Makindo Medical Notes

Non-Accidental Injury (NAI) refers to physical harm deliberately inflicted on a child or vulnerable adult. While commonly associated with child abuse, NAI can also affect the elderly or dependent adults in cases of elder abuse. Medical professionals play a critical role in identifying and managing these cases to ensure the safety and well-being of the individual.

Causes

• Physical abuse: Hitting, shaking, burning, or other forms of bodily harm.
• Sexual abuse: Non-consensual sexual activity, particularly in children or vulnerable adults.
• Emotional or psychological abuse: Persistent maltreatment affecting mental health and development.
• Neglect: Failing to meet basic needs such as food, shelter, medical care, or hygiene.

Risk Factors

• Presence of domestic violence in the household
• Parental or caregiver substance abuse (drugs or alcohol)
• Family history of abuse or intergenerational trauma
• Parental mental illness (e.g., depression, psychosis)
• Social isolation or lack of family/community support
• Low socioeconomic status or financial strain

Clinical Signs

• Inconsistent history or delays in seeking medical attention
• Unexplained or poorly explained injuries
• Bruises in various stages of healing, indicating recurrent trauma
• Patterned injuries (e.g., belt marks, handprints, bite marks)
• Fractures, particularly in non-ambulatory infants or fractures of differing ages
• Burns, especially cigarette burns or immersion burns
• Abdominal injuries (e.g., damage to liver or spleen)
• Signs of neglect, such as malnutrition, poor hygiene, or developmental delay

Diagnostic Approach

• Thorough history: Collect a comprehensive medical, social, and injury-related history from the caregiver and patient.
• Physical examination: Look for clinical signs of abuse, including skin lesions, fractures, and signs of neglect.
• Radiological imaging: Skeletal survey, head CT, and other imaging to assess internal injuries and fractures.
• Blood tests: Coagulation screen to rule out clotting disorders, especially in cases with extensive bruising.
• Multidisciplinary team involvement: Work with safeguarding services, social workers, and pediatricians to ensure a comprehensive assessment.

Management

• Ensure immediate safety: Hospitalize the child or vulnerable adult if necessary to protect them from further harm.
• Involve safeguarding services: Immediately notify local safeguarding services (e.g., social services or child protection teams).
• Document thoroughly: Accurate medical records, including descriptions and photographs of injuries (with consent), are critical for legal and medical purposes.
• Report to authorities: Notify local child protection agencies or law enforcement when NAI is suspected.
• Medical and psychological care: Provide both physical treatment and psychological support to the victim.
• Follow-up: Coordinate ongoing care, including regular medical check-ups and social services involvement, to monitor well-being.

Red Flags for Non-Accidental Injury

• History that is inconsistent with the nature or severity of the injury
• Frequent visits to the hospital or multiple injuries at different stages of healing
• Injuries with specific patterns (e.g., hand marks, looped cords, bite marks)
• Signs of neglect, including malnourishment or poor growth
• Fearful, withdrawn, or hypervigilant behavior in the child

Key Considerations

• Always consider NAI when encountering unexplained or suspicious injuries, especially in young children or vulnerable adults.
• NAI is a medical and safeguarding emergency requiring immediate intervention and protective measures.
• Accurate documentation and collaboration with multidisciplinary teams (MDTs) are crucial for diagnosis, treatment, and legal procedures.

Role of the Healthcare Professional

• Early identification of potential abuse cases
• Ensure the safety and protection of the child or vulnerable adult
• Report any suspicions to appropriate safeguarding authorities
• Provide comprehensive care, including medical treatment, psychological support, and involvement of social services