ABSTRACT

A 6-month-old baby girl was noted to have a bruise on her left forearm. She was previously healthy and was asymptomatic. She had a good appetite and had not been noted to be fussy or in pain. Her physical examination was otherwise normal and revealed no additional bruises or injuries. Her forearm is shown in Image 37. https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9780429170423/e1d751c1-a9c7-4bb9-9d59-53742c84031a/content/fig37.jpg"/>

What is your diagnosis?

How would you further evaluate this infant?

84The image shows a bruise on the child’s dorsal left forearm. The mother noticed the baby had been teething for the past week and had been sucking on her forearm. The location of the suction mark fit perfectly with the shape of her mouth and the location where the baby can reach and suck. She was also witnessed sucking on her forearm during the medical visit. This suction mark is similar to the associated ecchymosis seen in bite marks and results from the negative pressure caused by suction and tongue thrusting. 1 , 2 It may also result from positive pressure from teeth that disrupt the small blood vessels. 2

The suction mark is consistent with the provided explanation. In the absence of additional concerns after obtaining a full history and physical examination, there is no need for further testing. The mother was advised to provide her baby with something to chew on such as a firm rubber teething ring and to try to distract the baby so she cannot cause additional marks.