Guidelines for performing a skeletal survey in children with bruising

I. Skeletal survey is necessary in children <24 months old with bruising if any of the following features are present:

History of confessed abuse
History of bruising occurring during domestic violence
Additional injuries on physical exam (eg, burns, whip marks)
Patterned bruising
>4 bruises NOT limited to bony prominences
Ear, neck, torso, buttocks, genital region, hands, feet if there is no history of trauma

II. Skeletal survey is also necessary in children <12 months old with bruising in the following locations:

Cheeks, eye area, ear, neck
Upper arms or legs (not over bony prominences)
Hands, feet
Torso, buttocks, genital region
>1 bruise NOT limited to bony prominences

III. Skeletal survey is also necessary in children <9 months old with bruising in the following locations:

>1 bruise in ANY location

IV. Skeletal survey is also necessary in children <6 months old with bruising in the following locations:

Bony prominences (head T-shaped area, frontal scalp, extremity bony prominences) EXCEPT if a single bruise and patient presents with history of fall

These guidelines apply to children who do not have a verifiable mechanism of accidental trauma (ie, MVC or fall in public place), do not have underlying bleeding disorder such as hemophilia, and who do not have a clear history of birth trauma that accounts for the injury.

MVC: motor vehicle collision.

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