Non-accidental Injury (1*)

Question 1

What are the common types?

Answer 1

• Head injury – Shaken Baby Syndrome
• Skin injuries – Bruising, Blisters, Burns, Bites
• Bone injuries
• Brain injuries
• Fabricated or induced illnesses – Poisoning

Question 2

In its presentation, when should a NAI be suspected?

Answer 2

History:
• Child < 3 yrs
• Delayed presentation of injury
• Caregiver hx inconsistent in terms of story changing or not matching up with severity/type of injury
• Unwitnessed injury
• Evidence of drug/alcohol use in the household

Examination:
• Injuries of varying ages
• Presence of burns/scalds
• Bruises consistent with gripping
• Subconjunctival/retinal haemorrhage
• Multiple subdural haemorrhages
• Human bite marks
• Rib/long bone fractures

Question 3

How is it investigated?

How is it managed?

Answer 3

➊ • XR – check for any fractures
• Bloods – rule out any organic causes

➋ • Involve safeguarding
• Ensure other children at home are safe
• Clear and thorough documentation