Written by Kimiko Dunbar
Spoon Feed
Of 138 infants evaluated with excessive crying, none had facial petechiae. Unexplained petechiae warrant further evaluation for trauma or abuse.
Facial petechiae: sentinel injury or colicky baby?
Sentinel injuries, such as bruises, are relatively minor physical injuries that are implausible based on history or a child’s developmental abilities. They are especially important for clinicians to recognize, because they may precede more severe abusive injury. Facial petechiae in infants can be caused by accidental or intentional injuries, and in some literature have been attributed to excessive crying or colic. This single-center retrospective review asked whether excessive crying causes facial petechiae in infants. 138 infants were examined at a specialized clinic for fussiness and crying, most with a median crying time of 4 hours per day. 75% of infants were diagnosed with colic; none had facial petechiae on exam. This study is limited by retrospective design, reliance on caregiver report, and inability to verify exam findings prospectively. The study concludes that crying does not cause facial petechiae, and unexplained petechiae should prompt evaluation for trauma or possible abuse.
How does this change my practice?
Outside of the newborn nursery, I can’t say I see facial petechiae often. Similar to subconjunctival hemorrhage (previously covered in JournalFeed here), this physical exam finding warrants further investigation. Further, this underscores the importance of a detailed physical exam in this young and highly vulnerable population, as this could be an opportunity to prevent non-accidental trauma.
Source
The Prevalence of Facial Petechiae in Infants Evaluated for Excessive Crying. Pediatr Emerg Care. 2025 Oct 1;41(10):796-800. doi: 10.1097/PEC.0000000000003434. Epub 2025 Jun 25. PMID: 40551087.
