What Caused This 7-Year-Old Girl’s Facial Bruise?

Answer: C. Suction-induced bruise, or “love bite”

Further questioning of the child and mother revealed that the child had been playing with a soda bottle. The mother did witness her sucking on the mouth of the bottle during her ED stay. After obtaining this critical piece of information, it was determined that the child had a self-inflicted suction-induced bruise.

Discussion. The concept of a suction-induced bruise, or “love bite,” is familiar to most people yet is incorrectly named. In reality, this bite is a “gentle nibbling” of the skin that can produce a bruise due to a “strong, continuous suction kiss.”¹ Therefore, any act that results in this constant suction has the potential to result in a bruise, as was the case with our patient.

The mechanism of action is when suction on the skin bursts small blood vessels just under the skin’s surface.

This case is unique compared with previous reports of suction-induced bruises in children in that this bruise resulted from an accidental, isolated incident. In 1 previous case, an 8-year-old girl presented with bruises on the left forearm. These bruises continued to form on her left forearm only during her hospitalization and, despite the child’s denial, were later found to be self-induced by “suckling and pinching.”² In a similar case, a 10-year-old boy denied self-inflicting his recurrent upper-arm bruises, yet he no longer developed these marks after consulting with mental health services.³ In another case, a 4-week-old infant was found to have bruises on his forearm that initially had been thought to be abuse-related. However, the bruises later were found to be self-induced through sucking.⁴

Outcome of the case. Our 7-year-old patient’s only bruise was located between her nose and mouth. When staff discovered that the bruise was self-induced by the child sucking on the mouth of a bottle, the patient was embarrassed. The accidental nature of the bruise and our patient’s embarrassment stand in sharp contrast to the 2 previously reported cases of suction-induced bruises in similar-aged patients, making factitious purpura a highly unlikely diagnosis in our patient’s case. Additionally, our patient’s bruise was caused by sucking on a bottle rather than sucking directly on skin at the site of the bruise, as had occurred in the 3 cases reported in the literature.

References:

1. Al Fallouji M. Traumatic love bites. Br J Surg. 1990;77(1):100-101.
2. Lackmann GM, Niehues T, Kamp G, Lenard HG. Love-bites on the forearm. Dermatology. 2001;202(1):75-76.
3. John CM, Fazakerley M, Sills J. ‘Love bites’—an unusual cause of bruising! Acta Paediatr. 2009;98(7):1078.
4. Venkata RN, Woolley C. Infantile sucking bruises. Arch Dis Child. 2015;100(4):413.