ABSTRACT
A 2-year-old girl presented with linear abrasions noticed on her back. She was initially seen by the physician assistant who was concerned about child abuse. The child’s back had linear bruises and healed abrasions as shown in Image 32a. Her physical examination was otherwise normal, including growth parameters. https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9780429170423/e1d751c1-a9c7-4bb9-9d59-53742c84031a/content/fig32a.jpg"/>
What is the likely aetiology of these marks?
74 https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9780429170423/e1d751c1-a9c7-4bb9-9d59-53742c84031a/content/fig32b.jpg"/>These marks appear to be accidental. They occur when a child bumps down a staircase on his/her buttocks catching the spinous processes of his/her mid to lower spine on the stair edge. The longitudinal abrasions just over the spinous processes in this area are the key feature. The question to ask the parents is: ‘Has your child been playing up and down the staircase as if it were a slide?’ In some children these abrasions and bruises heal and result in hyperpigmentation of the skin as shown in Image 32b. Any mark or bruise on a child may raise the concern of child abuse and it is essential to distinguish between accidental and abusive injuries especially in children too young to make a disclosure. In children who are mobile and active like this child, bruises from play and accidents tend to occur on bony prominences. 1
