By: Emily Hogikyan, MD
“Those who don’t cruise rarely bruise” was the title of a landmark study of young children published 20 years ago. Today, this title remains a timeless reminder to be concerned about bruises in infants. As we observe child abuse prevention this month, it is a prime opportunity to emphasize the importance of bruising on infants. At around 9 months of age, babies begin to hold onto surfaces to support themselves as they develop their walking skills, this is called “cruising”. Prior to this developmental stage of mobility, babies are mostly immobile and rarely self-injure to cause bruising. Therefore, when bruises are observed on babies who are not yet cruising, abuse should be considered.
Bruises on babies are potentially high-risk findings because bruises often precede other, more severe abusive injuries. Children in their first year of life have the highest rate of child abuse of any age group, and they are the most likely age group to die from abusive injuries. Infants are not able to tell us if they are being harmed, so it is vitally important for all adults to be aware of signs of abuse in infants and to learn about how to respond.
Bruises generally occur when a bony surface of the body (ex: forehead or shins) collides with something hard. This is a common cause of bruises in infants who are learning to cruise and walk. Any type of bruising on a baby who is not yet cruising or walking often suggests that the baby has been abused.
TEN-4-FACESp bruising clinical decision rule developed and validated by Mary Clyde Pierce, MD, Director of Child Abuse Peditarics and colleagues provides a useful acronym to help identify when a bruise is more likely to be caused by abuse.
The “4” in this acronym signifies that any bruise, anywhere on the body of an infant 4.9 months of age and younger is concerning for abuse. For infants 5.0 months and older, bruising to the Torso (chest, belly, back, buttocks), Ear, Neck (TEN), Frenulum, Angle of Jaw, Cheeks (fleshy part), Eyelids, Subconjunctivae (whites of the eyes) (FACES) is also concerning. The p stands for patterned bruising. Bruises in specific shape like slap, grab, or loop marks are also concerning and should be further evaluated by a medical professional.
If you are concerned that a child is being abused, it is important to act quickly to protect the child. Lurie Children’s has staff on site, 24/7 to help with evaluations.
To report suspected child abuse in Illinois, call DCFS: 800-25-ABUSE (800-252-2873). Anyone may call and report abuse. The health and safety of the child may depend on your ability and willingness to act.
With your help and awareness, we can help to protect our most vulnerable children from abuse. Links to learn more about child abuse may be found here.