Mandatory reporting and jurisdictional child-protection frameworks — formative SAQs

SAQ 1 — The reasonable-belief threshold and a sentinel-injury report (10 marks)

A 4-month-old infant is brought to the emergency department by both parents with a swollen left thigh. X-ray reveals a spiral femur fracture. The parents state the infant rolled off the bed, but the infant is not yet rolling over. On examination you also notice a small bruise on the left pinna. ^{[13] [8]}

Questions

1. State the mandatory-reporting threshold and explain why this presentation meets it. (4 marks) ^{[1] [13]}
2. Outline the investigations you would arrange and why. (3 marks) ^[13]
3. Describe how you would document this encounter to evidentiary standard. (3 marks) ^[8]

Model answer

Threshold and why it is met (4). The threshold for mandatory reporting is a reasonable belief that a child has suffered or is at risk of significant harm — not proof, certainty, or a conviction. A spiral femur fracture in a non-rolling infant is developmentally implausible as a fall from a bed, and a bruise on the pinna is an inflicted-injury pattern. A reasonable person in the clinician's position, holding this information, would form a belief that this infant has suffered inflicted injury. The clinician reports; the agency investigates — the clinician does not need to confirm abuse before notifying. ^{[1] [13]}

Investigations (3). A skeletal survey is indicated for any child under two years with suspected physical abuse, to identify occult fractures — particularly healing posterior rib fractures, classic metaphyseal lesions, and scapular or spinous process fractures. A repeat skeletal survey at 11–14 days may reveal fractures not visible acutely. A bleeding screen (coagulation studies, full blood count) addresses the differential of a bleeding diathesis. Neuroimaging is considered if any features suggest abusive head trauma. ^[13]

Documentation (3). Document contemporaneously and objectively. Record the history from each parent separately and verbatim in quotation marks, noting the developmental implausibility. Document the examination findings with a body map, including the bruise location and the fracture. Take clinical photographs. Record timed, dated, signed notes. Document who you consulted (senior clinician, child-protection team), when and what you reported to the authority, who you spoke to, and the agency's response. The medical record may become evidence, so it must be factual, non-speculative and complete. ^[8]