Recognising Non-Accidental Bruising in Disabled Children
It is widely recognised that disabled children are significantly more likely to experience abuse than their peers. A research review by Stalker et al in 2010 identified higher incidences of reported child abuse in the UK disabled population than in the non-disabled population1. Children with behavioural and communication difficulties were recognised as being at higher risk as well as those with learning difficulties, sensory impairments and concentration problems.
Child abuse in this population was also felt to be proportionally under-reported and the little research available indicates that the disabled population are more likely to received reduced levels of intervention on recognition of abuse. For example; it is less likely they will be put on the child protection register.
The most recent CORE info systematic review in July 2014 identified that accidental bruising patterns in disabled children differ significantly from those of non-disabled children2,3. They recognised bruising of the feet, knees and thighs as a frequent site of accidental bruising in disabled children as well as higher incidences of bruising to the hands, arms and abdomen. It was however noted that the lower legs, ears, neck, chin, anterior chest and genitalia were rarely bruised accidentally.
This recent review also identified that bruising incidence significantly increases with increasing independent mobility in this group. The most frequent causes of injury in the walkers was noted to be falls in comparison to equipment and self-infliction in the wheelchair users. With regards to recognising non-accidental bruising, it is important to remember that a child with significant physical disabilities resulting in immobility should be consider to be non-independently mobile in a similar way to a young infant.
1) Child Protection and the Needs and Rights of Disabled Children: A Scoping Study.University of Strathclyde 2010. Kirsten Stalker, Pam Green Lister, Jennifer Lerpiniere, Katherine McArthur
3) Systematic reviews of bruising in relation to child abuse—what have we learnt: an overview of review updates. Maguire S, Mann M. Evidence Based Child Health: A Cochrane Review Journal. 2013;8:255–263