Non-accidental injury
and child abuse
Definitions
Child abuse: deliberate infliction of harm
to a child or failure to prevent such harm
Types
Physical (NAI)
Bruises, fractures, wounds,
burns, bites, cuts
Sexual
Poisoning
Neglect
Emotional
Fabrication/induced illness
Munchausen syndrome by proxy
Neglect: Persistent failure to meet a
childs physical and emotional needs such
to impair their health and development
Epidemiology
4% children alerted to
social services
Real numbers likely higher
Risk factors
Low birthweight
Unwanted pregnancy
Congenital abnormality
Young mother
Low SEC
Parent with mental health problems,substance
misuse disorder or themselves a victim of abuse
First born child
Aetiology
Abuser often parent or co-habiting adult
More risk of serious injury or death due
to physical vulnerability
All levels of society
Clinical
presentation
Multiple injuries of
different ages
Injury inappropriate for age
Injury inconsistent with history
or a changing history
Delayed presentation
Frequent ED attender
Parental attitude (lack of concern)
Report of abuse from child
Diagnosis
History
Child if possible
Odd history from parents
Examination
Whole body - fingermarks, whip marks,
signs of suffocation, face/buttock/perineum injury
Fundoscopy - retinal bleeds
Investigations
Bloods - clotting (if extensive bruises)
X-radiograph skeletal survey
CT head if warranted (intracranial bleeds)
Management
Definitive
Admit child
Contact duty social worker
Check local policies and referrals
(e.g. forensic services if rape)
Health visitor and NSPCC
(place of safety, parental support etc.)
Initial ABCDE
Referral
Paediatrics
Ophthalmology
(if retinal haemorrhage etc.)