Child Abuse – PEM Induction Post Test

The following bruises should make you suspicious of NAI:

A 3yo child presents to the ED via ambulance with a mid-shaft deformity of left forearm. 

Accompanied by his mother (single parent) and his maternal uncle, the child has no past medical history of significance and the family deny any previous involvement with social services. 

History given by his mother: whilst playing in the house, she witnessed him fall off a 1ft high trampoline, landing heavily on wooden flooring onto his left forearm, with deformity immediately evident. She had attended the child immediately and called for the maternal uncle (present in the house) to call 999 for an ambulance.

On arrival in ED, the ambulance crew inform staff of concerns raised by the 999 call handler: initial verbal aggression from the uncle towards the call handler had prompted police to also be called to the property.

The mid-shaft radius and ulnar fracture is thought to be consistent with the history reported. The child is treated with analgesia, the fracture stabilised in a backslab, and a referral is made to orthopaedics for manipulation under anaesthesia.

Concerns are again raised by staff about the interaction between the uncle and the mother and child: whilst the uncle remains calm in the department, he is noted to smell strongly of cannabis and alcohol, and both the mother and child appear uncomfortable, subdued and nervous in his presence. 

The mother states that the uncle has moved into their house as he has recently split from his partner.

Given these concerns, what initial steps should you take?

Match the mechanism to the injury: