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Bruises in infants and toddlers: those who don't cruise rarely bruise. Puget Sound Pediatric Research Network.

OBJECTIVES: To determine the frequency and location of bruises in normal infants and toddlers, and to determine the relationship of age and developmental 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 bruises as well as known or suspected abuse was also recorded. A chi2 test or Fisher exact test was used to determine the significance of differences.

MAIN OUTCOME MEASURES: Presence and location of bruises as related to age and 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 children 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). However, 17.8% of cruisers and 51.9% of walkers had bruises (P<.001). Mean bruise 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 and knee. Bruises 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 were not observed at any age. There were no differences in bruise frequency by sex. African American children were observed to have bruises much less frequently 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 atypical areas, such as the trunk, hands, or buttocks, should prompt similar concerns.

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