A 4-month-old infant is seen for a health supervision visit. She is meeting her developmental milestones, and her mother has no concerns. On physical examination, there is a small bruise on her right buttock. The remainder of her examination is normal.
Of the following, the best next step is to?
Correct Answer: A. Ask her mother about the bruise
EXPLANATION
A bruise occurs when vessels are torn and blood accumulates in the tissues. This non-ambulatory infant has a bruise involving her buttocks, a fleshy part and relatively protected area of the body. The best next step is to ask her mother for more details about the bruise. An unexplained bruise in an infant is concerning for an inflicted injury. Although it may appear minor and will likely heal without complications, it is considered a sentinel injury and indicates a high risk for more serious or fatal abusive injuries. Other examples of sentinel injuries include burns, oropharyngeal injuries, patterned injuries, and lacerations to the frenulum. Scheduling a follow-up visit the next day would increase this infant’s risk for future abusive injuries. A report to child protective services should be made if there is any suspicion for abuse or neglect. However, a more detailed history prior to making a report should be the next step.
REFERENCES
Child Abuse and Neglect: Advocating for Your Patients
Bruce McIntosh, MD
Slides: https://www2.acopeds.org/meetings/2022spring/guide/program/files/768-1650307804-1901.pdf