Synopsis
Treat bruising or injury in a non-mobile child as a sentinel clinical finding, identify emergencies and mimics, arrange an urgent complete assessment, investigate occult harm and establish a safe multi-agency plan.
- Bruising is unusual in a child who cannot move independently; arrange urgent same-day paediatric safeguarding assessment.
- Stabilise neurological, respiratory or circulatory compromise immediately and consider covert head, skeletal and abdominal injury.
- Establish the infant's achieved milestones and reconstruct who noticed the mark, when, where and after what exact event.
- Undress and examine the whole infant respectfully, including mouth and scalp, while measuring and describing every lesion.
- Do not use bruise colour to estimate age, and do not assume one medical mimic explains all findings.
- Use senior-guided laboratory and imaging protocols, which may include skeletal survey, neuroimaging and targeted abdominal assessment.
- Review previous attendances and consider siblings, twin or other young children exposed to the same caregiving environment.
- Refer concerns promptly, document a named safe plan and assign ownership for follow-up imaging and pending results.
Key red flags
Any unexplained bruise in a child who is not yet independently mobile warrants urgent professional assessment rather than routine watchful waiting.
Bruises on ears, neck, cheeks, torso, buttocks or genital region, patterned marks, clusters or petechiae around an injury require careful explanation.
Oral bleeding, torn frenulum, scalp swelling or subconjunctival haemorrhage may be sentinel injuries even when the infant appears comfortable.
A history of a short fall cannot simply be accepted as explaining severe neurological, skeletal or internal injury without specialist correlation.
Delay in presentation, changing accounts, prior unexplained injuries or a sibling with suspicious harm increases the need for a coordinated chronology.
Sleepiness, irritability, apnoea, seizures, bulging fontanelle, vomiting or abnormal tone can indicate abusive head trauma and needs emergency assessment.
Investigation priorities
Confirm mobility, characterise lesions and detect additional injury or illness.
Management branches
A non-mobile infant presents with bruising, oral trauma or unexplained injury.
- Perform ABCDE and assess neurological state, feeding and pain.
- Escalate immediately for seizures, apnoea, shock or reduced consciousness.
- Secure safe continuous supervision while assessment is organised.
- Start contemporaneous notes before details and timings are lost.
The infant is stable enough for structured safeguarding assessment.
- Document actual mobility and take separate open caregiver accounts.
- Undress and inspect every skin surface, mouth and scalp.
- Arrange laboratory, skeletal, head and abdominal investigations proportionately.
- Review earlier records and identify other potentially vulnerable children.