Bruising and child protection investigation outcomes

Building on previous work by this esteemed group of child protection researchers, this study explores the relationship between bruising characteristics and outcomes of child protection investigations of children referred for suspected physical abuse (PA). This work used complete assessment and multiagency case conferences to determine outcomes of cases referred for witnessed abuse, alleged abuse, unexplained injuries, concerning histories, domestic abuse or sibling abuse. Of those with bruising, there was no effect of developmental stage between cases where PA was confirmed and cases where PA was excluded. Confirmed abuse cases had more bruises and more sites affected than the PA-excluded group. Odds of PA-confirmed bruises on buttocks, genitalia, cheeks, neck, trunk, head, front of thighs or upper arms were significantly greater than in PA-excluded children. Petechiae, linear or patterned bruises and clustered bruising were significantly greater in the PA-confirmed group. The strength of this study is the decision made by multiagency assessment in determining outcome, which minimises circular reasoning where outcome is based on characteristics of the bruises themselves. The authors put this study into context as a population study highlighting distinct patterns of bruising emerging that differ between children with confirmed PA and those where is PA excluded after assessment.

Reviewer: Catherine Skellern,