Edward Heather L, Moore Jessica, Has Phinnara, Ruest Stephanie M, Goldberg Amy P, Bagley Jessica, High Pamela, Loncar Cynthia L, Barron Christine E
Department of Pediatrics, The Warren Alpert Medical School of Brown University.
Department of Pediatrics Child Protection Program, Hasbro Children's Hospital.
Pediatr Emerg Care. 2025 Jun 23. doi: 10.1097/PEC.0000000000003434.
Petechiae on the face in infants are known to be caused by trauma; however, they are also sometimes attributed to infant crying. This study aims to determine the prevalence of facial petechiae in infants with excessive crying.
We conducted a single-center, retrospective record review of 138 infants (under 1 y old) evaluated at a specialized outpatient clinic for crying and fussiness between January 2015 and March 2020. Medical records were reviewed for caregiver-reported crying by clinical history and behavior diaries, and the presence of facial petechiae on physical exam (specifically documented with a checkbox on the exam form). Descriptive statistics were used to describe the average time spent crying, medical history, and prevalence of facial petechiae.
There were 138 infants (mean age 2 mo) evaluated by a pediatrician for facial petechiae (N=187 physical exams). Colic was diagnosed in 74% of the infants. Infants were excessive criers with no statistically significant difference between the time that infants were reported to cry and/or fuss per day by caregivers' clinical history (median 4 h/d) and by caregiver-completed home behavior diaries (median 3.8 h/d). No infants had facial petechiae on physical exam.
While facial petechiae is believed to be due to excessive crying, this study supports that facial petechiae in infants is rare and that there is no association between crying and facial petechiae. In the absence of medical causes, facial petechiae in infants should be evaluated as a potential traumatic injury and practitioners should consider possible physical abuse.
婴儿面部瘀点已知可由外伤引起；然而，有时也归因于婴儿哭闹。本研究旨在确定哭闹过度的婴儿面部瘀点的患病率。
我们对2015年1月至2020年3月期间在一家专门的门诊诊所因哭闹和烦躁而接受评估的138名1岁以下婴儿进行了单中心回顾性记录审查。通过临床病史和行为日记审查医疗记录中照顾者报告的哭闹情况，并在体格检查时检查面部瘀点的存在情况（具体在检查表上用复选框记录）。使用描述性统计来描述平均哭闹时间、病史和面部瘀点的患病率。
有138名婴儿（平均年龄2个月）由儿科医生评估面部瘀点情况（共187次体格检查）。74%的婴儿被诊断为腹绞痛。婴儿哭闹过度，照顾者通过临床病史报告的婴儿每天哭闹和/或烦躁的时间（中位数4小时/天）与照顾者填写的家庭行为日记（中位数3.8小时/天）之间无统计学显著差异。体格检查时没有婴儿出现面部瘀点。
虽然面部瘀点被认为是由于哭闹过度，但本研究支持婴儿面部瘀点很少见，且哭闹与面部瘀点之间没有关联。在没有医学原因的情况下，婴儿面部瘀点应被评估为潜在的创伤性损伤，从业者应考虑可能的身体虐待。
