Non-Independently Mobile: A child who is not yet rolling, crawling, bottom shuffling, pulling to stand, cruising or walking independently. This includes all children under the age of six months and most children under nine months. Please note that, while some babies can roll from a very early age, this does not constitute mobility. The term also includes children with a disability who are non-mobile.
Bruising: A collection of blood, visible to the naked eye as an area of discolouration, which has leaked into the surrounding tissues after vascular disruption. This occurs principally as a result of trauma, or occasionally as the result of a disease process. Typically, bruises are caused by blunt force trauma, although they may be associated with any type of impact and can accompany many different types of wounds.
Petechiae: A petechia is a small (<3 mm) red or purple spot on the skin or conjunctiva, caused by a bleed from broken capillary blood vessels. Petechiae cannot be pushed away using a glass spatula or a finger. Even under pressure, the reddening of the skin remains visible.
Birthmark: A birthmark is a permanent mark on the body that is present at, or soon after, birth – usually within the first month. Birthmarks can either be pigmented (coloured), hypopigmented (pale) or vascular (due to increased blood vessels in or under the skin). Some may blanch, but others may not and resemble a bruise.
These may not be present at birth and appear instead during the early weeks or months of life. Blue-grey spots (slate-grey naevus, formerly known as Mongolian blue spots) can look like bruising. Where a practitioner believes a mark is likely to be a birthmark but requires further advice to be certain, the practitioner should seek advice from a Consultant Paediatrician, who should arrange to see the child the same day. If there is still uncertainty, a referral should be made to Children and Families Duty Social Work.
Birth injury: Both normal birth and instrumental delivery may lead to bruising and to bleeding into the white of the eye (sub-conjunctival haemorrhage). However, staff should be alert to the possibility of physical abuse even within a hospital setting and follow this protocol if they believe the injury was not due to the delivery. Birth injuries should be documented by midwives caring for the infant and the handover to health visitors should include any birth injuries.
Sub-conjunctival haemorrhage (SCH): A subconjunctival haemorrhage (SCH) is bleeding occurring in the white of the eye. SCHs can be small and discrete or can cover the whole eye. They can occur in one or both eyes. A SCH is caused by rupture of blood vessels under the surface of the eye.
Self-inflicted injury: It is very rare for non-mobile infants to injure themselves. Suggestions that a bruise has been caused by the infant hitting themself with a toy, or hitting the bars of a cot, should not be accepted without detailed assessment by a Paediatrician and Social Worker. Sometimes, even when children are moving around by themselves, there can be concern about how a mark or bruise occurred and in these situations a referral should always be made to Children’s Services.
Injury from other children: It is unusual, but not unknown, for siblings to injure a baby. In these circumstances, the infant must still be referred for further assessment, which must include a detailed history of the circumstances of the injury and consideration of the parents’ ability to supervise their children.
Sentinel injuries are visible, minor, poorly explained injuries in young infants that raise concern about abuse. They may be a sign that another hidden injury is already present.