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5 Paediatrics
5.2 Abuse (see also NAI)
M. Lalanda
Be on the lookout for cases of non-accidental injury of children. One cannot judge from the appearance of the parents. The cardinal point to note is that a credible history should be obtained for every case of child injury. Certain categories of injury require admission, even if the history sounds acceptable. These include long bone fractures in children under 12 months old, skull fractures in children under 12 months old and the presence of other healing fractures noted when the injury site is X-rayed. Suspicious injury patterns are a torn labial frenulum, slap marks, punctate burns (caused by a cigarette) etc. If in any doubt, first seek advice from A&E senior. If the Liaison Health visitor is present in the department also contact her. If advised, or no senior available, then during office hours contact Belmont House, Dr Wynne or Dr Rudolph (tel 26106) and refer the child to them. If the child needs to be admitted for further consideration or for safety reasons, contact the paediatric registrar (not the SHO) at the Clarendon Wing. Out of hours, contact the paediatric registrar
N A I
If in doubt as to whether the child you have examined has or has not been abused please ask for an opinion from the staff at Belmont House. Take particular care in children under 2 years (and especially under 1 year) with fractures. Always admit such children when < 1yr under the paediatrician of the day. Do not hesitate to ask the Paediatric Registrar on call to see the child or discuss with Dr Wynne - bleep 2493 or Secretary ext 6106.
Symptoms such as screaming in an underweight (i.e. less than 3rd per centile, or mid-upper arm circumference less than 15 cm.) infant or child may warrant admission or early out-patient appointment.
Examination of these children should include height and weight (and plot on the centile chart), drawings of the injuries with measurements, and a full general examination. If there is a question of sexual abuse, wait until an experienced paediatrician arrives to carry out a joint examination. Consider a skeletal survey in children under 3 years.
The Health Visitor in A & E, (ext 22523 - bleep 80-2132) is available to discuss individual children, and she has access to the Child Abuse "At Risk" Register. If she is not available, contact the Medical Social Work Dept (ext 27151) for advice. Out of hours, the duty social services will help (tel Leeds 696198). If you are experiencing difficulty, contact the Paediatric Registrar.
Children who are victims of NAI should not go home unless this is advised by the Paediatric Registrar and the Social Services. Be careful with burns (esp cigarette sized burns) as the position may indicate NAI. All genital injury or torn frenulum should be regarded with suspicion; you may be happy with the history, but it is wise to see what the Paediatric Registrar feels about it.