Non‑Accidental Injury (NAI) and Child Abuse
Non‑accidental injury (NAI) and child abuse are major safeguarding concerns in paediatric emergency care. Early recognition, prompt clinical stabilisation, careful evidence preservation and timely multi‑agency referral are essential to protect children and to produce robust records for later review (NICE NG76; CG89; Working Together).
Key principles
- Always treat life‑threatening problems first; stabilise the child before forensic or safeguarding steps.
- Assess plausibility by comparing the injuries with the child’s developmental stage and the account given.
- Preserve evidence: avoid unnecessary washing or removal of clothing, photograph injuries according to local policy, and retain items (clothing, dressings) in labelled bags.
- Document contemporaneously, factually and in neutral language; record verbatim statements and the exact chronology.
- Involve senior paediatric and safeguarding clinicians early and follow local referral pathways to children’s social care, police and specialist services.
Recognition: red flags and high‑risk indicators Consider NAI when one or more of the following is present:
- Injury inconsistent with the history or the child’s development/mobility.
- Multiple injuries, especially of differing ages, or fractures in infants who are non‑ambulant.
- Bruising in unusual locations (ears, neck, torso, buttocks, genitals) or patterned/linear marks suggesting an implement.
- Any bruise in an infant under 4 months, or torso/ear/neck bruising in a child ≤4 years (TEN‑4 rule) (CG89).
- Immersion scalds with clear lines of demarcation and absent splash...