The teacher of a 6-year-old noticed suspicious bruises on the child’s leg and notified Children’s Protective Services. Arrangements were made to see the child at school.
The social worker noted 2 complete and 2 partial hand imprints on the child. It was the common practice of this CPS office to trace the image of the bruise onto a piece of paper for comparisons with potential perpetrators (Figure).
The child was interviewed but denied any trauma at home or school. The family also denied any issues at home and was unaware of any source of trauma. The family showed appropriate concern and agreed to take the child to a physician.
The physician provided CPS with a letter stating that there were no medical issues that would cause bruising. He documented an additional bruise on the buttock.
Do you suspect abuse, or is there another possible explanation for the bruising?
(Answer and discussion on next page)
1. Lee A. Bruises, blood coagulation tests and the battered child syndrome. Singapore Med J.
This article provides a good review on coagulation and bruising as they relate to child abuse. IT also intersects with the case presented here because it points out that abnormal coagulation factors do not exclude abuse. In this case ITP was the diagnosis, but the large pattern bruising also had to be explained.