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Did he really do that to himself?
  1. R Halpin-Evans,
  2. K Wooding
  1. Paediatrics, Morriston Hospital, Swansea, UK

Abstract

Background Safeguarding children is a significant workload for both general and community paediatricians. As a result of policies for bruising, particularly in the non-ambulant child, the volume of multi-agency referrals to paediatricians is significantly increased. It can be particularly challenging to determine whether or not an injury is non-accidental (NAI).

Cases We present three breast fed male infants, aged between twelve days and four weeks old, referred by primary care colleagues over an eight month period as “unexplained bruises”. In each instance, the explanation offered by the parents was that the child had “done it to himself” by sucking on his forearm.

All three were admitted, but management varied, reflecting developing departmental experience. The first two babies were discharged, following full investigation, with social services input. In the light of previous experience however, the third baby was not investigated, the explanation accepted as plausible.

Results

Conclusion It is widely acknowledged that paediatricians are increasingly reluctant to take on child protection work due to it's complex and emotive nature. In the first two cases, as there was no previous consultant experience of sucking as a mechanism for bruising, the babies were fully investigated. Literature search yielded no medical reference to this mechanism, however, there is frequent reference on a number of parenting websites. The assessing paediatrician should continue to have a high index of suspicion when assessing children with bruises, but we hope that in reporting these cases in medical literature, to raise awareness of this mechanism among paediatricians as a possible plausible explanation for such bruises.

Abstract G180(P) Table 1

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