MISC - Non accidental injury

Question 1

What is non accidental injury

Answer 1

physical harm that is deliberate or failure to prevent from harm

Question 2

Risk factors of NAI?

Answer 2

Substance abuse
young parental age
single parent
socio-economic disadvantage

Question 3

What is shaken baby syndrome?

How does it present

Answer 3

Presents with a triad:

Retinal haemorrhages
subdural haematoma
encephalopathy - drowsiness

Question 4

How can children subect to NAI present?

Answer 4

Delayed ppt after injury

bruising, broken bones, drowsiness, neglet, failure to thrive

• spinal fractures
• humeral fractures (<18 months)
• posterior rib fracture

Question 5

What warrants same day assessment?

Answer 5

Brusing in a non-mobile infant

Question 6

What investigations are done for excluding or testing for NAI?

Answer 6

Skeletal survery

CT head scan

Bloods : FBC, Coag screen, bone profile

Opthal review : fundoscopy for retinal haemorrhages

Question 7

How to manage suspected NAI?

Answer 7

Make sure child is in a safe place - admit to ward

Involve senior colleagues, named doctor for child protection and social services

Question 8

How to explain NAI management to parents?

PACES

Answer 8

• We have to talk about what to do next from a medical and non-medical standpoint.
• Whenever we have a case where we don’t know why an injury has occurred, we have to involve some other people.
• This includes social services and the child safeguarding team (and maybe the police).
• This is a routine requirement for all children in these situations, and our aim is to keep your child safe.
• Sometimes when children have similar injuries, they do not happen by accident and they are caused by someone else.