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PostScript the author of the letter is correct that the number of children with bruises is greater in children who were referred to child protection services with suspected physical abuse than in premobile children sampled from the general population. The finding that bruises in premobile children in the general population are a rare occurrence was confirmed in a systematic review published by this group in 20053 updated annually.4 However, the population in this study is very different to the general population of children. We attempted to point this out at length in the discussion ‘The population were children where the suspicion of physical abuse had already been raised. This may affect the pattern of bruises seen, which is unlikely to be representative of an age-matched general population’. However, we are grateful to have the opportunity to reiterate the point. Within the study, there were 137 babies referred into the child protection team with suspected physical abuse. Physical abuse was confirmed after investigation and case conference in 78% (107) of cases; however, physical abuse was excluded in 30 children. The majority of these children had a single bruise. It was the bruise itself that raised the initial concern about physical abuse and was the reason that these children were referred into the child protection team. These findings would support the fact that practitioners are aware of the importance of bruising in the premobile baby and thus have a low threshold to refer into the child protection system. It would also support the fact that physical abuse is indeed confirmed in the majority of such cases. We know that there are a very small population of babies in the general population who do sustain the occasional accidental bruise (the author of the letter is correct to give estimates of around 1% of the general population). These children are probably more likely to be referred for assessment to exclude physical abuse. We have a forthcoming publication from a study that looks at bruising patterns in children sampled from the general population which we hope will add to the scientific literature about this very topic. Alison Mary Kemp

Author response

In the response to the letter1 regarding the study ‘Bruising in children who are assessed for suspected physical abuse’,2 Arch Dis Child July 2014 Vol 99 No 7

Correspondence to Dr Alison Mary Kemp, Child Health, Department of Child Health, Cardiff CF14 4YS, UK; [email protected] Competing interests None. Provenance and peer review Not commissioned; internally peer reviewed. 699

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PostScript To cite Kemp AM. Arch Dis Child 2014;99:699–700. Accepted 26 March 2014 Published Online First 2 May 2014

▸ http://dx.doi.org/10.1136/archdischild-2014-306295 Arch Dis Child 2014;99:699–700. doi:10.1136/archdischild-2014-306380

REFERENCES 1 2

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Mecrow I. Bruising in non-mobile babies. Arch Dis Child 2014;99:700. Kemp AM, Maguire SA, Nuttall D, et al. Bruising in children who are assessed for suspected physical abuse. Arch Dis Child 2014;99: 108–13. Maguire S, Mann MK, Sibert J, et al. Are there patterns of bruising in childhood which are diagnostic or suggestive of abuse? Arch Dis Child 2005;90:182–6. http://www.core-info.cf.ac.uk (accessed 18 Mar 2014).

Arch Dis Child June 2014 Vol 99 No 7

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Author response Alison Mary Kemp Arch Dis Child 2014 99: 699-700 originally published online May 2, 2014

doi: 10.1136/archdischild-2014-306380 Updated information and services can be found at: http://adc.bmj.com/content/99/7/699.2

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