Non-accidental injury

Non-accidental injury

No child is exempt but some children are at particular risk, including those under 3 years of age, those with disabilities and those in families su ff ering socioeconomic deprivation. A careful clinical assessment is required ( Figure 44.43 and Table 44.20 ). Characteristic patterns should alert the clinician to the possibility of non-accidental injury (NAI) ( Table 44.21 ). NAI occurs in di ff erent forms: emotional, physical, sexual and neglect. When suspected it should be discussed with child safeguarding teams. All injuries should be documented carefully . It may be prudent to admit the child until further checks have been made. /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF

TABLE 44.20 Factors that raise concern in the clinical assessment of suspected non-accidental injury. History Delay in seeking medical advice Variable story Mechanism inconsistent with injury pattern Examination Unexpected bruising to the buttocks/back of legs ‘Finger-mark’ bruises Bruises of various ages Burns, deep scratches, etc. TABLE 44.21 Fracture patterns with a high speci /f_i city for non-accidental injury. Multiple fractures at different stages of healing/old fractures Posterior rib fractures Corner or bucket-handle metaphyseal fractures Scapular fractures Any fracture in a child below walking age

Bulstrode CJK, Wilson-MacDonald J, Eastwood DM et al Oxford textbook of trauma and orthopaedics , 2nd edn. Oxford: Oxford University Press, 2017. Flynn JM, Weinstein SL (eds). Lovell and Winters pediatric orthopaedics vols 1 and 2, 8th edn. Philadelphia, PA: Lippincott, Williams & Wilkins, 2020. org/pediatric-orthopaedics (accessed 25 March 2021). . (eds). Kocher MS, Mandiga R, Zurakowski D et al . Validation of a clinical prediction rule for the di ff erentiation between septic arthritis and transient synovitis of the hip in children. J Bone Joint Surg Am , 2004; 86 (8): 1629-35. Non-accidental injury

No child is exempt but some children are at particular risk, including those under 3 years of age, those with disabilities and those in families su ff ering socioeconomic deprivation. A careful clinical assessment is required ( Figure 44.43 and Table 44.20 ). Characteristic patterns should alert the clinician to the possibility of non-accidental injury (NAI) ( Table 44.21 ). NAI occurs in di ff erent forms: emotional, physical, sexual and neglect. When suspected it should be discussed with child safeguarding teams. All injuries should be documented carefully . It may be prudent to admit the child until further checks have been made. /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF

TABLE 44.20 Factors that raise concern in the clinical assessment of suspected non-accidental injury. History Delay in seeking medical advice Variable story Mechanism inconsistent with injury pattern Examination Unexpected bruising to the buttocks/back of legs ‘Finger-mark’ bruises Bruises of various ages Burns, deep scratches, etc. TABLE 44.21 Fracture patterns with a high speci /f_i city for non-accidental injury. Multiple fractures at different stages of healing/old fractures Posterior rib fractures Corner or bucket-handle metaphyseal fractures Scapular fractures Any fracture in a child below walking age

Bulstrode CJK, Wilson-MacDonald J, Eastwood DM et al Oxford textbook of trauma and orthopaedics , 2nd edn. Oxford: Oxford University Press, 2017. Flynn JM, Weinstein SL (eds). Lovell and Winters pediatric orthopaedics vols 1 and 2, 8th edn. Philadelphia, PA: Lippincott, Williams & Wilkins, 2020. org/pediatric-orthopaedics (accessed 25 March 2021). . (eds). Kocher MS, Mandiga R, Zurakowski D et al . Validation of a clinical prediction rule for the di ff erentiation between septic arthritis and transient synovitis of the hip in children. J Bone Joint Surg Am , 2004; 86 (8): 1629-35. Non-accidental injury

No child is exempt but some children are at particular risk, including those under 3 years of age, those with disabilities and those in families su ff ering socioeconomic deprivation. A careful clinical assessment is required ( Figure 44.43 and Table 44.20 ). Characteristic patterns should alert the clinician to the possibility of non-accidental injury (NAI) ( Table 44.21 ). NAI occurs in di ff erent forms: emotional, physical, sexual and neglect. When suspected it should be discussed with child safeguarding teams. All injuries should be documented carefully . It may be prudent to admit the child until further checks have been made. /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF

TABLE 44.20 Factors that raise concern in the clinical assessment of suspected non-accidental injury. History Delay in seeking medical advice Variable story Mechanism inconsistent with injury pattern Examination Unexpected bruising to the buttocks/back of legs ‘Finger-mark’ bruises Bruises of various ages Burns, deep scratches, etc. TABLE 44.21 Fracture patterns with a high speci /f_i city for non-accidental injury. Multiple fractures at different stages of healing/old fractures Posterior rib fractures Corner or bucket-handle metaphyseal fractures Scapular fractures Any fracture in a child below walking age

Bulstrode CJK, Wilson-MacDonald J, Eastwood DM et al Oxford textbook of trauma and orthopaedics , 2nd edn. Oxford: Oxford University Press, 2017. Flynn JM, Weinstein SL (eds). Lovell and Winters pediatric orthopaedics vols 1 and 2, 8th edn. Philadelphia, PA: Lippincott, Williams & Wilkins, 2020. org/pediatric-orthopaedics (accessed 25 March 2021). . (eds). Kocher MS, Mandiga R, Zurakowski D et al . Validation of a clinical prediction rule for the di ff erentiation between septic arthritis and transient synovitis of the hip in children. J Bone Joint Surg Am , 2004; 86 (8): 1629-35.