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Non-accidental injury — RACP Paediatrics MCQ

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HardSafeguarding, development, mental healthNon-accidental injuryRACP Paediatrics

A 7-month-old is brought with a swollen thigh after reportedly rolling off a low couch. X-ray shows a metaphyseal corner fracture. There are bruises on the ears and torso, and the history changes between caregivers. What is the most appropriate investigation?

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Correct answer: A — Skeletal survey with child protection and paediatric review

Metaphyseal corner fracture, non-mobile age, patterned bruising and inconsistent history are highly concerning for inflicted injury. A skeletal survey and child protection pathway are required, alongside assessment for medical mimics when appropriate. The priority is safety while maintaining careful, objective documentation.

Reference: RCH Child abuse guideline; Australian child protection guidance