Non-accidental injury (NAI)

Question 1

When to suspect NAI

Answer 1

• The injury is unexplained
• The severity of the injury is incompatible with the history
• The history keeps changing
• The injury is inconsistent with the developmental age of the child
• Delay in seeking medical attention following an injury

Question 2

NAI history

Answer 2

• Normal history
  
  • PMH - Disability
  • Obs history - Premature
• Bruising
  
  • Ask whether parent had noticed it? ICE
  • How did it happen?
  • Haemophilia
    
    • Nosebleeds?
    • Gums bleed after brushing teeth?
    • FHx of bleeding problems
• Fractures
  
  • Osteogenesis imperfecta
    
    • Previous fractures
    • Blue sclera
• Detailed Social history
  
  • How are things at home?
  • Who’s at home?
  • Who looks after the child?
  • Parent’s occupation
  • Any problems with housing? School?
• Voice concern
  
  • Unusual bruising
  • Need to rule out serious cause - further investigations
  • Concern for child’s safety first
  • Have to inform senior, possibly social services

Question 3

Bruising

Answer 3

• Common areas include bony sites
  
  • Shins
  • Elbows
  • Chin
  • Knees
• Unusual areas include
  
  • Buttocks
  • Trunk
  • Genitals
  • Ears
  • Backs of hands