Additional injuries in young infants with concern for abuse and apparently isolated bruises

Nancy S. Harper, Kenneth W. Feldman, Naomi F. Sugar, James D. Anderst, Daniel M. Lindberg

Research output: Contribution to journalArticlepeer-review

31 Scopus citations


Objective To determine the prevalence of additional injuries or bleeding disorders in a large population of young infants evaluated for abuse because of apparently isolated bruising. Study design This was a prospectively planned secondary analysis of an observational study of children <10 years (120 months) of age evaluated for possible physical abuse by 20 US child abuse teams. This analysis included infants <6 months of age with apparently isolated bruising who underwent diagnostic testing for additional injuries or bleeding disorders. Results Among 2890 children, 33.9% (980/2890) were <6 months old, and 25.9% (254/980) of these had bruises identified. Within this group, 57.5% (146/254) had apparently isolated bruises at presentation. Skeletal surveys identified new injury in 23.3% (34/146), neuroimaging identified new injury in 27.4% (40/146), and abdominal injury was identified in 2.7% (4/146). Overall, 50% (73/146) had at least one additional serious injury. Although testing for bleeding disorders was performed in 70.5% (103/146), no bleeding disorders were identified. Ultimately, 50% (73/146) had a high perceived likelihood of abuse. Conclusions Infants younger than 6 months of age with bruising prompting subspecialty consultation for abuse have a high risk of additional serious injuries. Routine medical evaluation for young infants with bruises and concern for physical abuse should include physical examination, skeletal survey, neuroimaging, and abdominal injury screening.

Original languageEnglish (US)
Pages (from-to)383-388.e1
JournalJournal of Pediatrics
Issue number2
StatePublished - Aug 2014

Bibliographical note

Funding Information:
Supported by the Health Resources and Services Administration/Maternal and Child Health Bureau, Emergency Medical Services for Children Program ( H34MC19346-01-02 ). The funder played no role design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript. Each author has provided paid expert testimony for prosecution and defense in cases of alleged child physical abuse.


  • CAP
  • CT
  • Child abuse physician
  • Computed tomography
  • ExSTRA
  • Examining Siblings To Recognize Abuse
  • PT
  • PTT
  • Partial thromboplastin time
  • Prothrombin time
  • SS
  • Skeletal survey


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