LEARNING & IMPROVEMENT SUBGROUP Issue 2
1
v
Salutary
tales
Learning in
practice
Issue 2 August 2015
Non- accidental injury in
infants
Aaauagust 15
SAFEGUARDING CHILDREN IS EVERYONE’S BUSINESS
AUTHOR: DR D J STALKER; CHAIR
LEARNING & IMPROVEMENT SUBGROUP
SOMERSET SAFEGUARDING CHILDREN
BOARD
Learning & improvement
subgroup
The L&I subgroup of Somerset
Local Safeguarding Children Board
meets quarterly to review cases
where children have been injured
as a result of child abuse or neglect.
Representatives from Police, acute
Paediatric services (hospital
based), Health Visiting, Education,
Children’s Social Care, Safety
Partnership and Clinical
Commissioning Group sit on the
group.
Last year 18 cases were analysed
and discussed by the group. The
review involves collecting
management reports from all
agencies involved in the care of a
child and their family and
considering whether there is
learning to be had across agencies.
This learning may take the form of
recommendation for a Serious Case
Review, a single agency review, a
multiple agency review (e.g. health)
or some other form of case
management scrutiny such as
appreciative enquiry or
multiagency audit.
Of these 18 cases, 7 were infants
(aged under 12 months). One
simply related to management in a
distant area which only had
relevance to that area’s protocols.
The remaining 6 were looked at
within the group and
recommendations made for
subsequent actions including
serious case review, single agency
review, Health review, specific
learning events (e.g. a rerun of the
case conference using the “goldfish
bowl” technique) and use in the
MAPIGs.
Thematic review
In addition to these actions it was
agreed that a thematic review of
the 6 cases would be useful to pull
together some of the themes. None
will be new, all are well known
vulnerabilities but it is worth
stating them again to embed them
deep in a practitioner’s soul.
Types of injury
The commonest injuries seen were
bruises on face, back and arm. It is
important to remember the much
repeated adage:
LEARNING AND IMPROVEMENT SUBGROUP | Issue 2
“if you don’t cruise, you won’t
bruise”
Non – mobile infants with bruising
should be reviewed immediately by
a medical practitioner to consider
non - accidental injury as a cause
but also to rule out nasty medical
reasons for bruising such as
leukaemia.
Two infants had a torn frenum.
This is the tag of skin which holds
the upper lip onto the upper gum
(see figure 1). In the absence of a
reported (credible) injury, inflicted
injury (usually from blunt force – a
fist or something being jammed
into the mouth) is the usual cause
in a non – mobile infant. Infants do
not have enough strength to do this
to themselves. In addition very
young infants do not have sufficient
development to put something in
their mouth.
Fractures and brain injuries were
also seen. Clearly brain injuries
may have long lasting effects
causing cerebral palsy, learning
difficulties, and behavioural
problems. Brain injuries are also
the biggest cause of death in
children who have been abused.
What is the learning from this
review?
Many of these cases had the same
vulnerability factors in the
parent/families which we see time
and time again:

Young parents

Mental Health issues and self-harm

Drug and alcohol abuse
2

Domestic abuse

Poverty or financial stress

Criminality

Homelessness/housing issues
From this case series several
themes were identified which again
have been seen before in many
serious case reviews:

Professional optimism

Acceptance of parent’s
version of events without
any critical thought
(respectful disbelief)

Lack of professional
challenge between agencies

Poor communication
between departments

Lack of professional curiosity

Lack of access/visibility of
children
In addition there is specific
learning for individual agencies
regarding:

Documentation and
recording/flagging of Child
Protection/Child in Need
plans on clinical records in a
timely manner

Considering inflicted head
trauma as one of the
diagnostic possibilities in an
Figure 1
infant presenting with
persistent vomiting

Understanding importance of
frequent unscheduled
attendances (especially
during pregnancy) as an
indicator that “something is
going on”

Clinicians should consider
social (parenting) &
psychological aspects of
welfare not just clinical

Midwives should ask re
Domestic Abuse at least
twice in pregnancy without
partner present
Lastly all agencies need to
“think the unthinkable”, be
unashamedly nosy and
make sure any information
shared is heard and acted
upon.