Overview

• Non-Accidental Injury → any physical harm in a child that is deliberately inflicted or results from the failure of a caregiver to prevent such harm.
• Risk Factors → caregiver substance abuse, young parental age, single-parent households, and socio-economic disadvantage.
• Shaken Baby Syndrome:
  • Triad (ESR) → retinal haemorrhages + subdural haematoma + encepholapthy.
    • Encephalopathy → may present as drowsiness.

Making Diagnosis

Clinical Features

• Children <2 years.
• Often delayed presentation following injury.
• Inconsistencies in caregivers narratives.
• Bruising, broken bones, drowsiness, neglect, failure to thrive.
  • Spiral Fractures.
  • Humeral Fractures <18m. (Most common associated fractures → radial, humeral, femoral).
  • Posterior Rib Fracture.
• Bruising in non-mobile infant → same day assessment.

Investigations

• Skeletal Survey
• CT Head Scan
• Bloods (FBC and Coagulation Screen) and Bone Profile
• Opthalmology Review → fundoscopy for retinal haemorrhages.