In this study we present a series of photographs taken under controlled conditions illustrating standardised bruises induced on participants using a weight dropping mechanism.
Traditionally, opinion regarding the 'age' of a bruise was based in large part on the colour of the bruise, and authors of forensic textbooks gave their own suggested 'timetable' of colour changes with time (summarised in Langlois and Gresham 1991).
This article will demonstrate that using the color of the bruise as the primary criteria to determine its age is not the best practice.
The limited available research and related literature on the topic are flawed and inconsistent.
Any bruising (or a mark that might be bruising) in a baby or child of any age who is not independently mobile should raise concern and be subject to further enquiry by all professionals Unexplained bruising or any bruising in a child not independently mobile must always raise suspicion of maltreatment and should result in an immediate Referral the Safeguarding Hub and requires an urgent paediatric assessment.
It can be difficult to ascertain if bruising or skin lesions have been caused as a result of non-accidental injury (NAI) and a discussion must take place with the duty Consultant Paediatrician resulting in a clear decision about how to proceed.
The vascular supply to the skin is arranged in two layers.
A deep plexus of vessels is located in the deeper layers of the dermis.
These vessels are connected to a more superficial layer of vessels in the dermal papillae and surrounding the epidermal appendages (hair follicles, sweat glands, apocrine glands, sebaceous glands).
Based on current literature and published recommendations, this practice point will help clinicians to distinguish between accidental and inflicted bruises, to evaluate and manage bruising in the context of suspected child maltreatment, and to evaluate for an underlying medical predisposition to bruising.
Key Words: Bruises are common childhood injuries that usually result from minor accidental trauma, such as a bump or fall, sustained during routine active play.