Normal bruises in pre-school children

Sir, I recently conducted a pilot study of normal bruises in normal 3to 4-year-old children in a Manchester day nursery. A group of 6 children was examined over a period of six weeks and bruises and other signs of trauma recorded. The results will be familiar to every parent, as well as to every clinician seeing children, but for me they were a salutary experience in relation to child abuse. No child had fewer than three bruises at each of the 60 examinations. Certainly shins, knees, and elbows were common sites but finger-tip size bruises over the lumbar spine were seen in all 6 children, and bruising over the biceps and scapulae were also common. Explanations were often highly improbable and totally believable, including 'Fischer-Technic rocket', and for a 10 x 1 cm bruise on the buttock 'missed pot sit'. As far as I know no child suffered abuse during the period of observation. I recommend this exercise to anyone concerned with child abuse; it highlights pathological trauma just as it is possible to contrast accidental and nonaccidental trauma when abused children are admitted to the lively community of a children's ward. I thank Mrs Ryder and her staff at Nuthurst Road Day Nursery, and her superiors who authorised my visits.