Suspicion of Child Abuse Complicating the Diagnosis of Bleeding Disorders

Abstract

Bruising is common in childhood and may be an important indicator of abuse. Physicians must accurately differentiate bruises resulting from abuse and those resulting from accidents. Complicating this task is the occasional child with nontraumatic purpura or an atypical presentation of a bleeding disorder [1–3]. We report three children with bruising due to medical problems in whom the diagnosis of child abuse was pursued, resulting in delays in the diagnosis of the underlying disorders. The parents involved were convinced that there was a problem and sought additional diagnostic testing. These cases are presented, analyzed, and suggested techniques for a comprehensive evaluation of such patients are considered.