Non accidental injury

• What is non-accidental injury?

  Any physical harm in a child that is deliberately inflicted or results from the failure of a caregiver to prevent harm
• What are the RFs of NAI?

  Previous child maltreatment of domestic violence in family

  Caregiver substance abuse or mental health issues

  Hx of caregiver being abused

  Emotional volatility

  Poverty & poor housing

  Children in care system

  Children & young people with disabilities are more likely to be the victim of abuse
• What are the key clinical manifestations of NAI?

  Hx

  < 2 yrs

  Delayed presentation following injury

  Inconsistencies in narrative

  Unwitnessed injuries

  Evidence of drug/alcohol use in house

  Burns/scalds

  Bruises (esp on head & face)

  Subconjunctival/retinal haemorrhage

  Human bite marks

  Immersion scalds

  Torn frenum

  Cigarette burns

  Female genital mutilation
• What are the DDx of NAI?

  Accidental injury

  Bleeding disorders

  Haematological malignancy
• What is the management of NAI?

  Report any suspicions to consultant

  Safeguarding

  Medical treatment of injuries

  Documentation -> very clear & concise
• What are the possible complications of NAI?

  Recurrence or escalation of NAI

  Psychological distress

  Poor health outcomes

  Substance misuse & employment difficulties later in life