Baker’s Dozen B’s of Bashed Baby Badness

You can’t get through emergency medicine training these days without the TLA ‘NAI’ ringing in your ears every time a sick child pops up on the triage screen. Can you remember all the things to look for if you suspect non-accidental injury?

Baker’s Dozen B’s of Bashed Baby Badness:

Bullsh!t story

Mechanism not consistent with injury, late presentation, no explanation, changing story, vague story, mechanism not consistent with developmental level, or ‘something just ain’t right…‘,

Background

Parental factors: drugs, domestic violence, single parent, foster care, socioeconomic factors

Child factors: developmental delay, behavioural problems, twin, premature, chronic disease

Behaviour

Both the child and the parent: poor interaction, scared, aggressive, sexualisation, avoidant

Brain

Shaken baby changes, subdural haemorrhages of differing ages

Back of the Eyes

Retinal Haemorrhages (often difficult to examine without an ophthalmologist)

Burns

Cigarettes, hot water immersion, palms

Bites

…it’s horrible, but it happens

Bruises

As a general rule, non independently mobile children should not have bruises. Bruises over non bony areas are suspicious eg, neck, thighs, abdomen, fleshy part of arms, buttocks

Bones

Other than the “toddlers fracture”, long bone fractures always suspicious. See below for more details.

Broken frenulum

Slap across face is common mechanism, can occur in toddler falling forward onto face

Bottom and genitals

Always important to look, fully expose to examine but quickly cover up to prevent heat loss

Blunt abdominal trauma

Very uncommon injury in babies and young children

If you’re not sure which ‘bones‘ (fractures) to look for…just remember to:

Suspect Harm from Mother or Father

• S: sternum, scapular, spine or vertebrae
• H: humerus (other than supracondylar), hand (non-ambulating), head (skull fractures – multiple, non-parietal, complex, with associated brain injury)
• M: multiple fractures, metaphyseal corner fractures, metaphyseal bucket handle fractures
• F: foot (non-ambulating), femur (non-ambulating), fractured ribs

[3 fractures each, 12 types in total]

Useful resources

• CHANDLER assessment of the sick child
• Recongnising abuse Child Abuse Prevention Service (Australia)
• Report abuse Child Abuse Prevention Service (Australia)
• RCH Melbourne CPG — Child Abuse
• Welsh Child Protection Systematic Review Group