8.44 Unexplained Injuries to Young Children
In March 2015, 8.36.4 was amended to include the designation of the term “unexplained” should not influence staff into making assumptions that the injury is either accidental or non-accidental.8.36.6, Serious Unexplained Injury Strategy Discussion and 8.36.7, Conclusion were added.
Physical injuries in young children may be life threatening or cause permanent neurological damage. Reviews children under 1 year old are especially vulnerable.
Any suspicious injury in a pre or non-mobile and/or pre or non-verbal child must be regarded with extreme concern including:
Any injury and its explanation must be assessed in relation to the infant's developmental abilities and the likelihood of the occurrence. The designation of the term “unexplained” should not influence staff into making assumptions that the injury is either accidental or non-accidental. All efforts must be made to establish an explanation for the injury which in turn may assist in determining whether or not the injury is accidental or non-accidental, and if a crime has been committed.
Young children and infants are highly vulnerable and may have a serious injury without obvious physical signs e.g. shaking injuries may result in internal head injuries. Nevertheless significant internal injuries may be caused and result in:
Serious Unexplained Injury Strategy Discussion
If at the outset or before the conclusion of initial S47 Enquiries the mechanism for an injury to an infant or young child remains unknown, a serious unexplained injury strategy discussion should be convened. This Strategy Discussion should be undertaken as outlined in Strategy Discussions Procedure but must include additional considerations and the attendance of key staff.
Guidance as to who should attend strategy meetings is detailed in Strategy Discussions Procedure, Participants to Strategy Discussion / Meeting. In order for the serious unexplained injury Strategy Discussion to be effective the following personnel must be in attendance:
It may be necessary to hold more than one serious unexplained injury Strategy Discussion to finalise enquiries into an unexplained injury to an infant or young child.
Where the S47 investigation is unable to determine how an injury was caused, the minutes of the final serious unexplained injury Strategy Discussion must record how each hypotheses/differential diagnosis was investigated and finalised or excluded. Participants to the final serious unexplained injury Strategy Discussion must all agree that all opportunities to determine the causation of an injury have been examined, and at the time of the serious unexplained injury Strategy Discussion there are no outstanding enquiries that can be undertaken.
Should there be any professional disagreement during the course of the above procedure, reference must be made to the Resolution of Professional Disagreements.
Brighton & Hove
- Brighton & Hove Referral flow chart for bruises for health professionals
- Brighton & Hove Bruising Leaflet for parents
- West Sussex Bruising in Children who are Not Independently Mobile (NIM) Guidance for Professionals
- Body Maps
- West Sussex Unexplained Mark Leaflet for Parents