EM SAQs · Mandatory reporting and child protection
The bruised non-mobile infant
ACEM-style SAQ on sentinel injury recognition and mandatory reporting.
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Concern features: non-mobile infant; any bruise under 4 months is a TEN-4 positive component; rolling at 7 weeks is developmentally implausible; delayed presentation if present; changing history.[1]
Assessment: full undressed examination (scalp, frenulum, ears, genitalia, back); growth chart; developmental assessment; careful contemporaneous documentation with body map; senior involvement early.[1]
Investigations (protocolised): consider skeletal survey (age <2 with suspected physical abuse), CT head as indicated, ophthalmology if intracranial injury concern, coagulation/FBC to assess mimics — investigations support medical care and forensics, they do not replace notification.[1]
Mandatory reporting: notify statutory child protection on reasonable suspicion; duty overrides confidentiality; strategy discussion with social work; do not collude or confront in a way that destroys evidence/trust carelessly.[3]
Disposition: safety plan — home only if child protection and senior team agree safe; otherwise place of safety; assess siblings; arrange follow-up medical and safeguarding tracks.[3]
References3ShowHide
- [1]Pierce MC, et al. Validation of a Clinical Decision Rule to Predict Abuse in Young Children Based on Bruising Characteristics. JAMA Network Open, 2021.PMID 33852003
- [2]Adams JA, Kellogg ND, Farst KJ, Harper NS, Palusci VJ, Frasier LD, Levitt CJ, Shapiro RA, Moles RL, Starling SP. Updated Guidelines for the Medical Assessment and Care of Children Who May Have Been Sexually Abused. J Pediatr Adolesc Gynecol, 2016.PMID 26220352
- [3]Christian CW, et al. The evaluation of suspected child physical abuse. Pediatrics, 2015.PMID 25917988