Policies on bruises in premobile children: Why we need improved standards for policymaking

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Abstract

This review of the 91 English children's services departments with specific policies on bruising in premobile children found a major disjuncture between research evidence and its interpretation in guidance. Many policies require all premobile children found with a bruise to be seen urgently by a paediatrician, and in some, all bruised children are subject of a formal child protection investigation regardless of the explanations for the bruise or the views of front-line practitioners. However, the research on bruises in premobile children on which these policies were based was found to be limited and contradictory and did not fully support the guidance given. National guidance given by the National Institute for Health and Care Excellence and many local policies state that bruising in premobile children is suggestive of physical abuse because accidental bruising is uncommon despite the only longitudinal study of bruising showing 27% of premobile children were bruised over an average of 7.6 weekly observations. The paper calls for an urgent review of these policies and guidance and improved standards for policymaking.

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