Sir.—I was encouraged to see in the Journal (133:906-909, 1979) another article (this by Ellerstein) describing the superficial injuries of abused and neglected children. Minor injuries are more common in this population1 than major injuries and may antecede them.2 We have recently published data3 that expand on Dr Ellerstein's statement, "Multiple bruises of the buttocks or the genital area are not commonly accidental."
Compared to two groups of accidentally injured children, soft-tissue injuries (contusions, abrasions, scratches, and lacerations) were more common in the abused group (P <.001) not only over the buttocks and genitalia, but also over the cheeks, neck, trunk, and posterior thigh. Lacerations were almost seven times more common in the accidently injured emergency room group than in the abused group (P <.001). Dr Ellerstein's focus on superficial injuries is helpful but his failure to emphasize their distribution "neglects" a useful cue in the