We're all always told to suspect NAI in any child that comes in. In major trauma NAI is very possible and it would be easy to get swept away with making sure the child was physically OK. Even in minor injuries we don't always remember it.
Bruises:
It is difficult to age bruises just from the colour. The following are worrying signs:
- bruises in a non mobile child
- shins and knees are normal places to bruise
- abusive bruises are often seen on soft bits of the body like buttocks, abdomen and back
- the ear, neck and head are often affected
- petechiae are commonly seen in abused children, and less common in accidental bruises
- bilateral bruising, symmetric or geographic bruising is worrying
The NSPCC have a leaflet, and LearnPediatrics has lots of information.
Fractures
- In non ambulatory child is worrying
- Metaphysis fractures are normally because the child has been pulled.
- Metaphyseal fractures are also called bucket handle fractures.
- Spiral fractures are suggestive of twisting
- Posterior ribs, scapular and sternum are pathognomic of child abuse.
- Humeral fractures
Burns
Head Injuries
- Clinical prediction rule
- Skull fractures are uncommon without NAI
Misc.
- Duodenal perforation
- Torn frenulum is not a sensitive predictor
- Epistaxis
There is a case here.
All these worrying signs are nicely summarised on LITFL - the Bakers Dozen of Bashed Baby Badness.
https://www.rcemlearning.co.uk/foamed/brackium-emendo-long-bone-and-nai-dftb18/
https://www.rcemlearning.co.uk/foamed/pem-chapter-12-nai/
https://emergencymedicinecases.com/pediatric-physical-abuse/
https://www.rcemlearning.co.uk/foamed/recognition-of-child-abuse-in-the-ed/
Showing posts with label PAP6. Show all posts
Showing posts with label PAP6. Show all posts
Monday, 7 October 2013
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