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Published on: November 29, 2017
The Prevalence of Facial Petechiae in Infants Evaluated for Excessive Crying
Heather L Edward1,2, Jessica Moore1, Phinnara Has3
1Department of Pediatrics, The Warren Alpert Medical School of Brown University.
Insights
Facial petechiae in infants is rare and not linked to excessive crying. If no medical cause is found, consider trauma or physical abuse.
Area of Science:
- Pediatrics
- Neonatology
- Dermatology
Background:
- Facial petechiae in infants are often attributed to trauma or infant crying.
- The association between excessive crying and facial petechiae requires further investigation.
Purpose of the Study:
- To determine the prevalence of facial petechiae in infants experiencing excessive crying.
- To investigate the relationship between infant crying duration and the occurrence of facial petechiae.
Main Methods:
- Retrospective record review of 138 infants under one year old evaluated for crying and fussiness.
- Data collected included caregiver-reported crying duration and physical examination findings for facial petechiae.
- Descriptive statistics were used to analyze crying times and petechiae prevalence.
Main Results:
- No infants among the 138 evaluated exhibited facial petechiae during physical examination.
- Infants were diagnosed with colic in 74% of cases and were excessive criers (median 3.8-4 hours/day).
- No statistically significant difference was found between reported crying times and the presence of petechiae.
Conclusions:
- Facial petechiae in infants is rare and shows no association with excessive crying.
- In the absence of medical causes, facial petechiae should be evaluated for potential traumatic injury, including physical abuse.
- Healthcare providers should consider non-accidental trauma when evaluating infants with facial petechiae.
Objectives:
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.
Methods:
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.
Results:
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.
Conclusions:
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.
