Bruises in the shapes of handprints, belt buckles, cord loops or encirclements represent child physical abuse7 The dating of bruises by color is advocated by medical textbooks and older literature on child abuse.
The age of a bruise and the historical timing of an injury may have important legal implications for determining a perpetrator's identity.
The skin is the most commonly injured organ system and the easiest to examine.
The likelihood of having accidental bruises is a function of a child's behavior and developmental ability.
Bruises are rare in infants who do not cruise or walk.7 The shape or pattern of injury may also suggest inflicted trauma.
The history of a child suspected to be abused should be elicited in a nonaccusatory manner.
When possible, separate interviews should be held for the caregiver(s) and the child.
A complicated and challenging scenario arises when the caregiver accuses an adult from whom the caregiver is divorced or separated as the perpetrator.
In this case, the injury must be evaluated in the context of the history obtained from all those involved and from the physical examination.
[From Maguire S Are there patterns of bruising in childhood which are diagnostic or suggestive of abuse?
Family physicians who are involved in the care of children are likely to encounter child abuse and should be able to recognize its common presentations.
In addition, physicians caring for children must remain cognizant of the many medical conditions whose presentation can mimic signs of physical abuse.
The most important information leading to a diagnosis of physical abuse is obtained through the medical history.
The physical manifestations of nonaccidental trauma are varied and most commonly involve the skin, bone or central nervous system.