Bruising in preschool children with special needs

The authors are to be congratulated for the systematic review ‘‘Are there patterns of bruising in childhood which are diagnostic or suggestive of abuse?’’. It is an extremely valuable piece of work, providing data for paediatricians working in the field of child protection. Results show that non-abusive bruises are generally small, sustained over bony prominences, and found on the front of the body. Abusive bruises are away from bony prominences, and the commonest site is the head and neck (particularly face), followed by buttocks, trunk, and arms. The paper highlights that children with significant motor delay would not be expected to have the same bruising pattern as their peers, but points out that most studies in the literature exclude children with neurodisability or diseases that predispose to bruising, to a varying degree. Locally a small pilot study examining the bruising pattern in 14 children with a variety of disabilities aged 15 months to 4 years who attend two preschool special needs opportunity groups has shown interesting results. Thirteen of the 14 children (where there were no concerns about abuse) had bruises, the child with no bruises being the only child in the study who was unable to crawl. The other children were all cruising or walking, although onewore piedro boots, another had splints, and some had an unsteady gait. The average number of bruises was 5.7 (range 0–20) and size varied between 0.5 cm and 2.0 cm in diameter. Five children (35.7%) had bruising on their buttocks/bottom, four (28.6%) had bruising on their arms, and two (14.3%) had bruises on their face or neck—all areas usually associated with abusive bruising. Bruising patterns in children with disabilities or special needs may be very different to bruising patterns in their peer group. Further research is needed.