Non Accidental Injury (in progress)

Question 1

What is a non accidental injury (NAI)?

Answer 1

Any mechanism of injury that is not consistent with the history given

Question 2

How common is NAI?

Answer 2

Accounts for 10-40 per 1000 presentations

Question 3

What may cause NAI?

Answer 3

Can be physical abuse, neglect, emotional abuse (can present as enuresis and constipation), sexual abuse (red flag- recurrent UTIs) etc.

Question 4

What are the investigations/ management for NAI?

Answer 4

Full Hx – look for discrepancies in the story

Full examination

ADMIT!- need to be in hospital

Think of other family members - other kids at home

Injuries/ presentations not in keeping with development

Distribution

Look at recent A&E attendances

Exclude underlying diseases

Look at the history of A&E admissions

Refer to safeguarding + social services

Question 5

Where are suspicious places to be injured?

Answer 5

Most of the back of the body
Sides of the back of the head (not the middle)

Eyes, cheeks, chin
Inner elbow
Umbilical region
Upper thighs

Question 6

What causes Enuresis?

Answer 6

School, sex, trauma, psychological, urine infection- how often are they going to the bathroom?

Question 7

What is shaken baby syndrome?

Answer 7

If a baby is forcefully shaken, his or her fragile brain moves back and forth inside the skull. This causes bruising, swelling and bleeding. Shaken baby syndrome usually occurs when a parent or caregiver severely shakes a baby or toddler due to frustration or anger — often because the child won’t stop crying.

Question 8

How do you manage shaken baby syndrome?

Answer 8

CT/ MRI
X ray
Life sustaining measures for resp/ cardiac

surgery for neuro bleeds