Types & Signs

To identify signs of possible abuse and neglect in children and young people under the age of 18, the National Institute For Health and Care Excellence (NICE) has issued a series of maltreatment guidelines to healthcare professionals.

Below are some examples and sites of non-accidental injury, which typically cause suspicion to be raised.

Bruises

  • Shape, pattern and age of bruises.
  • Bruises shaped like hands, ligatures or identifiable implements.
  • Bruises on non-bony parts of the body, face and ears.
  • Multiple bruises or clustered bruises.
  • Bruising in a non-mobile child.
  • Bruising over soft tissues.

Bites

  • Any bite which appears human.
  • Small bite marks require adequate explanation.
  • Animal bites are sign of poor supervision.

Lacerations & Abrasions

  • Symmetrical in shape or location.
  • On ankles or wrists – signs of a ligature.
  • In non-mobile children.
  • Around the face.

Thermal Injuries, burns & scalds

  • Implement shaped – like a cigarette or iron.
  • Scalds with borders - immersion injury.
  • Buttocks & back.
  • Soles of feet.
  • Backs of hands.

Fractures

  • Single or multiple in children without predisposed medical condition.
  • Rib fractures – indicate grabbing, squeezing, shaking.
  • Different age of fractures.
  • Spiral fractures.

Intracranial Injuries

  • Infant head injury – often known as Shaken Baby Syndrome.
  • Any without adequate explanation.
  • In a child under age of 3.
  • Along with any multiple subdural haemorrhages.
  • In the presence of retinal haemorrhage.
  • Alongside rib or long bone fractures.

Eye Trauma

  • Retinal haemorrhage with no medical explanation.
  • Bleeding - retinal, pre-retinal, intra retinal, sub-conjunctival etc

Spinal injuries or visceral injuries

  • Present without a history of major trauma.

Fabricated illnesses

  • Any potentially induced illnesses.
  • Poisoning.

Infant Death

  • Sudden Infant Death Syndrome.
  • Unexplained or implausible accidents.
  • Signs of smothering.

Key non-accidental injury safeguarding questions

When trying to detect and identify cases of non-accidental injury, a wide range of factors are taken into account and points considered.

  • Presentation of the child: Are there multiple injuries?
  • Medical history: Is it variable or inconsistent with the injuries seen?
  • Timeframes involved: Is there a delay in seeking medical attention?
  • A&E Attendance: Are there multiple occurrences? Or frequent access?
  • Developmental stage: Are the findings consistent with the child’s age?
  • Signs of neglect: Is the child unkempt, smelly or dirty?

Have you been told to seek legal advice by the Police or Social Services?

Are they refusing to accept your explanation for an injury?

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