What should I do if I see a bruise in a non-cruising infant?

A bruise in a non-cruising infant is not normal and should be concerning for child abuse or a significant medical issue.  Take a careful history of how the bruise may have occurred.   Remember to get a good assessment of the situation without accusing the caregiver of any wrongdoing.  No harm is ever done by being kind to a perpetrator, but irreparable harm can be done by accusing an innocent caregiver.

  • Who has been taking care of the infant for the past few days?
  • Are there siblings in the house?
  • Has the infant had any bruising in the past?
  • Does the mechanism of injury match the infant level of development?

Beware of explanations involving carseat straps, infant swings, or normal use of other common baby equipment—while it might be possible, it’s still very unusual for babies to have bruises as the result of normal use of baby equipment.

Also, while bruising in any location in a non-cruising infant is concerning, be particularly aware of bruises that are not on bony prominences.  High risk areas include the ears, neck, trunk, and buttocks/diaper area.

Unless there were multiple adult witnesses or other historical factors that confirm that accidental nature of the bruise, most infants with bruising need further evaluation.

Have the child taken to the closest pediatric emergency department for further evaluation including the following:  skeletal survey, CT scan of the head, CBC, PT/PTT, +/- platelet function assay, photography, and a forensics consult.  CPS should be notified immediately.

If you have a baby in your office with a bruise, and you are unsure about how best to proceed, call (502) 629-6000 and ask for the Forensics team.  We can discuss the situation with you and help you decide the next step.