ensure clear documentation of history and physical signs.
    • Details of siblings and immediate family.
  3. Refer to duty paediatrician. Admit to PAU.
    • Explain to family: admission to consider medical causes but also that you are raising a child protection concern as "everyone working with children must follow the guidance when they find a bruise or a mark which appears to be a bruise, in a baby".

Clinical assessment

Pre-mobile babies with a bruise must always be assessed by a senior doctor/clinician at the earliest opportunity.

  • It is not possible to age a bruise based on a naked eye assessment.1
  • Bruising was the most common injury in children who have been abused.
  • Accidental bruising is rare in pre-mobile infants.

Bruising features which are suggestive of physical abuse:

  • Bruising in children who are not independently mobile.
  • Bruises which appear away from bony prominences.
  • Bruises to the face, abdomen, arms, buttocks, ears, neck and hands.
  • Multiple bruises in clusters.
  • Multiple bruises of uniform shape.
  • Bruises which carry the imprint of an implement or a ligature.
  • Bruises accompanies by petechiae, in the absence of underlying bleeding disorders.

1. RCPCH (2020): Child protection evidence systematic review on bruising.

 

 

Developmental milestones

  • 1-4 weeks: loves looking at faces, can fix and follow
  • 6 weeks: develops a social smile
  • 4-12 weeks: lifts head while lying prone, starts to roll
  • 3-5 months: reaches for objects
  • 5 months: mouths all objects
  • 6 months: passes objects from one hand to the other
  • 6-8 months: starts to sit without support
  • 6-9 months: starts trying to crawl
  • 9-11 months: learns to drop items
  • 10-18 months: learns to walk, very unsteadily at first

Editorial Information

Last reviewed: 31/07/2022

Next review date: 31/07/2024

Author(s): C. Donald.