Paediatric Non Accidental Injury


You have been asked to review a child who is two years old who presented with a limp. On examination the patient is noted to have metaphyseal corner fractures of the tibia. A social services referral is required and the patient needs to be admitted for observation.

It is important to note that we rarely deal with this alone and you should mention you would involve your paediatric colleagues early and perhaps attend the patient’s parents with them.


  • Introduce yourself
  • Gather information – Ask the parents about why they brought the patient in, how they sustained the injury and what they know about the investigations that have been performed.
  • Explain the nature of the injuries on the X-Ray and that the X-Ray findings are suggestive of non-accidental injury/shaking injuries. Do so in a non-accusatory method
  • Explain to the parents that when patients with these types of injuries present there are certain protocols that must be followed including referral and further investigation.
  • Explain that you are not accusing them, but that the protocols are in place to ensure patients/children are kept safe.

This is a question that is normally best answered by the paediatric team.

What tends to happen is that a risk assessment is undertaken. In addition, the child is positioned in view of the nursing station and parents may stay with the child whilst investigations take place.