Child Abuse and Neglect

Question 1

Factors which point towards child abuse

Answer 1

Children may disclose themselves

Story inconsistent with injuries

Repeated attendances at A&E departments

Delayed presentation

Child with a frightened, withdrawn appearance - “frozen watchfulness”

Question 2

Possible physical presentations in child abuse/neglect

Answer 2

Bruising - in a non-mobile infant should be referred for same day paeds assessment

Fractures: particularly metaphyseal, posterior rib fractures or multiple fractures at different stages of healing

Torn frenulum: e.g. from forcing a bottle into a child’s mouth

Burns or scalds

Failure to thrive

Sexually transmitted infections e.g.Chlamydia, Gonorrhoea, Trichomonas

Question 3

What is “non-accidental injury”?

Answer 3

Any bodily injury in a child that has been deliberately inflicted on them, or any injury where the caregiver has failed to prevent such an injury

Question 4

Radiological findings in NIA

Answer 4

Rib, skull, finger, clavicle fractures

Metaphyseal corner fractures (occur due to twisting/pulling motion on a limb)

Question 5

Management of NIA

Answer 5

Admit the child for safeguarding whilst ongoing investigations

Management of injuries

Early involvement of child protection

Engage police and place with foster carers if no medical concerns

Strategy Meeting and Child Protection Conference (parents present)