8.43 Unexplained Injuries to Young Children

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Last reviewed in July 2020

Date of next review - July 2022


Click here to view Flowchart on Injuries to Young Children.


Physical injuries in young children may be life-threatening or cause permanent neurological damage. Reviews highlight the fact 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:

  • Minor injuries with an inconsistent explanation;
  • Significant bruising;
  • Any fractures;
  • Any major injury.

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:

  • Lethargy, poor feeding, apnoea or irregular breathing;
  • Fits;
  • Variable consciousness;
  • Intra-cranial bleeding and retinal haemorrhages;
  • Skull and rib fractures;
  • Death.

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.


  • To review the current investigation and enquiries made to date;
  • Identify additional enquiries that will assist in determining the mechanism of any unexplained injury, who will undertake these enquiries and time scale for completion;
  • Identify any specialist advice that may assist in determining the mechanism of any unexplained injury;
  • To consider all possible hypotheses and differential diagnoses relating to any injury and for each either determine the extent to which they might explain the injury or exclude them where possible;
  • In light of the information gathered at the time, consider whether the threshold for legal intervention has been reached;
  • Identify and formulate an interim safety plan for the child. (e.g. remain in hospital, EPO etc);


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:

  • Children’s Social Care Service Manager (Chair)
  • Social Work Manager
  • Investigating Social Worker
  • Safeguarding Investigations Unit Investigating Officer
  • Safeguarding Investigations Unit Detective Sergeant
  • The paediatrician who undertook the Paediatric Assessment
  • Named Doctor
  • Named Nurse
  • Local Authority Solicitor
  • Other specialists who have been involved in the assessment of the injury
  • Other relevant professionals, health professionals and specialists may be required
  • Notetaker to attend and take full minutes in addition to completion of Record of Strategy Discussion form.



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 hypothesis/differential diagnosis was investigated and finalised or excluded. Participants in 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.

Such cases may require a Fact-Finding Hearing

Should there be any professional disagreement during the course of the above procedure, reference must be made to the Resolution of Professional Disagreements.

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This page is correct as printed on Thursday 1st of October 2020 12:42:26 PM please refer back to this website ( for updates.