Child safeguarding — suspicious bruising in a non-mobile infant
PLAB 2 & PRES 3 · paediatrics · hard · 8 minutes
Candidate brief
You are an FY2 doctor/SHO in the paediatric Emergency Department. Ms Lauren Murphy has brought her 6-month-old daughter, Mia, because of bruising noticed after an reported fall from a sofa. Assess Mia’s immediate clinical needs, obtain an appropriate history, identify any safeguarding concerns and explain your proposed management to her mother. Verbalise any examinations, investigations, referrals and safety measures you would undertake.
What examiners look for
Bruising is unusual in an infant who is not independently mobile and requires careful medical and safeguarding assessment. The injury must be considered in relation to the child’s developmental ability. Ask what the child can actually do rather than relying only on their age. Concerning features include bruising on the ears, neck, torso or protected areas; symmetrical or clustered marks; fingertip or grip patterns; multiple injuries; and an explanation that is absent, changing or incompatible with development. Treat urgent injuries first. Safeguarding concerns must not distract from ABCDE assessment, pain relief or investigation of possible head, abdominal, skeletal or other occult injury. Take an exact account without attempting to conduct a forensic interview. Use open clarification, avoid leading questions and record spontaneous statements in the speaker’s own words. Speak with caregivers separately when appropriate. Consider domestic abuse, caregiver stress, substance misuse and the safety of siblings and other children. Complete a full top-to-toe examination with consent and a chaperone. Record every lesion objectively on a body map. Follow local procedures for clinical photography. Consider medical explanations such as bleeding disorders, but do not allow investigations for a medical cause to delay safeguarding action. Do not confront a suspected perpetrator or promise secrecy. Explain that information may need to be shared to keep the child or another person safe. Do not discharge the child until the senior paediatric, safeguarding and relevant statutory teams have agreed and documented a safe plan.
Guideline references
- https://www.nice.org.uk/guidance/cg89
- https://www.nice.org.uk/guidance/cg89/chapter/recommendations
- https://www.nice.org.uk/guidance/ng76
- https://www.nice.org.uk/guidance/ng76/chapter/recommendations
- https://www.gov.uk/government/publications/working-together-to-safeguard-children--2
- https://www.gmc-uk.org/professional-standards/the-professional-standards/protecting-children-and-young-people
- https://www.gmc-uk.org/professional-standards/the-professional-standards/protecting-children-and-young-people/confidentiality-and-sharing-information
- https://www.gmc-uk.org/professional-standards/the-professional-standards/protecting-children-and-young-people/keeping-records
- https://www2.healthservice.hse.ie/organisation/national-pppgs/hse-child-protection-and-welfare-policy/
- https://healthservice.hse.ie/staff/information-healthcare-workers/children-first/children-first-in-the-hse/
- https://healthservice.hse.ie/documents/7688/HSE_Guide_2_Recognising_and_Reporting_Child_Protection_and_Welfare_Concerns.pdf
- https://www.tusla.ie/children-first/mandated-persons/what-are-the-thresholds-for-making-a-mandated-report/
- https://www.tusla.ie/children-first/mandated-persons/how-do-i-report-a-concern-about-a-child/
- https://www.tusla.ie/children-first/web-portal/
- https://childprotection.rcpch.ac.uk/child-protection-evidence/bruising-systematic-review/
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