Bruises, blood coagulation tests and the battered child syndrome.

[child syndrome]

Cutaneous bruises are a common symptom and a sign of injury and blood coagulation disorders in childhood . A carefully-taken history , coupled with a thorough physical examination , would lead to the diagnosis , or guide the clinician to the necessary laboratory investigations . Most children suffering from non-accidental injury can have their diagnosis established on clinical grounds alone and do not require laboratory investigation . An initial screening with full blood counts , prothrombin time and activated partial thromboplastin time will be adequate in most cases if laboratory investigation is indicated , but the clinician must be aware of the limitations of these tests . The finding of an abnormal coagulation test does not exclude child abuse as it can be a consequence of maltreatment , or the two conditions may coexist . Whenever necessary , the opinion of a haematologist should be sought in order to obtain an accurate diagnosis , which is essential for subsequent management and the prevention of further injury in the case of child abuse .