Non-accidental injury

Question 1

Features in history suggestive of NAI

Answer 1

Delay in seeking medical help
Differing or changing history from witnesses
Mechanism inconsistent with injury or developmental stage of child
Previous concerns about NAI
Inappropriate level of concern from parents

Question 2

Features in examination suggestive of NAI

Answer 2

Signs of neglect
Unusual affect of child - withdrawn/overly affectionate with strangers
Multiple injuries of different ages
Injuries suggestive of implement eg belt marks

Question 3

Injuries more likely to be NA

Answer 3

Burns
Bites
Metaphyseal injury/fracture
Rib fractures (esp posterior)
Multiple bruises of different age and in unusual areas
Subdural haemorrhage (shaken baby) - irritability, retinal haemorrhages, signs of raised ICP

Question 4

Management

Answer 4

Diligent note-keeping
Body map diagrams and pictures with consent
Involve seniors
Inform local child and families school work team
Priority first is to treat illness or injury
Ensure place of safety - foster care - ideally with parental consent
Investigations to exclude organic cause (eg bleeding disorders), or detect other injuries (skeletal survey, CT head)
Social workers