2nd September 2020

A 4-month-old girl, Annie, is brought to A&E by her 21-year-old mother

A 4-month-old girl, Annie, is brought to A&E by her 21-year-old mother Victoria. Victoria reports that Annie has been lethargic and irritable in the last 24 hours and she is not feeding as well as she does usually. Victoria states that this morning, Annie became unresponsive and stopped breathing for approximately 30 seconds – Victoria found this very scary and called 999 when this happened. 

Annie was born by normal vaginal delivery, she weighed 3.5 kg at birth, and there were no neonatal complications. 

On examination, Annie is noted to have several small, circular, bruises on the posterior aspect of her ribcage as well as some bruises to her upper thighs. Victoria tells you that she has noticed these bruises before and says that Annie got them whilst she was playing with her toys at home.

Which of the following factors in this history, most strongly raises your suspicion that Annie has suffered a non-accidental injury? Select the SINGLE most appropriate option from the list below. Select ONE option only.