ABSTRACT
This 6-year-old boy was engaged in a physical altercation with a same-age neighbour. He was brought to the child protection clinic for evaluation of his injuries. He had been in good health with no significant medical history. He was verbal and cooperative and described what had happened in great detail. Image 31 shows two of the injuries sustained by this child. https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9780429170423/e1d751c1-a9c7-4bb9-9d59-53742c84031a/content/fig31.jpg"/>
How are the bruises seen on this child characterized?
What are clues that help to verify the cause of these injuries?
Can these marks be used to identify who inflicted them?
72These injuries represent patterned bruises, elliptical in shape. Close inspection shows that the bruises are composed of tiny petechial haemorrhages.
The elliptical shape of these bruises indicates that the child was struck with a rod-shaped implement. 1 The petechial nature is consistent with rupture of tiny capillaries near the surface of the skin from rapid contact with the object. The boy stated that he was hit many times with a souvenir pencil (approximately 12 inches [4.5 inches] long and 4.4 cm [1.75 inches] in circumference). A flat object such as a ruler would produce parallel linear injuries rather than the elliptical bruises seen here.
While the marks confirm the object, the exact amount of force and strength with which the object was applied to the skin cannot be precisely estimated. Given the age and strength of a normal child, it is possible that these injuries were inflicted by another child and not an adult or parent. In this case, the disclosures made by the child and other historical information are key to determining the events that occurred.
