A 32-Day-Old Male Infant with a Fall

Background: Abusive head trauma is a form a child abuse that leads to brain injuries. Currently, it's the most common cause of traumatic death in children less than 2 years old. Case presentation: A 32-day-old male infant was evaluated in the emergency department after the mother reported the infant fell from a bed while she briefly stepped away. The mother comforted the crying infant for several minutes before he suddenly became quiet which prompted her to call emergency medical services. After a benign physical exam, a head CT revealed multiple densities which were concerning for a cerebral hemorrhage and, thus, abusive head trauma. The patient was transferred to another emergency department where a thorough history and physical exam were conducted again. A head MRI at the second hospital revealed multiple foci of hemorrhage. The following differential diagnoses were considered: metabolic disease, benign hemorrhage, cerebral sinus venous thrombosis, birth trauma, accidental trauma and bleeding disorders. After reviewing the patient's family history and laboratory studies, an initial diagnosis of intracranial hemorrhage due to a bleeding disorder during parturition was made. The patient was discharged and followed up over multiple visits. Repeat physical exams, MRI, and laboratory studies were all negative for signs of a bleeding disorder. A final diagnosis of intracranial hemorrhage due to birth trauma was made. Conclusion:This case highlighted the importance of ruling out differentials that present similarly to abusive head trauma since a diagnosis of child abuse can lead to dire consequences for the child and parents.