child with multiple ecchymoses … is it abuse?

Case report: Child abuse is a public health problem; bleeding disorders can mimic some of these situations. We alert to this problem reporting a case of suspected child abuse in a toddler with multiple ecchymoses. The history and clinical evaluation, including coagulation tests, achieved the diagnosis of severe type I von Willebrand disease failing to prove social dysfunction. Comments: Physical abuse suspicion in children with bruising symptoms should raise the concern of a potentialbleeding disorder. Laboratory tests should be done on the basis of patient and family history, physical examination and prevalence of bleeding conditions. Nonetheless, laboratory testing indicating the presence of a bleeding disorder does not exclude concomitant child abuse and social monitoring and vigilance should be maintained.