Non accidental injury

Question 1

How many children die a week of child abuse

Answer 1

1-2 c

Question 2

One in four young adults have experienced severe child abuse

Question 3

General signs of neglect

Answer 3

Dirty skin, nappy rash, dirty and tangled hair, uncut nails, etc

Question 4

How many children a year in the uk need child protection

Answer 4

50,000

Question 5

Physicla ecicenc

Answer 5

Evidence old injuries
Multiple bruising
Xray - old and new fractures
Tearing of frenulum behind upper lip
Cigarette burns, bite marks
Indications of bleeding insice skull/brain
Child may well be withdrawn facial appearacnec fear - frozen watchfulness
STI/pregnancy

Question 6

What is frozen watchfulness

Answer 6

Physcial abuse themselves
Witness domestic abuse
Watch everything thats happening around them

Question 7

When are sus of NAI raised

Answer 7

Delay in presenation
Vague, elusive or changing history
Angry or abusive parents even when gently questioned
Discrepancy between witnesses, history and findings
Injuries in very ypung pre-mobile children

Question 8

Risk factors child abuse

Answer 8

Prev episodes
Abuse in sibling
Single poorly supported parent
Domestic abuse
Substancve misuse in parent
Parent mental ill health
Child with disability
Long time in NICU

Question 9

Toxic trio

Answer 9

Substance misuse
Domestic abuse
Parental mental ill health

Question 10

What do not mention to parents about safeguarding?

Answer 10

Fabricated illness

Question 11

What can do when concerned about safeguarding

Answer 11

Ring social services for advice - dont have to refer
Infrom parents
Speak to multiple seniors

Question 12

Investigations fo rNAI

Answer 12

Blood test - FBC, coag screen
Skeletal survey
CT head
Opthalmoscopy

Question 13

What is a askeletal survey

Answer 13

Radiographs skull, thorax, long bones, hands, feet, pelvis and spine
Repeat 7-10 dyas - can see healing fractures that may ahve been missed

Question 14

Indications for skeletal survey

Answer 14

<2 any evidenve abuse
<5 suspicious fracture
Older child unable to communicate pain

Question 15

NAI classical injuries

Answer 15

Classical metpahysal lesions
Posterior rib fractures
Scapular fractures
Spinous process fractures
Sternal fractures

Question 16

Moderate specificity lesions

Answer 16

Multiple fractures
Fractures different afes
Epipjysea seperatuns
VERTEbral bodu fractures and subluxations
Digital fractures

Question 17

Low specifity lesions

Answer 17

Clavicular
Long bone
Subperticular fractures

Question 18

What see on X ray in calssic metaphyseal fractures

Answer 18

Bucket handle - metaphysis gets sepreated
Corner fracture - corner sliced off by tendon - avulsion fracture

Question 19

CT hea dscan indications

Answer 19

All children under 1 if sus NAI
Any child with neurological symptoms

Question 20

What look for on CT head NAI

Answer 20

Subdrual bleeding
Diffuse axonal injury

Question 21

Differential diagnosis

Answer 21

Accidental injury
Osteogensis imperfecta
Clotting disorders
Mongolian blue spot
Scalded skin syndrome

Question 22

Osteogensis imperefecta

Answer 22

Autosomal dominant
Variable everity

Question 23

Mongolian blue spot

Question 24

Scalded skin syndrome

Answer 24

Groin and armpits staph infeciton
Treat with antibiotics
Unclear demarcation lines

Question 25

Referal to social care

Answer 25

Telephone-> in writing Arrange assessment incl police Child protection investigation if appropriate Case conference - write report on child

Question 26

Sus abuse outcomes

Answer 26

Removal to place of safety - emergency foster carer Case caonference Child protection plan Allow home with supervision and support care by other relative Foster care

Question 27

How much more likely is physical abuse when intimate partner violence occurs in first 6 months of life?

Answer 27

3.4 times as likely

Question 28

Indirect questions to ask in a history around NAI

Answer 28

Is everything ok at home Is your partner supportive If woman is preganant - looked after properly? partner taking care of you>

Question 29

Direct questions for NAI

Answer 29

Do you ever feel frightened of your partner Have you ever been in a relationship where you have been hit or hurt in some way Are you currently in a relationshup where thats happening to you

Question 30

Risk factors

Answer 30

Exceddive crying Unintended pregnancy Developmental problems

Question 31

What to not about bruises in NAI

Answer 31

Shape - hands, linear, ligatures Pattern - non bony parts of body Multiple brusies or clusteres bruises Age - if cant mobilise - cant cruise dont bruise

Question 32

When should suspicions be high in lacerations or abrasions?

Answer 32

In non-mobile children Symmetrically Around face Around ankles or wrists in position of ligature

Question 33

Where do thermal injuries raise sus of NAI?

Answer 33

Soles of feet Buttocks/back Back of hands Shape - concerivbale implement eg cigarette or iron Sharply delineated borders - immersion injury 0 donut (where bottom in contact with bottom of bath and rest is burned by water)

Question 34

Fractures when to investgiate for NAI

Answer 34

Single or mulitple ni those without medical condition predisposing Different age fractures esp when no documentation Metaphyseal corner fractures Occult rib fractures - shaken Spiral fractures

Question 35

When to suspect NAI with intracranial injuries

Answer 35

Without adequate explanation < 3 In presence of: Retinal haemorrhage Rib o rlong bone fracture Ass injuries Multiple subdural haemorrhgae

Question 36

Differentials for NIA

Answer 36

Coagulopathy - excessive bruising and haemarthrosis FH present - coag screen Osteogensis imperfecta - FH + X ray

Question 37

When should a skeletal survey be repeated

Answer 37

11-14 days - periosteal reaction

Question 38

Acute vs non acute head presentation

Answer 38

Acute - CT Non acute - MRI within a week

Question 39

What cna US be used for

Answer 39

can be used to diagnose metaphyseal and rib fractures as well as identifying subperiosteal fluid.

Question 40

What happens when sus NAI?

Answer 40

* The child may be admitted to a paediatric ward as a place of safety whilst a social worker makes urgent enquiries and puts a safety plan in place. * Senior paediatric/child protection review should be undertaken. * A skeletal survey should be considered. * If abusive head trauma is suspected, the child should be referred for ophthalmology review to identify possible retinal haemorrhages.13