What are the key considerations for a GP when assessing a patient with potential non-accidental injury?

Consider the child's appearance, behaviour, symptoms, physical signs, and results of investigations, as well as interactions between the child and caregiver, to gather comprehensive information. (1)

Seek an explanation for any injury or presentation from both the parent or carer and the child in an open and non-judgemental manner. (1)

Be alert to injuries or signs that are inconsistent with the child's developmental stage, normal activities, or existing medical conditions, and consider whether explanations are suitable or unsuitable. (1)

Pay particular attention to injuries that are suspicious, such as bruises in non-mobile children, multiple bruises or clusters, bruises of similar shape and size, bruises on non-bony parts or face, ligature marks, bite marks unlikely to be caused by a young child, and burns with unusual patterns or locations. (1)

Assess for other injury types such as lacerations, abrasions, scars, or thermal injuries that have an unsuitable explanation, especially if they are on protected areas or in patterns indicating inflicted injury. (1)

Be vigilant for signs of internal injuries, including intracranial injuries, spinal injuries, visceral injuries, or oral injuries, especially when explanations are absent or unsuitable. (1)

Consider the possibility of non-accidental injury if injuries are inconsistent with the history, presentation, or child's developmental abilities, or if there are multiple injuries of different ages or occult fractures. (1)

Remain aware of the context of presentation, including unusual patterns of healthcare contact, frequent visits, or reports that do not align with the child's medical history. (1)

In cases of suspected maltreatment, follow multi-agency safeguarding arrangements and document all findings thoroughly. (1)