Published online July 20, 2009
PEDIATRICS Vol. 124 No. 2 August 2009, pp. 604-609 (doi:10.1542/peds.2008-2900)

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ARTICLE

Bruising Frequency and Patterns in Children With Physical Disabilities

Amy P. Goldberg, MD^a, Jane Tobin, RN-CDDN^b, Janet Daigneau, PT^c, Robert T. Griffith, MD^d, Steven E. Reinert, MS^e and Carole Jenny, MD^a

^a Child Protection Program, Department of Pediatrics, Hasbro Children's Hospital, Providence, Rhode Island
Departments of ^b Nursing
^c Physical Therapy
^d Medicine, Meeting Street School, Providence, Rhode Island
^e Department of Information Services, Lifespan Corporation, Providence, Rhode Island

OBJECTIVE: We obtained normative data on bruising in children with physical disability in functioning and evaluated factors associated with bruising in this population.

METHODS: We studied children with physical and/or cognitive disabilities who attend a school that provides comprehensive services. Over a 15-month period, the children had skin examinations, including external inspection of the genitalia and anus. For each child, we gathered information on demographics, medications, growth measures, medical conditions, equipment used, and muscle tone. Functional independence in basic mobility, self-care, and social communication was assessed by using the Functional Independence Measure for Children (WeeFIM). Results were compared with a previously studied nondisabled or "typical" population of children.

RESULTS: Fifty children and adolescents 4 to 20 years of age had 2 skin examinations. There was no relationship between the number of bruises and the child's age, race, or BMI. Overall, our subjects were more likely to have at least 1 bruise noted than nondisabled children from a comparable study. There was no significant relationship between the number of bruises and functional mobility, self-care, cognition, or muscle tone. The bruising locations in our study group were different from those of nondisabled children. However, in both groups bruises were rarely found on the neck, ears, chin, anterior chest, or buttocks.

CONCLUSIONS: The children in our study were different from nondisabled children in the frequency and pattern of their bruising. Areas uncommonly bruised in typical children were also uncommonly bruised in the disabled children. Although increasing age and mobility clearly make a difference in the number of bruises a typically functioning child sustains, these factors are not relevant when evaluating bruises on a child with disabilities. Other factors such as muscle tone, cognition, and equipment should be considered when evaluating a child with significant disabilities who presents with bruises.

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Key Words: child abuse • disabled children • contusions • wounds and injuries • skin • children with disability in functioning • neuromotor • developmental disabilities

Abbreviations: WeeFIM—Functional Independence Measure for Children

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Accepted Dec 1, 2008.

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