Medline Plus writes that "child abuse is doing something or failing to do something that results in harm to a child or puts a child at risk of harm." Child abuse may be in the form of physical, sexual or emotional harm. Neglect, or failing to provide for a child's needs, is also a form of abuse. On March 11, 2013, Nancy Walsh has reported for MedPage Today, Infant Bruising May Signal Later Abuse.
A retrospective case-control study has determined that more than one-quarter of infants diagnosed with an abusive injury had a prior "sentinel" injury such as an unexplained bruise. According to Lynn Sheets, MD, of the Medical College of Wisconsin in Milwaukee, and colleagues, out of 200 infants who were discovered to be definitely abused and having received an injury to the head or other site, 27.5% had an earlier sentinel injury. It has been highlighted that certain types of injury are very rare in infants who are not yet able to stand and walk independently, including bruises and intraoral frenulum tears, and these injuries should be considered warning signs. The researchers have cautioned, "Failure to recognize and take action when relatively minor, suspicious injuries occur may have devastating consequences for the infant and family."
That fact that these injuries are often followed by later more serious harm has been recognized, however, the true prevalence of sentinel injuries in infants later diagnosed with abuse has not been determined. In order to clarify this, Sheets and colleagues examined records for 401 infants younger than a year old who had been seen by a child protection team at a tertiary care pediatric hospital between 2001 and 2011. In these infants "a sentinel injury was defined as being visible, having been noticed by at least one parent, and deemed suspicious because of the unlikelihood of accidental injury."
The researchers concluded, "When a bruise is present, it should be considered as potentially sentinel for physical abuse if there is no predisposing disorder or plausible explanation." Among the infants who were definitely abused, they were more than four times as likely to have had a sentinel injury than were those considered to be at intermediate risk. In greater than 40% of cases where there was definite abuse following a sentinel injury, the parent had indicated that a healthcare provider knew about the original injury. The researchers have advised, "Reporting the sentinel injury to child protective services is appropriate in many cases in which there is no plausible explanation, even when there are no additional occult injuries found."