How can I differentiate between accidental and non-accidental injuries in children during a routine examination?

During a routine examination, differentiate accidental from non-accidental injuries in children by carefully assessing the injury characteristics, explanations given, and the child's developmental stage. Non-accidental injuries often have unsuitable or absent explanations that are implausible, inadequate, or inconsistent with the child's presentation, normal activities, age, or developmental stage. Alerting features include bruises in non-mobile children, bruises in clusters or of similar shape and size, bruises on non-bony parts of the body (such as face, eyes, ears, buttocks), or bruises suggestive of ligature marks. Other suspicious signs include human bite marks unlikely to be caused by a young child, multiple or symmetrical lacerations or scars, burns or scalds with patterns indicating forced immersion or shaped by implements, and fractures of different ages or occult fractures. Intracranial injuries without major accidental trauma or medical cause, retinal hemorrhages, rib or long bone fractures, spinal injuries, intra-abdominal or intrathoracic injuries with absent or unsuitable explanations, and oral injuries with no suitable explanation should raise suspicion. Consider the child's behaviour, demeanour, and interaction with carers, and seek explanations from both child and carers in a non-judgemental manner. If concerns arise, discuss with safeguarding professionals and follow local multi-agency safeguarding arrangements