Essential baseline assessment of an infant or young child with SDH
| Multiagency team members | Paediatrician with expertise in child protection |
| Paediatric neurologist and/or neurosurgeon | |
| Neuroradiologist | |
| Ophthalmologist | |
| Area child protection team social worker and police | |
| Clinical history | Full paediatric case history |
| Full documentation of all possible explanations for injury | |
| Social and police history | Identify any previous child protection concerns, relevant criminal record of carers |
| Examination | Thorough general examination |
| Documentation and clinical photographs of coexisting injury | |
| Monitor head circumference | |
| Ophthalmology | Ophthalmologist to examine both eyes using indirect ophthalmology through dilated pupils |
| Radiology | Initial cranial CT scan |
| Repeat neuroimaging at 7 and 14 days (MRI scan preferable) | |
| Discuss neuroimaging with neuroradiologist | |
| Full skeletal survey: repeat imaging at 10–14 days | |
| Serology | Full blood count repeated over first 24–48 hours |
| Coagulation screen | |
| Urea and electrolytes, liver function tests, blood cultures | |
| Early strategy meeting of all agencies involved to come to a joint decision about the likely cause of SDH and appropriate line of management. | |
| Possible outcome | Action |
| Likely physical child abuse | Social services will invoke section 47 of Children Act, initiate a child protection investigation and make provision for the immediate safety of the child and siblings |
| Medical cause of SDH identified | No further child protection concerns: continue medical management |
| Physical child abuse unlikely, cause of SDH unknown | Further clinical investigation in consultation with tertiary specialists to fully exclude all different causes of SDH |