🏥 Stations

🧠 Qbank

📖 Book

😃 More

💳 Pricing

🔒 Dashboard

📖 OSCE Learning

🔒 OSCE Stations

🔒 Qbank

🔐 Membership
Share your insights

Help us by sharing what content you've recieved in your exams


Non-accidental injury

Specialties > Child health

Background knowledge 🧠

Definition

  • Non-accidental injury (NAI) refers to physical injuries intentionally inflicted on a child, often as a result of child abuse.
  • Includes various forms of physical, emotional, and sometimes sexual harm.
  • Must be distinguished from accidental injuries to ensure appropriate intervention.

Epidemiology

  • NAI is more common in children under 2 years of age.
  • In the UK, it is estimated that 1 in 14 children have experienced some form of abuse.
  • Boys and girls are affected equally, though the type of injury may vary.
  • NAI is a leading cause of death in children under 1 years old.
  • Socioeconomic factors, including poverty, substance abuse, and domestic violence, are significant risk factors.

Aetiology and Pathophysiology

  • Causes include physical abuse, neglect, emotional abuse, and sometimes sexual abuse.
  • Physical abuse leads to injuries such as fractures, bruises, burns, and head trauma.
  • Emotional and psychological damage can result in long-term mental health issues.
  • NAI often occurs in the context of dysfunctional family dynamics.
  • Repetitive injuries may cause chronic pain and disability.

Types

  • Bruising: Commonly on the face, ears, neck, and arms; patterns may indicate object use.
  • Fractures: Rib fractures, metaphyseal lesions, and skull fractures are suspicious for NAI.
  • Burns: Scalds and contact burns with clear demarcation, especially in unusual areas like buttocks.
  • Head trauma: Can result in subdural haematomas and retinal haemorrhages.
  • Abdominal injuries: May include liver or spleen lacerations, often without external signs.

Clinical Features 🌡️

Symptoms

  • Often nonspecific and may include crying, irritability, or lethargy in infants.
  • Older children may express fear of certain individuals or locations.
  • Children may report pain, though they may also be non-verbal due to fear.
  • Psychosomatic symptoms like headaches or abdominal pain are possible.
  • Developmental regression, e.g., loss of toilet training.
  • Behavioural issues, including aggression or withdrawal.

Signs

  • Bruising in non-mobile children or in unusual patterns.
  • Multiple injuries at different stages of healing.
  • Signs of neglect, such as poor hygiene or malnutrition.
  • Retinal haemorrhages or skull fractures in infants.
  • Abnormal behaviour towards the examiner, including fearfulness or extreme compliance.
  • Inconsistent explanations from caregivers regarding the injury.

Investigations 🧪

Tests

  • Skeletal survey: X-rays to identify fractures in different stages of healing.
  • CT or MRI: Imaging to assess for head injuries or abdominal trauma.
  • Ophthalmology exam: To check for retinal haemorrhages.
  • Blood tests: Coagulation profile to rule out bleeding disorders mimicking NAI.
  • Photographic documentation: To record physical findings for legal purposes.
  • Social services referral: For assessment of the family environment.

Management 🥼

Management

  • Ensure immediate safety of the child; may involve police and social services.
  • Admit to hospital if injury is severe or child is at risk.
  • Multidisciplinary approach: Involve paediatricians, social workers, and the police.
  • Documentation: Accurate recording of all findings is essential for legal processes.
  • Support for the family, including counselling and social interventions.

Complications

  • Physical: Chronic pain, disability, or death.
  • Psychological: PTSD, anxiety, depression, and attachment disorders.
  • Social: Disruption of family unit, foster care placement, and legal proceedings.
  • Developmental delays due to trauma or brain injury.
  • Increased risk of future abuse or becoming an abuser.

Prognosis

  • Prognosis varies depending on the severity and timing of intervention.
  • Early intervention improves outcomes; chronic exposure worsens prognosis.
  • Physical injuries may heal, but psychological scars can persist.
  • Ongoing support and monitoring are crucial to prevent recurrence.
  • Legal outcomes may impact family dynamics and future child safety.

Key Points

  • NAI is a critical issue in paediatrics requiring vigilance and multidisciplinary management.
  • Early recognition and intervention can save lives and improve long-term outcomes.
  • Accurate documentation and a structured approach are essential for legal and medical purposes.
  • Always consider NAI in cases of unexplained or unusual injuries in children.
  • Collaboration between healthcare professionals, social services, and law enforcement is crucial.

No comments yet 😉

Leave a Reply

Child health