Non-Accidental Injury

Question 1

What are the presentations of non-accidental injury?

Answer 1

• Bruising (on non-contact areas)
• Broken bones (spiral fractures of long bones; non-ambulant)
• Drowsiness (subdural haematoma)
• Neglect (unkempt)
• Failure to thrive
• STIs / Recurrent UTIs
• Inconsistent history
• Torn frenulum labii superioris (tongue)
• Glove and stocking burn
• Anal fissures / Encopresis

Question 2

Who is most commonly the abuser in cases of non-accidental injury?

Answer 2

• 30% fathers
• 15% unrelated man
• 10% older brother

Question 3

Who should be involved in the management of suspected non-accidental injury?

Answer 3

• Senior colleagues
• Named doctor for child protection
• Contact social services and make a formal referral
• Consider contacting the police (Child Abuse Investigation Team / CAIT)
  
  • Convene a case conference
  • Place child’s name on child protection register
  • Give support to parents
  • Ask for regular follow-up by paediatricians
• Consider contacting Multi-Agency Safeguarding Hub (MASH)
  
  • Includes a variety of people that help manage different aspects of a child’s life

Question 4

What are the signs of shaken baby syndrome?

Answer 4

• Classical triad of features
  
  • Retinal haemorrhages
  • CT → Brain swelling / Encephalopathy
  • CT → Subdural haematoma

Question 5

What are the appropriate investigations for suspected non-accidental injury?

Answer 5

• Full body ± Skeletal survey → have to note ALL blemishes on child’s body on a body map
• Check Child Protection Register
• CT head scan
• Bloods and bone profile → rule out leukaemia, ITP, haemophilia
• Fundoscopy (retinal haemorrhages)

Question 6

What is the management of non-accidental injury?

Answer 6

• Admit the child
• Child in need plan - plan made to give children extra support for health, safety ± developmental issues
• Child protection plan - plan made to protect children thought to be at risk of significant harm
• Treat any injuries