Non-accidental injury

Question 1

What are 7 types of non-accidental injury?

Answer 1

1. Physical
2. Sexual abuse
3. Poisoning
4. Suffocation
5. Neglect
6. Emotional abuse
7. Fabricated and induced illness (Munchausen syndrome by proxy)

Question 2

With paediatric presentation of trauma, what things should make you suspicious?

Answer 2

talking about children walking and reaching for things if not mobile yet - age of child important

Question 3

What proportion of long bone fractures in <2 year olds are associated with non-accidental injury?

Answer 3

50%

Question 4

What are 9 things that should make you consider the possibility of non-accidental injury in children?

Answer 4

1. injury not consistent with history given
2. not possible in age of child (e.g. cannot walk)
3. changing or vague history
4. delay in seeking medical attention
5. lack of parental concern
6. frequent emergency department attendances
7. multiple fractures of different ages
8. rib fractures with history of low mechanism of injury
9. long bone fractures in children <3 years

Question 5

What must you do if you have any suspicions about non-accidental injury?

Answer 5

obtain senior opinion, involve Paediatric team

Question 6

What investigation must be ordered if there is clinical suspicion of non-accidental head injury in children?

Answer 6

immediate request for CT head

Question 7

What is the triad of clinical features in shaken baby syndrome?

Answer 7

retinal haemorrahges

subdural haematoma

encephalopathy

Question 8

What causes shaken baby syndrome?

Answer 8

intentional shaking of a child 0-5 years old

Question 9

What are 7 particular presentations of possible child abuse?

Answer 9

1. Bruising
2. Fractures: particularly metaphyseal, posterior rib fractures or multiple fractures at different stages of healing
3. Torn frenulum: from forcing bottle into child’s mouth
4. Burns or scalds
5. Failure to thrive
6. Sexually transmitted infections e.g. chlamydia, gonorrhoea, trichomonas
7. Human bite mark not by a young child

Question 10

What are 3 features of fractures in children that should make you suspect non-accidental injury?

Answer 10

1. Metaphyseal fractures
2. Posterior rib fractures
3. Multiple fractures at different stages of healing

Question 11

What are 3 aspects of the management of non-accidental injury?

Answer 11

1. Admit child for safeguarding whilst ongoing investigations
2. Management of injuries
3. Early involvement of child protection

Question 12

Why do metaphyseal corner fractures occur in non-accidental injury?

Answer 12

due to twisting/pulling motion on a limb