What are the referral criteria for suspected non-accidental injury to child protection services or paediatric specialists?

Referral to child protection services or paediatric specialists should be considered if there is suspicion of child maltreatment based on specific injury patterns or presentations, such as intracranial injuries without a confirmed accidental cause, retinal haemorrhages, rib or long bone fractures, or other inflicted injuries, especially in children under 3 years old ¹.

Suspect non-accidental injury if a child presents with injuries that have an absent or unsuitable explanation, particularly if the presentation is inconsistent with the child's developmental stage or normal activities ¹.

Specific indications include multiple bruises or bruises in clusters, bruises on non-bony parts or face, bite marks unlikely to be caused by a young child, lacerations or scars with an unsuitable explanation, burns in characteristic patterns or locations, fractures in the absence of a medical condition predisposing to fragility, intracranial injuries, or injuries such as spinal injuries, intra-abdominal or intrathoracic injuries, and injuries in children with disabilities where maltreatment cannot be excluded ¹.

Other considerations include poisoning with inappropriate substances, non-fatal submersion incidents with an unsuitable explanation, frequent or unusual presentations to healthcare, and fabricated or induced illnesses ¹.