Bruising in non-mobile infants: challenging assumptions and reassessing the evidence

Abstract

This paper demonstrates that the assumption of accidental bruising in non-mobile infants being rare is not supported by research. It highlights weaknesses in the evidence-base and shows that between 0.6% and 5.3% of non-mobile children had a bruise on a single observation and 27% had a bruise over an average of 7.6 weekly observations in a longitudinal study. Thus between 1 960 and 17 300 infants had an accidental bruise on any one day compared to 410 child protection plans starting a year for infants because of physical abuse. Moreover research shows the lack of an explanation from a parent or changing explanations does not necessarily indicate guilt.

The paper then reviews local authority procedures produced by safeguarding partnerships. These misinterpret research and sometimes contradict it, whilst exaggerating the likelihood that a bruise is non-accidental. Procedures differed in their interpretation of when a child is premobile and the actions that safeguarding staff should take; further, a quarter did not comply with legal requirements in “Working Together” mandating either a strategy discussion (28 procedures) or a Section 47 investigation (7 procedures) in all cases of bruises in children under 6-months-old. Finally, the paper considers the impact on families, and the implications for legal decision-making.