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Non-accidental injury — RACP Paediatrics MCQ

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ModerateEmergencyNon-accidental injuryRACP Paediatrics

A 10-month-old presents with a femoral fracture. The parents report the child rolled off the sofa. There is no consistent mechanism for the injury. The child has multiple bruises in varying stages. What is the most important investigation to perform?

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Correct answer: A — Skeletal survey

An unexplained femoral fracture in a non-ambulant child with multiple bruises of varying ages raises strong concern for non-accidental injury (NAI). A skeletal survey is the key investigation to identify occult fractures (healing rib fractures, metaphyseal corner fractures are highly specific for NAI). Mandatory reporting, social work involvement, and ophthalmology review (retinal haemorrhages) are also required.

Reference: RCH Melbourne – 2023 – Child Abuse CPG; RACP Paediatric Curriculum – Child Protection