Relatively minor abusive injuries can precede more severe physical abuse
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