Makindo Medical Notes.com

Non-Accidental Injury (NAI) refers to physical harm inflicted on a child or vulnerable adult deliberately. It is commonly associated with child abuse but can also occur in elderly or dependent adults. The role of medical professionals in identifying and managing these cases is vital.

Causes

• Physical abuse (e.g., hitting, shaking, burning)
• Sexual abuse
• Emotional or psychological abuse
• Neglect (failure to meet basic needs such as food, shelter, and medical care)

Risk Factors

• Domestic violence
• Parental substance abuse (drugs or alcohol)
• Family history of abuse
• Parental mental illness
• Social isolation or poor support networks
• Low socioeconomic status

Clinical

• Inconsistent history or delays in seeking medical attention
• Unexplained or poorly explained injuries
• Bruises of different ages (multiple stages of healing)
• Patterned injuries (e.g., belt marks, handprints, bite marks)
• Fractures, especially in non-ambulatory infants or fractures of different ages
• Burns (cigarette burns, immersion burns)
• Abdominal injuries (liver, spleen damage)
• Signs of neglect (malnourishment, poor hygiene)

Needs a Diagnostic Approach

• Thorough history, including social history and injury mechanism
• Physical examination looking for signs of abuse
• Radiological imaging (skeletal survey, head CT, and other relevant imaging)
• Blood tests (coagulation screen to rule out clotting disorders)
• Multidisciplinary team (MDT) involvement, including safeguarding team, social workers, and pediatricians

Management

• Ensure the safety of the child or vulnerable adult (hospital admission if necessary)
• Involve safeguarding services immediately (social services, child protection team)
• Documentation: Detailed and accurate medical records are crucial, including photographs of injuries with consent
• Report the case to local child protection agencies or law enforcement if abuse is suspected
• Provide medical and psychological care to the victim
• Follow-up with social care and regular medical check-ups to monitor well-being

Red Flags for Non-Accidental Injury

• History inconsistent with the severity of the injury
• Frequent hospital visits or multiple injuries
• Injuries with specific patterns (e.g., hand marks, looped cord, bite marks)
• Signs of neglect (malnourishment, poor growth)
• Fearful or withdrawn behavior from the child

Key Considerations

• Always consider NAI in unexplained or suspicious injuries, particularly in young children
• NAI is a medical emergency requiring immediate safeguarding measures
• Documenting findings accurately and involving appropriate multidisciplinary teams is critical for both diagnosis and legal protection

Role of the Healthcare Professional

• Identify potential cases of abuse early
• Ensure the safety and protection of the child or vulnerable adult
• Report suspicions to the appropriate safeguarding authorities
• Provide comprehensive care, including medical, psychological, and social support