Wed3November0840PM 5

A 6-month-old child is brought to the Emergency department having fallen off a chair the previous day. The child appears clinically well, but he has a boggy occipital swelling.

Which of the following would be the appropriate action?

(Please select 1 option)

Discharge and arrange an appointment at the next paediatric clinic

Discharge and notify the duty social worker

Discharge after warning the parents that suspicions about possible child abuse have been aroused

Confront the parents as you suspect this is a non-accidental injury, given the delay in presenting to hospital

Arrange urgent head CT Correct

Explanation

This scenario describes a baby with possible non-accidental injury.

The child presents having fallen off a chair. It is important to ascertain why a baby of 6 months was sitting on a chair unsupervised. The presentation is also delayed. The baby has sustained a fracture and will therefore need to be observed and monitored.

He also needs to be in a place of safety until social service investigations have been carried out.

The boggy swelling suggests a fracture, so a CT head scan needs to be carried out. He also needs a skeletal survey.

Reference:

NICE. Head injury (CG176): Investigating clinically important brain injuries.

Answer Statistics

1

9%

2

10%

3

3%

4

8%

5

72%

Times answered: 256