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.)