If a young child isn't "cruising," there shouldn't be bruising. Physicians have recognized that bruises are rare in healthy infants who have not yet begun to crawl or "cruise." Any bruising in infants younger than 6 months has been considered a "red flag" for abuse, along with bruising to the torso, ear and neck in infants and toddlers. Bruises identified in infants often raise concerns for bleeding disorders and/or inflicted injury.
However, these signs can be overlooked, as in the following example described by Terra Frazier, DO, Child Abuse Pediatrician in Children's Mercy's SCAN (Child Abuse and Neglect) Clinic.
A 2-month-old child presented with bruising to his forehead. This was recognized as concerning by the primary care physician, who referred the patient for further evaluation. Despite recognition by medical providers of the significance of the injury, law enforcement and juvenile attorneys continued to consider the injury "mild bruising" and did not take further action to protect the child. If these agencies would have had easy access to outside resources that provide information and validated the medical provider's expression of concern, they may have acted differently.
"This case isn't unique, so if we could do a better job of accurately identifying abuse, it could help prevent additional abuse," Dr. Frazier said.
To help spread this knowledge, the SCAN clinic has developed an app called "Child Protector" to help health-care workers, law enforcement personnel and child welfare agencies determine whether injuries to infants and children are accidental or inflicted. The app can be downloaded without charge. "Child Protector" complements Mechanisms of Injury in Childhood, an animated program co-developed by Dr. James Anderst, MD, MSCI, Division Director of SCAN at Children's Mercy, which helps determine whether injuries to children and infants are accidental or inflicted.
The "Child Protector" app provides multiple features such as realistic animations of how childhood injuries may occur, questions to assist in determining likelihood of abuse, recording tools for medical professionals and investigators, and a helpful collection of over 60 animations depicting different types of injuries in infants and children.
The SCAN Clinic's six attending physicians, two fellows and nurse practitioner devote significant amounts of time educating different groups, testifying in court and providing expertise. One area of particular concern involves infants under six months of age.
Dr. Anderst co-authored an article published in The Journal of Pediatrics that reported on a study of nearly 3,000 infants who were referred to specialists for abuse evaluation. The study found that 50 percent of these infants under 6 months of age were at high risk of additional injury and should be evaluated for physical abuse.
"Of course, a child under six months of age with a bruise doesn't automatically indicate abuse, but if we as hospital staff members are aware that bruising isn't typical before children are mobile, it may help children in this age group receive help when necessary. The SCAN Clinic Professionals are on call to provide assistance," Dr. Anderst said.
Learn more about the Children's Mercy SCAN Clinic.