Signs of Abuse

Features to watch out for, that may raise concerns of abuse:

• An unusual or questionable history
• A changing history
• The finding of multiple skin bruises or burns
• Multiple Emergency Department attendance
• Late or delayed presentations to the ED

Knowledge of the injury patterns suggestive of NAI in children is essential. The most common locations (but least specific) for fractures due to child abuse are the humerus, tibia and femur [6].

The differential diagnosis in cases of suspected child abuse include true accidental injury, osteogenesis imperfecta and metabolic bone disease. Skeletal survey is a useful initial imaging modality but should be undertaken by the in-patient team after referral. The Emergency Department doctor’s job is to consider NAI. If concerned at all, refer the child on.

NAI – consider it or miss it!