Children of a nursery age do invariably sustain ‘bumps and bruises’ during the course of normal play. According to the NHS over 20% of UK children attend A&E annually. Only 0.1% of all injuries are deemed to be non-accidental in origin.
Occasionally a child will present with more significant injuries. The injuries may be identified when the child arrives at nursery or may be noticed during the day.
A number of factors will raise suspicion that an injury may be non-accidental, including the type of injury, delay in presentation and an inconsistent account/history.
A nursery has a key role in the safeguarding system and any concerns should be reported to the appropriate authorities at the earliest possible stage.
Type of injury
Accidental injuries in toddlers are commonly seen in bony areas such as the knees, elbow, nose and forehead. Other injuries which raise concern include, but are not limited to:
o Bruising on a baby
o Multiple bruises
o Ears and neck
o Chest, groin and soles of feet
o Bilateral black eyes
o Bite marks
o Burns/scalds
Bruising
It is very difficult to accurately date a bruise. They may become visible over hours or a day or two. Studies have concluded that the accuracy with which a clinician could correctly age a bruise to within 24 hours was 40%.
A fresh bruise will generally be pinkish red in colour and change to a bluish colour before fading to a green/yellow colour. However not all bruises develop in this way and often all the colours are seen at the same time.
Bruises will develop differently depending on the site of the injury. For example bruises to the knee and forehead develop quickly as the skin is shallow in these areas. Bruises can appear in a different location to the actual injury. A child may bang his forehead on a table and develop a black eye.
Patterned bruising can indicate the use of an object such as a belt or finger marks.
There may be a medical explanation for bruising which initially appears to be suspicious. For example, Certain conditions such as haemophilia can cause easy bruising.
Fractures
Spiral fractures of the tibia (lower leg) are quite common in young children and are commonly referred to as toddler fractures. Fractures of the longer bones – humerus and femur are more unusual and may indicate non-accidental injury.
Fractures to the ribs, skull and lumbar will also cause concern and fractures in babies/toddlers are unusual given their lack of mobility.
Certain medical conditions can lead to easy fracturing such as brittle bone disease and vitamin D deficiency (Ricketts).
Burns
Burns are generally a red flag for non-accidental injury. Particular areas of concern include:
o Cigarette burns
o Friction burns are suggestive of dragging
o Clear outlines : imprint from an object
o Burns around the face/mouth
Appropriate action
Certain injuries may be suggestive of non-accidental injury.
It is important to obtain a detailed explanation / history of the injury. There will sometimes be an innocent explanation for a suspicious injury.
If there is any doubt the injury should be reported to the appropriate agencies.
The duty to report is never extinguished. If concerns remain they should be reported even if the Local Authority Designated Officer/Ofsted have previously failed to act.
Any concerns with abuse where a nursery or a member of nursery staff is implicated should also be reported immediately to your insurers. They will be able to provide the appropriate guidance and support which in certain cases will need legal intervention.
This article is provided by dot2dot in association with its legal advisors BLM (www.blmlaw.com).
0+
