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Bruising in a non-mobile infant — DCH MCQ

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HardSafeguardingBruising in a non-mobile infantDCH

A 4-month-old infant is seen in general practice. She can roll from front to back but cannot crawl, bottom-shuffle, pull to stand or otherwise move independently. Examination shows discrete bruises on her cheek and upper arm. Her parent initially says that she rolled into the cot side but subsequently gives a different account. There are no petechiae, mucosal bleeding or other apparent injuries. What is the most appropriate immediate management?

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Correct answer: D — Make a same-day children's social care referral and arrange urgent paediatric assessment

The correct answer is D. Rolling alone does not meet NICE's current definition of independent mobility. Bruising in this infant, particularly on the cheek and upper arm and accompanied by an explanation that changes over time, therefore constitutes an alerting feature warranting suspicion of maltreatment. The clinician should initiate the local safeguarding pathway, refer to children's social care and arrange urgent senior paediatric assessment. The history should be recorded verbatim and the bruises measured, mapped and appropriately photographed. Routine or next-day review would create an unsafe delay. Possible bleeding disorders should be considered during the urgent assessment, but coagulation testing must not postpone safeguarding action. Referral is the professional's responsibility and should not be delegated to the parents.

Reference: NICE. Child maltreatment: when to suspect maltreatment in under 18s (CG89), recommendation 1.1.2 and Using this guidance section 4. Updated 3 December 2025. https://www.nice.org.uk/guidance/cg89/chapter/Recommendations