non-accidental injury
don't go it alone!
- ED seniors, paeds, local safeguarding team all there to help.
red flags
➥ bruising in non-mobile child
➥ facial injuries on soft tissue of face
➥ injuries on “triangle of safety”, ear pinna
➥ delayed presentation, inconsistent story, abnormal interaction between child and parent
➥ recurrent attendance, especially in different hospitals
'ten-4 faces p': suspicious places to have a bruise
- torso
- ear
- neck
- anywhere on infant <4 months
- frenulum
- angle of jaw
- cheek
- eyelids
- subconjunctival
- patterned
investigations approach (as per RCPCH)
- FBC, Clotting screen, LFT
- Vit D, PTH
- skeletal survey
- CT head? MRI brain?
- Ophthalmology
misc medicolegal aspects
- Police if parent leaves department with child before being assessed
consent
- child with adequate understanding may have capacity
- one person with parental responsibility