Infant "Fell Out of Car Seat"

A 5-month-old girl is brought to your facility for decreased level of consciousness. According to the parents, the infant reportedly fell out of her car seat earlier this morning. Prenatal history is unremarkable; immunizations are up to date. Initial examination shows a lethargic female infant with vital signs as follows: temperature, 99.7°F; blood pressure, 91/65 mm Hg; heart rate; 180 beats/min; and initial O2 saturation, 86% on room air. Supplemental oxygen and an IV fluid bolus are given, which correct the hypoxia and tachycardia. Physical exam shows a depressed anterior fontanelle and bilateral periorbital ecchymosis, as well as multiple bruises of varying ages on the face and body. An old scar on the left side of the forehead is noted as well. While still somewhat lethargic, the infant does move all extremities to painful stimuli. A weak cry is present. Initial radiographs of the chest and skull are obtained; the one of the skull is shown. What is your impression?