see also [[Domestic violence]], [[Paediatric consent#Parents who won't give consent / overriding parental consent for life-saving treatment|Overriding parental consent for life-saving treatment]] See: - [TEN 4 FACES screen victoria](https://www.rch.org.au/vfpms/guidelines/Bruising/) - [RCH - Child Abuse CPG](x-devonthink-item://8A9328BB-EEDC-44F4-B9F0-7EAE835358AD) - [victoria RCH VFPMS guideline](https://www.rch.org.au/vfpms/guidelines/physical_harm_or_non-accidental_injury/) - [Rosen - child abuse](x-devonthink-item://E944A3B6-FD3B-4A1F-AECB-5F2DC440614D) - [cameron paeds - child at risk](x-devonthink-item://38D49DC2-58A4-4449-84DC-D07BFF108A39?page=13) > [!quote] mnemonic > Those who don’t cruise, don’t bruise *List the patterns of soft tissue injury which are suggestive of non accidental cause* - grab marks - pinch - slap - impressions from belts/hairbrush - bites - Location- torso/ear/neck in children <4 TEN4 - multiple sites & multiple ages - burns- immersion, branding, cigarette burns *List the patterns of bony injury in NAI* - multiple sites, multiple ages - metaphyseal fracture of long bones (violent torsion or traction injury) - epiphyseal fractures (SH I + II) due to jerking/wrenching - spiral fracture of long bones (femur, tibia, radius) - scapula, spinous process, sternal and rib fractures (posterior) *What are some signs of neglect that you'd look for in a child with a suspected NAI:* 1. general hygiene- infestations 2. weight/height for age, failure to thrive 3. inappropriately clothed for weather 4. unusual interaction with parent 5. Developmentally delayed *What features on history would make you suspect NAI* 1. Inconsistent history, injury doesnt fit with mechanism 2. Delay in seeking medical help 3. Injury pattern doesn't fit with developmental level of child 4. Parental history of violence or drug/alcohol abuse 5. Social circumstances- foster care 6. Frequent ED attendances with various injuries *State four features of bruising that might alert you to suspicion of physical abuse in a child?* - bruising on children who are not independently mobile (age <6 mo) - bruising on torso (chest, abdo, back, buttocks, genitalia), ears and neck -- TEN 4 FACES. upper arms or anterior thigh may also raise concern in certain circumstances - bruising that is not on front of body or over a bony prominence - bruising that is abnormally large or multiple bruises - bruising that is clustered or patterned - bruising with [[Petechiae]] - bruising that does not fit with the mechanism described > note: the age of a bruise cannot be determined on the basis of its colour; multiple briuses that appear different may have been sustained at the same time . the possibility that the child has a [[Haemophelia|bleeding disorder]] (eg haemophilia or VWd) or leukaemia should be considered, although it should be remembered that children with bleeding disorders can also sustain inflicted injuries # TEN 4 Faces > If these criteria are met, have clinical concern for abuse: > > - Bruising in TEN location (Torso, Ear, Neck) in child <4years-old > - Any bruising in child <4-6months-old > - Injury to FACES (Frenulum, Angle of jaw, Cheek, Eyelid, Sclera) in child of any age ![[Pasted image 20240710142950.png]] # reporting (victoria) - physical injury - VFPMS - 1300 661142 - clinical photography - mandatory reporting - DFFH Child Protection - sexual assault: - assessment: VFPMS - 1300 661142 - support and counselling - gatehouse - 93456391 - sexual assault crisis line after hours - 8345 3494 - mandatory reporting - child protection # specific injuries - proximal humeral or humeral shaft fracture <3 years - corner or 'bucket-handle' metaphyseal injuries - femoral fractures in infants <12 months - rib fractures - complex skull fractures - multiple fractures of different ages (but see earlier note about evaluating stages of bruise healing) - delayed presentation - unwitnessed injury - recurrent fractures - unexplained soft tissue markings ## Corner fracture of metaphyseal long bone #ortho #radiology - chip at the corner of metaphysis due to violent torsion or traction injury that avulses the normally very adherent periosteum at this site - almost always indicates NAI in children <18 months of age ![[Pasted image 20240724163717.png| tibial medial metaphyseal corner fracture]] ## epiphysial injury salter harris I or II due to jerking or wrenching ## spiral fracture of long bone - femur, tibia, radius ## rib fractures, scapula, spinous process, sternum - very rare in kids - suspect NAI ## skull fractures - Skull fractures other than single parietal fracture also sketchy