Recent Skin Injuries in Normal Children

Abstract

Objective. The objective of our study was to collect data on the totality of recent skin injuries in normal children and adolescents, and to determine the relationship between the number of injuries, the age of the child, and the time of year in a temperate climate. Methods. The participants in this study were children and adolescents seen successively for a reason other than trauma over a period of 1 year, by the first author (J.L.), in a university medical center in Québec City, Canada. The total body surface, with the exception of the anal-genital area, was examined systematically. The characteristics and location of all recent injuries (bruises, abrasions, scratches, cuts, burns, etc) were recorded. Scars from old injuries were ignored. The statistical method used for comparison was the Fisher's exact test. Results. Two thousand forty examinations were done on 1467 youngsters from 0 to 17 years of age. Nine hundred thirty-one examinations were done on boys and 1109 on girls. The majority of children 9 months and older (76.6%) had at least 1 recent skin injury, without a significant difference between the sexes. Seventeen percent of the total sample of children had at least 5 injuries, whereas 4% had 10 or more, <1% had 15 or more, and 0.2% had 20 or more. The sites involved were mostly the lower limbs. Less than 2% of the total sample of children had injuries to the thorax, abdomen, pelvis, or buttocks, and <1% to the chin, ears, or neck. The majority of injuries observed were bruises, regardless of the time of year. There were, however, more skin injuries during the summer and the proportion of abrasions was higher at this time of the year. The 0- to 8-month age group was unique from all points of view. Skin injuries were rare in this age group (11.4%); they did not vary with the season, and they were mainly on the head and the face. Their injuries were mostly scratches. Bruises were found in only 1.2% of this group. Conclusions. The majority of normal children (after the age of 9 months) and adolescents, who do not consult for trauma, had 1 or more recent skin injuries. These injuries, mostly bruises, are more prevalent in the summer in a region with a temperate climate and can be present on all parts of the body, although they are most frequently observed on the limbs, especially on the shins and knees. Even if there are no recognizable marks on the skin, physicians must pay particular attention to children who have injuries with other unusual characteristics (uncommon location, ≥15 injuries, bruises in a child <9 months of age, numerous injuries elsewhere than the lower limbs, numerous injuries in the cold seasons in a temperate climate, injuries other than bruises, abrasions or scratches) because they could be a sign of a bleeding disorder or physical abuse.bruising, child abuse, accidental injury.