Bruising is so common in mobile children that it stops registering. In a baby who cannot yet pull to stand and move along the furniture, it is close to absent - infants who do not cruise do not acquire bruises in the ordinary course of a day. That single developmental fact converts a trivial-looking finding into one that has to be explained.
The pattern matters as much as the presence. Bruising on the torso, the ear or the neck in a child under four, bruising anywhere in an infant under four months, and any bruise with a patterned shape are the findings that should stop the consultation and start a different one. So should a frenulum tear, a subconjunctival haemorrhage without a birth history to explain it, and bruising in a child presenting for something else entirely.
The practical habit is to undress and examine the whole skin of every infant you see for any reason - not to look for bruises specifically, but because you cannot find what you do not look at. Document what you find with site, size and shape in words, date and time the examination, and escalate the same day rather than arranging review. The children who come to serious harm have almost always been seen before, for something small.
- Fully undress and examine the skin of every infant, whatever the presenting complaint.
- Treat any bruise in a non-cruising infant as needing an explanation and a same-day safeguarding discussion.
- Note the high-concern sites: torso, ear and neck under four years; anywhere under four months; any patterned bruise.
- Check the frenulum and the conjunctivae, and record their state explicitly.
- Describe findings in words with site, size and shape, and record the date and time - photographs come later and often not at all.
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