Petechiae and subconjunctival hemorrhages in a child after a visit to the dentist.

INTRODUCTION

Subconjunctival hemorrhages and facial petechiae are rare oculo-cutaneous findings in the pediatric population and can be a sign of strangulation or traumatic asphyxia as a result of increased intrathoracic pressure.

CASE PRESENTATION: A 5-year-old female presented to medical care with facial petechiae and bilateral subconjunctival hemorrhages following a routine dental appointment. The child disclosed being physically restrained and "smacked" by the dentist. While her symptoms were initially characterized as an allergic reaction by Emergency Medical Services, the child was ultimately diagnosed with traumatic asphyxia due to her extensive facial petechiae and subconjunctival hemorrhages and reported facial swelling.

CONCLUSION

It is imperative for medical providers to recognize the clinical presentation of traumatic asphyxia, as non-accidental trauma should be considered in a child without a history of accidental injury. While reporting to a licensing body is not mandated in cases of child physical abuse perpetrated by health care providers, it is an important step in preventing future patient harm.