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(eg, leukemia) and witnessed accidental events. Rarely, infants can self-inflict bruises through forceful and repetitive sucking, commonly involving their forearms and hands, but reports describing this are limited.
Lack of familiarity with the appearance of self-inflicted sucking bruises may result in unnecessary medical and social services intervention, and their associated consequences. We describe a case of self-inflicted sucking bruises in a young infant.
A healthy 3-week-old white female was referred to the emergency department for concerns about physical abuse after her primary care physician noted bruising on her right forearm. Two days prior, three bruises were noted on her right forearm after returning from a walk outdoors. Parents initially thought they were pressure marks from the infant carrier but became concerned when a fourth bruise appeared the next morning. The infant was born at term by uncomplicated vaginal delivery; she received vitamin K at birth and had an uneventful newborn nursery course. She was exclusively breastfed and receiving vitamin D supplementation. Her mother was not taking any medications. Family history was negative for bleeding disorders. Her parents were the sole caregivers.
On physical examination, she was well-appearing. Her examination was unremarkable except for four curvilinear, erythematous bruises on the right lateral forearm (Figure).
A complete blood count, coagulation profile, liver function tests, lipase level, head computed tomography scan without contrast, and a pediatric skeletal survey were normal. Hospital social work met with the family and no social concerns were identified. Parents reported that their daughter often sucked vigorously on her hands. A multidisciplinary team reviewed the case and concluded her bruises were consistent with sucking bruises of infancy. She was subsequently discharged home with her parents.
To the best of our knowledge, our report here is one of only four in the literature to describe bruising in an infant due to self-inflicted sucking. Halpin-Evans and Wooding
described three breastfed infants ages 12 days to 4 weeks with unexplained forearm bruising. Two of the infants underwent complete medical and social evaluations for abuse, but self-inflicted sucking was accepted as a plausible explanation in all three cases. Venkata and Woolley
However, the relative scarcity of similar reports in the medical literature can lead to unnecessary diagnostic testing, health care costs, parental anxiety, and involvement of child and family social services. We hope our report raises awareness among medical providers of this unusual manifestation of bruising in infancy.