Non-accidental injury

Question 1

What are the types of child abuse according to NICE guidelines?

Answer 1

Child abuse may include physical, emotional and sexual abuse, neglect, and fabricated or induced illness.

Question 2

What are some features to consider neglect as a form of abuse?

Answer 2

Severe and persistent infestations (e.g. Scabies or head lice), parents who do not administer essential prescribed treatment, and failure to dress the child in suitable clothing.

Question 3

What are some features that should raise suspicion of neglect?

Answer 3

Failure to seek medical advice which compromises the child’s health, a child who is persistently smelly and dirty, and inadequate provision of food.

Question 4

What are some features to consider sexual abuse?

Answer 4

Persistent dysuria or anogenital discomfort without a medical explanation, pregnancy in a young woman aged 13-15 years, and hepatitis B or anogenital warts in a child 13-15 years.

Question 5

What are some features that should raise suspicion of sexual abuse?

Answer 5

Persistent or recurrent genital or anal symptoms associated with a behavioural or emotional change, anal fissure when constipation and Crohn’s disease have been excluded, and STI in a child younger than 12 years.

Question 6

What are some features to consider physical abuse?

Answer 6

Any serious or unusual injury with an absent or unsuitable explanation, cold injuries in a child with no medical explanation, and oral injury in a child with an absent or suitable explanation.

Question 7

What are some features that should raise suspicion of physical abuse?

Answer 7

Bruising, lacerations or burns in a child who is not independently mobile or where there is an absent or unsuitable explanation, and one or more fractures if there is an unsuitable explanation.

Question 8

Child Abuse - Neglect

Answer 8

Question 9

Child Abuse - Sexual or Physical - when you should consider or suspect

Answer 9

Question 10

What are some indicators that a child may be experiencing abuse?

Answer 10

Indicators of child abuse include:
- Story inconsistent with injuries
- Repeated attendances at A&E departments
- Delayed presentation
- Child with a frightened, withdrawn appearance - ‘frozen watchfulness’

Question 11

What are possible physical presentations of child abuse?

Answer 11

Possible physical presentations of child abuse include:
- Bruising
- 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