How should I approach the initial assessment of a child with suspected non-accidental injury in a primary care setting?

In the initial assessment of a child with suspected non-accidental injury, it is important to listen and observe, gathering information from various sources including history, physical appearance, behaviour, symptoms, and interactions with carers, to piece together the whole picture of the child's presentation ¹.

Seek an explanation for any injury or presentation from both the parent or carer and the child in an open and non-judgemental manner ¹.

Assess for alerting features of maltreatment, such as bruising in non-ambulant children, multiple bruises, bruises of similar shape and size, or bruises on non-bony parts or face, including the eyes, ears, and buttocks ¹.

Be alert to suspicious signs like bite marks unlikely to be caused by a young child, unsuitable explanations for injuries, or injuries in typical sites for inflicted harm, such as burns with sharp borders or scalds in unusual distributions ¹.

Consider the child's developmental stage and medical history to differentiate accidental from non-accidental injuries, and be vigilant for signs such as fractures, intracranial injuries, or visceral injuries without a suitable explanation ¹.

Document findings carefully and consider multi-agency safeguarding arrangements if maltreatment is suspected ¹.