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What we must focus on is how we can reassure ourselves about the index injury be it an isolated skull fracture or isolated bruise. Here I can offer a few tips: 1) obtain a thorough physical exam looking for any other signs of abuse, be it bruises, scars or injuries that would be more consistent with a fall, such as an abrasion; 2) obtain a good history of the event to see if the mechanism of injury seems plausible; 3) obtain a good developmental history to determine the motor skills of the child to help with determining if the mechanism of injury is plausible, 4) consult social work if available to delve deeper into the social situation and possibly uncover potential social concerns, such as domestic violence, previous CPS involvement, etc. and finally, 5) consult with a child abuse physician if available.