The appearance of bruises, and the site itself, are not in
themselves pathognomonic for (i.e. indicative of) physical
abuse, and a careful history is needed in all cases to make a
diagnosis. A history should include any family history of a
coagulation disorder, such as haemophilia, and connective
tissue disorders. In addition, physical abuse may cause:
■■ Increased intracranial pressure with signs of reduced
consciousness; vomiting; headache; and bulging fontanelle
(‘soft spot’ on the skull) during the first year of life
■■Fractures in an infant who is too young to walk, including
fractures that are unusual or unexplained in any age, such
as spiral fractures from twisting, rather than transverse
fractures from impact.
The appearance of bruises, and the site itself, are not inthemselves pathognomonic for (i.e. indicative of) physicalabuse, and a careful history is needed in all cases to make adiagnosis. A history should include any family history of acoagulation disorder, such as haemophilia, and connectivetissue disorders. In addition, physical abuse may cause:■■ Increased intracranial pressure with signs of reducedconsciousness; vomiting; headache; and bulging fontanelle(‘soft spot’ on the skull) during the first year of life■■Fractures in an infant who is too young to walk, includingfractures that are unusual or unexplained in any age, suchas spiral fractures from twisting, rather than transversefractures from impact.
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