Q: “My daughter arrived with bruises on her buttocks, and they haven’t faded. Should I be concerned?”
A: The marks on your daughter’s buttocks are probably not bruises, but birthmarks known as “Mongolian spots.” These are benign, flat areas of pigmentation that range from bluish gray to deep brown to black in color, often with wavy borders and irregular shapes. These harmless marks may resemble bruises, but they are not. They should not be misinterpreted as a sign of child abuse, nor do they indicate illness, disease, or another medical condition.
Although Mongolian spots are usually present at a child’s birth, they may appear as late as one month after birth. There is no known prevention. By the time a child is four or five years old, in most cases, Mongolian spots fade to invisibility. If any areas of pigmentation remain visible into the teen years, the spots are most likely permanent, but there is no need for treatment.
Mongolian spots are areas with a dense concentration of melanocytes, the skin cells that produce melanin, the normal pigment of the skin. When the melanocytes are close to the skin’s surface, they appear deep brown. The deeper they are in the skin, the more bluish they appear. Whether superficial or deep, these areas of pigmentation are not related to bruises or disease.
Mongolian spots most frequently appear on the base of the spine, across the lower back and buttocks. They are sometimes found on the legs, sides, upper back and shoulders, and, on occasion, on the ankles or wrists. They vary from the size of a pinhead to six inches or greater in diameter. Some children have only one small spot; others have numerous small spots or numerous large spots.
The majority of babies of African, East Indian, Asian, and Latino descent are born with (or develop soon after birth) at least one Mongolian spot. About one in 10 fair-skinned infants is born with a Mongolian spot.
Document, Document, Document
Because Mongolian spots are easily mistaken for bruises, they have been known to trigger accusations of child abuse against adoptive parents. All parents of children with Mongolian spots should be diligent about bringing the marks to the attention of their child’s pediatrician, so they can be documented in the child’s medical records. This should be done at the first post-adoption medical evaluation, and again at annual check-ups.
In cases where the discoloration is extensive, or the marks may be interpreted as having the shape of a hand print, families would be wise to document these marks in dated photographs for the child’s medical records. Families may choose to send photographs of the marks to their attorney, as well. Some families have their child carry with him a note from their physician regarding the spots, to provide appropriate explanation if the child is questioned.
It is important to educate caregivers and medical providers about the spots, especially if your family lives in a largely Caucasian community. When your child starts attending daycare or nursery school, discreetly show the spots to the care provider, explaining what they are and pointing out that they are not bruises. You may want to provide written medical information about Mongolian spots to your child’s school or camp, and ask your physician to note the existence of the spots on any required school forms. Also, be aware that emergency room physicians may be unaware of Mongolian spots, and may also need education.
Being transparent about the existence and location of Mongolian spots will prevent misunderstandings that may arise if a well-meaning care provider thinks they are bruises.