Child abuse research shows bruises in infants are not minor injuries

Findings of the “Sentinel Injuries in Infants Evaluated for Child Physical Abuse” study were published online this week in Pediatrics and show relatively minor injuries can precede more severe physical abuse in infants. The research was led by principal investigator Lynn K. Sheets, MD, medical director, Child Protection Center, Children’s Hospital of Wisconsin, and associate professor of pediatrics at the Medical College of Wisconsin.

Physical abuse is most common in infancy. The earliest signs of physical abuse in a baby who is unable to walk on his or her own can be small bruises or mouth injuries, known as “sentinel injuries.” Sentinel injuries are common in severely physically abused infants and can help identify those who are at risk for suffering more serious abuse.

Researchers examined records of 401 infants seen by the child protection team at Children’s Hospital of Wisconsin to compare the number of sentinel injuries in abused children versus children who had not been abused. Of the 200 infants found to have been abused, 27.5 percent had a previous sentinel injury. Most of the sentinel injuries were small bruises, which are unexpected injuries in young infants.

“It takes a lot to bruise an infant, and while accidents do happen, this study proves that a bruise is not just a minor injury,” said Dr. Sheets. “Identifying sentinel injuries and effective intervention require educating caregivers of young infants, child protective service workers and medical providers about the seriousness of sentinel injuries. Parents, relatives and daycare providers should be taught that bruising of the skin or injuries inside an infant’s mouth before he or she can walk should prompt them to seek medical evaluation,” she continued.

Improved detection of minor injuries in infants younger than age 12 months has the potential of preventing up to 27.5 percent of cases of severe abuse. With an estimated $210,000 lifetime cost estimate for each case of physical child abuse, prevention of further abuse through early detection and intervention has the potential for significant savings.

The study was funded by the Child Abuse Prevention Fund of Children’s Hospital of Wisconsin, the Wisconsin Children’s Trust Fund, and the Department of Pediatrics at the Medical College of Wisconsin.