Accidental bruising is common in healthy and active children. However, bruises can also be a sign of child abuse. An injury can be considered physical abuse if it is defined as inflicted and lasts beyond temporary reddening of the skin.

Differentiating inflicted bruises from those sustained accidentally can be challenging. However, a careful evaluation including the distribution, pattern, and history of the skin lesion in the context of the developmental capabilities of the child can help assess whether the injury was abusive in nature.

After neglect, physical abuse is the most frequently reported form of child abuse, with skin being a commonly injured organ system. Abrasions and bruises are the most common signs of child abuse on the skin. Mechanisms of bruising include hitting with a hand or implement, biting, and kicking.

It is important to note that cultural practices such as cupping and coining lead to ecchymosis formation in distinctive patterns. Proper evaluation is necessary because the use of cultural practices does not exclude the potential for child abuse. In these cases, significant attention should also be focused on educating the parents to explain the adverse outcomes, discourage future harmful behavior, and suggest alternative forms of treatment.

Physical abuse can occur in children of any age but has a mean age of 6 years. Over 75% of fatalities occur in children younger than 3 years of age, with neonates and infants (children younger than 12 months) at the highest risk for serious injury or death.