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Non Accidental Injury (NAI)

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This information has been provided for PICU staff only. For all other purposes, please see the full Abuse and Neglect Guideline link under Related Documents above.

General Points

Risk factors for Non Accidental Injury (NAI) include:

  • age<1
  • prematurity
  • mental or physical disability
  • family history of physical or substance abuse
  • mental illness, and
  • poor social support networks and home environment

The history and examination should raise concerns about NAI:

History

  • Explanation inconsistent with pattern or severity of injuries
  • History changing over time or between caregivers
  • Delay in seeking treatment
  • History of repeated trauma
  • Inappropriate parental response to situation
  • Child at risk from lack of supervision

Injuries

  • Intracranial bleeding esp subdural haemorrhage
  • Diffuse axonal injury or retinal haemorrhages
  • Skull fracture
  • Ruptured viscera
  • Genital trauma
  • Long bone fractures in a child less than 3 years old
  • Unusual injuries: bites, cigarette burns, rope marks, bruises
  • Neglect: malnutrition, poor hygiene
  • Emotional disturbance

Investigations

  • Full clinical examination: centiles, documentation of injuries. In cases of suspected sexual abuse, the examination is performed by Whakaruruhau
  • Skeletal survey: healed fractures
  • Full blood count, coags (+ vWf if family history)
  • Fundoscopy by opthalmologist
  • CT brain <2 years if history of concern
  • MRI if history of shaking
  • Medical Photography (police may also take photographs)

Management

  • Treat the injuries
  • Analgesia
  • Involve support groups: Kai Atawhai, Pacific Island Family Support
  • Notify on duty doctor for Whakaruruhau, who will also notify CYPS/police if concerns regarding the child's safety
  • Full documentation

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Document Control

  • Date last published: 31 October 2005
  • Document type: Clinical Guideline
  • Services responsible: Paediatric Intensive Care Unit
  • Editor: John Beca
  • Review frequency: 2 years