Because of the likelihood of child abuse and the potential for repeated inflicted head trauma, the infant is hospitalized and the child protective service is notified. During hospitalization, this infant does well. There is good weight gain and her neurological function and developmental evaluation are normal. A retina exam performed by an ophthalmologist is negative for hemorrhages. On hospital day three, she is noted to be less active than she has been and she vomits three times.
Abdominal examination is negative.
She vomits again and is noted to be lethargic. A nasogastric tube is placed. A repeat CT scan is obtained to rule out a hemorrhage. The repeat CT scan fails to find any brain abnormalities. The skull fractures and scalp swelling are unchanged.