Management of a child presenting with suspected non-accidental injuries
- Never accuse parents of lying or being abusers
- Take a careful history
- Complete a trauma form
- Check consistency of history
History
1. Detailed history of pain/ injury
2. Careful history of alleged accident—when, where, who was there, what time, what sequence of events, witnesses
3. Medical history
4. Family and social history
Examination
1. Facial expressions, exposed skin and clothing
2. Check face and head for marks
3. Oral inspection—lips, teeth, mucosa, scarring, bruising
4. General observed behaviour
Records
Document information at the time of examination. This documentation should be witnessed. If two carers or parents present to the clinic one can be taken elsewhere (to complete forms etc) while the other is re-questioned on the history.
Be sure to note:
- Time of arrival
- Names and addresses
- Illustrations of the size, position, type of injury
- Photographic evidence is beneficial
Management
Call Social Services or the Community Paediatrician and ask whether there is a record of the child/ family being known or any previous history of trauma.
Arrange a recall appointment, preferably in 1 week, as a follow up. If the child fails to attend this, it is important to note this and inform Social Services / Community Paediatrician of this, if they have already been contacted.