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Bruises in infants and toddlers: those who don't cruise rarely bruise. Puget Sound Pediatric Research Network
N F Sugar1, J A Taylor, K W Feldman
1Department of Pediatrics, University of Washington School of Medicine, Seattle, USA.
Insights
Bruises are uncommon in infants but increase with mobility. Bruising in non-ambulatory infants or in unusual locations in toddlers may indicate underlying medical conditions or abuse.
Area of Science:
- Pediatric Medicine
- Developmental Pediatrics
- Forensic Pediatrics
Background:
- Bruising in children can be a sign of abuse or underlying medical conditions.
- Understanding normal bruising patterns in healthy children is crucial for accurate diagnosis.
Purpose of the Study:
- To determine the frequency and location of bruises in healthy infants and toddlers.
- To correlate bruising with age and developmental milestones.
Main Methods:
- A cross-sectional survey was conducted in community primary care pediatric offices.
- Prospective data were collected on children younger than 36 months attending well-child visits.
- Demographics, developmental stage, and bruise presence/location were recorded, along with potential confounding medical conditions or suspected abuse.
Main Results:
- Bruises were found in 20.9% of 973 children without known medical causes or suspected abuse.
- Bruising was rare in infants younger than 9 months (1.7%) and those not yet cruising (2.2%).
- Bruise frequency significantly increased in cruisers (17.8%) and walkers (51.9%), with the anterior tibia and knee being the most common sites.
Conclusions:
- Bruising is uncommon in infants and pre-ambulatory toddlers, increasing significantly with mobility.
- Bruises in infants under 9 months or in atypical locations (trunk, hands, buttocks) in toddlers warrant further investigation for abuse or illness.
- Developmental stage is a key factor in bruise prevalence, with walkers experiencing significantly more bruising.
Objectives:
To determine the frequency and location of bruises in normal infants and toddlers, and to determine the relationship of age and developmental stage to bruising.
Design:
Cross-sectional survey.
Setting:
Community primary care pediatric offices.
Subjects:
Children younger than 36 months attending well-child care visits.
Methods:
Prospective data collection of demographics, developmental stage, and presence and location of bruises. Any medical condition that causes bruises as well as known or suspected abuse was also recorded. A chi2 test or Fisher exact test was used to determine the significance of differences.
Main Outcome Measures:
Presence and location of bruises as related to age and developmental stage.
Results:
Bruises were found in 203 (20.9%) of 973 children who had no known medical cause for bruising and in whom abuse was not suspected. Only 2 (0.6%) of 366 children who were younger than 6 months and 8 (1.7%) of 473 children younger than 9 months had any bruises. Bruises were noted in only 11 (2.2%) of 511 children who were not yet walking with support (cruising). However, 17.8% of cruisers and 51.9% of walkers had bruises (P<.001). Mean bruise frequency ranged from 1.3 bruises per injured child among precruisers (range, 1-2 bruises) to 2.4 per injured child among walkers (range, 1-11). The most frequent site of bruises was over the anterior tibia and knee. Bruises on the forehead and upper leg were common among walkers, but bruises on the face and trunk were rare, and bruises on the hands and buttocks were not observed at any age. There were no differences in bruise frequency by sex. African American children were observed to have bruises much less frequently than white children (P<.007).
Conclusions:
Bruises are rare in normal infants and precruisers and become common among cruisers and walkers. Bruises in infants younger than 9 months and who are not yet beginning to ambulate should lead to consideration of abuse or illness as causative. Bruises in toddlers that are located in atypical areas, such as the trunk, hands, or buttocks, should prompt similar concerns.
