Relatively minor abusive injuries can precede more severe physical abuse in infants. A study in the April 2013 issue of Pediatrics, “Sentinel Injuries in Infants Evaluated for Child Physical Abuse,” (published online March 11) tracked for the first time the prevalence of such “sentinel” injuries. A sentinel injury is a previous injury reported in the medical history that was suspicious for abuse, because the infant was not yet able to pull to a stand or walk while holding onto something (and thus less likely to injure himself or herself) or because the explanation given for the injury was implausible. Researchers examined records of infants seen by the child protection team at Children’s Hospital of Wisconsin between March 2001 and October 2011. Of the 200 children who were definitely abused, 55 (27 percent) had a sentinel injury. Of those, 80 percent had a bruise, 11 percent had an injury inside the mouth, and 7 percent had a fracture. Of 100 children where abuse was suspected but not confirmed, 8 had a sentinel injury. None of the infants in the control group – who had no history of abusive injuries – had a sentinel injury. The study findings suggest that in more than a quarter of cases of definite physical abuse, there may be escalating and repeated violence toward the infant instead of a single event of momentary loss of control by a frustrated or angry caregiver. Study authors conclude that improved recognition of sentinel injuries combined with appropriate interventions would prevent additional cases of child abuse.
The American Academy of Pediatrics is an organization of 60,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit www.aap.org