ABSTRACT
Accidental injuries Trauma resulting in the appearance of bruises may be accidental in nature and play-related in active children. These bruises are typically small and nonspecific in configuration. Important ‘mimics’ of abusive bruises are those caused by accidents (see Chapter 2, Bruises) (189). It is important to remember that abusive bruises differ from accidental bruises in that accidental bruises are generally located on bony prominences: the shins, knees, hips, spinous process of the vertebral column, chin, forehead, elbows, and extensor surfaces of the forearms2,3 (190-192). Some accidental injuries may be patterned or simulate child abuse (193). However, these injuries usually have a mechanism of causation that is consistent with the clinical findings. In addition, bruises, abrasions, and sometimes bullae resulting from tight clothing, socks, or friction marks from shoes and sandals are other findings that may mimic physical abuse (194-197). Abrasions resulting from shoes and sandals may be mistaken for burns (198). A thorough history of how the injury occurred and having the caregiver bring in the clothing in question are necessary to establish the diagnosis (199).
