NAIS

Question 1

Vulnerable groups

Answer 1

poverty
adult household member was abused as child
young emotionally immature/unmarried parents - single parents
disabled child
child raised by persons other than biological parents >/= three months
unplanned/unwanted pregnancy
one of twins

Question 2

Conduct of history from parent/guardian

Answer 2

delay in seeking medical help
visit various facilities/ doctors (recurrent injuries)
different versions (from time to time and between individuals)
history not consistent with facts
other parties often blamed/ involved

Question 3

Clinical features

Answer 3

skin - sixpenny and butterfly bruises, abrasions, burns, frenulum torn (pathogneumonic)
bruises of different ages

eyes - vitreous or scleral damage, retinal detachment, lens sublaxations

musculoskeletal - Caffey’s (3rd) syndrome - head injury combined multiple skeletal fractures often of varying age
fractures - spiral, wedge, epiphyseal plate
periosteal injuries

Head injuries - subdural haemorrhage - most common COD, cerebral injuries, diffuse axonal injury - shaken baby syndrome

Chest and abdomen - rosary rib fractures, ruptured liver, viscus perforation

General demeanour - frozen awareness, gaze avoidance

Question 4

What should you do?

Answer 4

High index of suspicion
thorough examination
meticulous/detailed notes/sketches/photos
consult colleague - without priming or prejudging
hospitalise - remove from situation/ investigate/ treat
social worker
inform regional director/ SAPS CPU - child protection unit