Non-accidental injury — red flags
What it means
Features suggesting child physical abuse: a history INCONSISTENT with the injury or developmental stage, CHANGING history, DELAYED presentation; bruising in a NON-MOBILE baby, torn frenulum, bites; fractures of differing ages, posterior rib and metaphyseal ('corner') fractures, spiral fractures in non-walkers; cigarette/immersion burns; RETINAL HAEMORRHAGES (abusive head trauma). Act: examine fully, document, consider skeletal survey/fundoscopy, refer to safeguarding.
Worked example
A 3-month-old (non-mobile) with bruising and a torn frenulum, brought in late with a vague story — abusive injury until proven otherwise; refer and investigate.
In the exam
A non-mobile infant has unexplained bruising and a torn frenulum, presented late with an inconsistent account.
What settles it
Bruising/fractures in a NON-MOBILE infant, and a history that doesn't fit the injury or development, are the strongest red flags — escalate rather than reassure.
Classically confused with
Types of abuse
Source: NICE CG89/NG76; RCPCH