Magazine article Clinical Psychiatry News

Evaluating Abusive Skin Injuries in Children. (Not the Usual Wear and Tear of Childhood)

Magazine article Clinical Psychiatry News

Evaluating Abusive Skin Injuries in Children. (Not the Usual Wear and Tear of Childhood)

Article excerpt

CAMBRIDGE, MASS. -- Recognizing the difference between an injury caused by abuse and one that is the result of normal wear and tear in childhood is important, but not well understood, Dr. Alice W Newton said at a meeting on behavioral pediatrics sponsored by Boston University.

Dr. Newton, of Harvard Medical School, Boston, presented a rundown of common skin injuries and how physicians should evaluate them:

* Bruises. The most common abusive mark, bruises result from the crushing of skin between two hard surfaces--causing leakage of blood into interstitial tissues. The crushing of skin can be caused by a direct blow, a forceful grasp, pinching, a blow from an object, or strangulation or suffocation.

There was a time in law enforcement when it was thought that bruises could be accurately dated, but this is no longer considered true. Visual aging of bruises is an inexact science. Deep bruises might not show up for a while, plus age and the complexion of the child are important factors, Dr. Newton said. Even the lighting of the room is important.

But there are some general rules to help estimate the age of a bruise. A bruise with yellow in it is probably more than 18 hours old. Red, blue, black, or purple will present from 1 hour after the injury occurs until the bruise is resolved. A red color can present at any time. Physicians should be aware that bruises of the same age on the same person can vary in color.

Accidental bruising is most likely to occur among toddlers who are just beginning to walk, Dr. Newton said. Common sites of nonabusive bruising will be the anterior tibia or knee, the forehead, the scalp, and any boney prominences elsewhere on the body.

The following signs should raise a red flag: bruises of varying ages; bruises in nonambulatory infants; bruises on multiple planes; and bruises located in unusual locations such as the ear and face, abdomen and back, buttocks, genitals, hands and feet, or posterior and upper thighs. …

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