W. James King and colleagues1 report that bruising was noted on examination for 46% of the children in their study of shaken baby syndrome in Canada. Such a high proportion warrants attention, but we must ensure that the diagnosis is correct.
A few years ago, a mother brought to my office her 31/2-month-old child, who had ecchymosis of the left cheek and left pinna. The mother reported 3 separate episodes of bruising before the presenting episode. She suspected abuse by a babysitter, and the case was reported to the appropriate authorities. The child was investigated for bleeding disorders, but none were found. On the basis of the results of a pediatric examination arranged by social services, the child was removed from the mother's care. Subsequent medical care was provided by the family physician of the child's foster parent.
I next saw the child at 10 months of age during a day visit to the birth mother. The presenting problem at that time was described as recurrent impetigo of the left pinna. Infected eczema of the left pinna had been diagnosed on several occasions in the intervening period, and a dermatologist had confirmed the diagnosis of impetigo. This story sounded odd and led me to speculate that the child might have a herpes simplex infection. The dermatologist had taken a sample for culture, and a phone call to the local laboratory confirmed that the viral swab was growing herpes simplex I. In view of this information, I suspected that the episodes of ecchymosis of the left pinna seen in the first few months of life were actually the result of the original herpes infection.
After letters and phone calls to the Ministry of Children and Families, the child was finally returned to the birth mother in the second year of life. The lesson to be learned is that in our haste to ensure the safety, welfare and protection of our pediatric patients, we should remember that all that glitters is not gold.
A.J. Walter Physician Surrey, BC
Reference
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