The Prevalence of Facial Petechiae in Infants Evaluated for Excessive Crying.

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.