Typical areas of accidental bruising:

Pattern of accidental bruising
Maguire, 2010

Typical pattern of abusive bruising:

Pattern of abusive bruising
Maguire, ADC Ed & Pract 2010

From prospective longitudinal study of children (<6 years):

  • 6.7% of premobile children had at least one bruise (2.2% of babies who could not roll over and 9.8% in those who could)
  • Most common site affected in all groups was below the knees, followed by ‘facial T’ and head in premobile and early mobile.
  • The ears, neck, buttocks, genitalia and hands were rarely bruised (<1%).
  • Gender, season or the level of social deprivation not associated with bruising patterns, although having a sibling increased the mean number of bruises.
  • There was considerable variation in the number of bruises recorded between different children, which increased with developmental stage, and was greater than the variation between numbers of bruises in collections from the same child over time – so some kids do just bruise more than others?

[Arch Dis Child 2014]


Are you sure it isn’t a Mongolian blue spot? Or capillary haemangioma? Or erythema nodosum?

Cupping in Chinese culture! Dermatitis artefacta?

  • Thrombocytopenia. Note film can show clues – inclusion granules in Chediak-Higashi.
  • Factor deficiency – bleeding from umbilical stump classic for XIII deficiency. Girls can have bleeding problems even if carriers rather than completely factor deficient.
  • Glanzmann’s thrombasthenia – platelet count normal! But severe eg fingertip bruising and bleeding from vaccination sites. Other platelet defects similarly.


Haematomas after Vit K at birth or immunisations? Bleeding from umbilical stump or Guthrie test? Dental treatment? Joint swelling or pseudoparalysis that might suggest a haemarthrosis?

Family history? 30% of haemophilias de novo mutations.

Skin/joint hypermobility/elasticity? See Ehlers-Danlos.