Understanding Bruising as a Sign of Physical Abuse

Understanding Bruising in Young Children

The Office of the Child Advocate works to make Michigan’s child welfare system safer and stronger. Part of this work includes helping adults recognize when a child may be experiencing physical abuse.

Why Bruising Matters

It can be hard to spot physical abuse in babies and toddlers. Children under age four cannot always explain how an injury happened, and bruises are sometimes seen as “normal” or not serious. But certain bruises can be a sign that a child is not safe.

Tools That Help Adults Identify Concerning Injuries

To support families, caregivers, and professionals, the OCA helped create a TEN‑4‑FACESp video. This tool explains which bruises are more concerning in young children and when an injury should be checked by a medical professional.

The Medical College of Wisconsin also created a training series that includes a session on bruising. These videos give clear, easy‑to‑understand guidance that can help prevent child abuse.

Why This Information Matters

Taking a few minutes to watch these videos and review the supporting materials can make a real difference. Knowing what to look for, and when to ask for help, can protect a child and may even save a life.

If you suspect child abuse or neglect, call 855-444-3911.

Bruising in children of all ages

Understanding what bruising can tell us about a child’s safety is essential. Some bruises are expected in childhood, while others may signal a need for immediate attention. The signs below highlight bruising features that should prompt concern and further evaluation.

What to look for

• Unusual Locations: Bruising on soft, non-bony areas like the torso, ears, neck, buttocks, or cheeks is highly concerning, as children rarely get accidentally injured in these spots. [1, 2, 3, 4]
• Patterned Marks: Bruises that clearly take the shape of an object (such as a belt buckle, handprint, linear stick marks, or loop marks from an electric cord). [1, 2]
• Clusters: Multiple bruises grouped together or injuries in various stages of healing (some yellow/green, some fresh red/purple). [1, 2, 3, 4, 5]
• Inconsistent Explanations: The story of how the injury occurred frequently changes, contradicts the physical evidence, or doesn't match the child's developmental age. [1, 2]
• Behavioral Clues: The child flinches at the approach of adults, appears excessively fearful or withdrawn, or shows sudden changes in behavior. [1, 2]