372 Paediatric Emergencies
Child Abuse (Non-accidental Injury)
10 Make certain you also inform the following by telephone:
(i) GP, to arrange for a home visit and to make sure all future clinic
attendances for the deceased child are cancelled.
(ii) Health visitor.
(iii) Social work department.
(iv) Paediatric team, if the team was not present at the resuscitation.
(v) Community Child Health Service, to cancel immunization
appointments, etc.CHILD ABUSE (NON-ACCIDENTAL INJURY)
DIAGNOSIS
1 Child abuse occurs when the adult responsible for the care of a child either
harms the child, or fails to protect them from harm. It can manifest in differ-
ent ways:
(i) Physical abuse including striking, shaking and burning.
(ii) Emotional abuse often associated with delayed emotional
development.
(iii) Sexual abuse.
(iv) Neglect including failure to provide shelter, clothing and
nourishment.
2 Maintain a high index of suspicion in the following cases, especially if the
child is <4 years old:
(i) History
(a) delay between the alleged injury and the presentation to the
ED
(b) inconsistency between the story and the actual injuries
(c) abnormal parental behaviour, poor interaction with the child
and apparent lack of parental concern
(d) frequent attendance in the ED by the child or a sibling, often
for little apparent reason
(e) previous injuries on different dates
(f) failure to thrive, or clinical signs of neglect.
(ii) Examination
(a) examine the child with the consent of at least one parent or
the child’s legal guardian. Undress the child fully in stages,
and carefully document all the findings
(b) measure bruises, scratches, burns and other skin marks
with a ruler. Arrange clinical photographs detailed in the
medical notes to provide contemporaneous evidence. Look
specifically for: