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Non-Accidental Injury (NAI)

The most common presentation of NAI are:

  • Head injury – Shaken Baby Syndrome

  • Skin injuries – Bruising, Blisters, Burns, Bites

  • Bone injuries

  • Brain injuries

  • Fabricated or induced illnesses – Poisoning

“An intraparenchymal bleed with overlying skull fracture from abusive head trauma” © James Heilman CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0/)

When NAI should be suspected:

  • In the history:

    • Child < 3 years

    • Delayed presentation of injury

    • Caregiver history inconsistent in terms of story changing or not matching up with severity/type of injury

    • Unwitnessed injury

    • Evidence of drug/alcohol use in the household

  • In the examination:

    • Injuries of varying ages

    • Presence of burns/scalds

    • Bruises consistent with gripping

    • Subconjunctival/retinal haemorrhage

    • Multiple subdural haemorrhages

    • Human bite marks

    • Rib/long bone fractures


Investigations

  • XR – check for any fractures

  • Bloods – rule out any organic causes


Management

  • Inform senior

  • Involve safeguarding and police


  • Ensure other children at home are safe

  • Clear and thorough documentation




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