Bruises in infants and toddlers - Those who don't cruise rarely bruise

Objectives: To determine the frequency and location of bruises in normal in fants and toddlers, and to determine the relationship of age and developmen tal stage to bruising. Design: Cross-sectional survey. Setting: Community primary care pediatric offices. Subjects: Children younger than 36 months attending well-child care visits. Methods: Prospective data collection of demographics, developmental stage, and presence and location of bruises. Any medical condition that causes bru ises as well as known or suspected abuse was also recorded. A chi(2) test o r Fisher exact test was used to determine the significance of differences. Main Outcome Measures: Presence and location of bruises as related to age a nd developmental stage. Results: Bruises were found in 203 (20.9%) of 973 children who had no known medical cause for bruising and in whom abuse was not suspected. Only 2 (0. 6%) of 366 children who were younger than 6 months and 8 (1.7%) of 473 chil dren younger than 9 months had any bruises. Bruises were noted in only 11 ( 2.2%) of 511 children who were not yet walking with support (cruising). How ever, 17.8% of cruisers and 51.9% of walkers had bruises (P < .001). Mean b ruise frequency ranged from 1.3 bruises per injured child among precruisers (range, 1-2 bruises) to 2.4 per injured child among walkers (range, 1-11). The most frequent site of bruises was over the anterior tibia sind knee. B ruises on the forehead and upper leg were common among walkers, but bruises on the face and trunk were rare, and bruises on the hands and buttocks wer e not observed at any age. There were no differences in bruise frequency by sex. African American children were observed to have bruises much less fre quently than white children (P < .007). Conclusions: Bruises are rare in normal infants and precruisers and become common among cruisers and walkers. Bruises in infants younger than 9 months and who are not yet beginning to ambulate should lead to consideration of abuse or illness as causative. Bruises in toddlers that are located in atyp ical areas, such as the trunk, hands, or buttocks, should prompt similar co ncerns.