Incidents of Non-Accidental Injury (NAI) in children have increased during the Coronavirus pandemic. Unsurprisingly, the combination of social isolation, financial stress, and loss of access to support and healthcare facilities has resulted in many vulnerable families being left unable to cope. In such situations, one small incident – a relentlessly crying baby, wilful toddler, or defiant child can tip a parent over the edge, leading to an NAI being inflicted.
What are Non-Accidental Injuries?
Of the 15.6 million children living in the UK, the NSPCC analysis of police data shows 23,529 recorded child abuse offenses over the 12-month period between 2019 and 2020. Although this figure seems low when compared with the number of children, it represents only the children that have come to the attention of the police. There are thousands more who fall through the cracks of the system, left to endure years of sustained abuse.
The following are NAI red flags that healthcare and educational professionals are trained to be alert for:
- Bruising in the shape of a hand, object (such as a spoon), linear bruises, or ligatures that are on non-bony parts of the body and/or the face and/or neck. A common saying is “if they can’t cruise, they can’t bruise”, meaning bruises on non-mobile children should always receive further investigation.
- Human bite marks.
- Lacerations or abrasions on non-mobile children, around the face, ankles, or wrists or where they appear symmetrically.
- Burns on parts of the body unlikely to come into contact with a hot object such as the soles of the feet, backs of the hands, and/or buttocks. NAI in the form of burns may be in the shape of an object such as a cigarette or iron.
- Metaphyseal corner fractures, also known as classical metaphyseal lesions or bucket handle fractures, observed in children under two. Rib fractures are also common in abused children who have been grabbed around the middle and shaken.
- Spinal injuries or visceral injuries absent major trauma or old fractures that were never treated are also potential signs of NAI.
NAI is more common in children growing up in poverty. Having additional needs and/or developmental delays can also increase a child’s risk of being abused, especially during Covid-related lockdowns.
The role of the expert in Non-Accidental Injury cases
Many parents are terrified when taking their injured child to A&E lest they be accused of inflicting an NAI. Mistakes in identifying NAIs can and do happen. In 2015, it was reported that a young couple, who had been wrongly accused of child abuse were unlikely to ever see their baby again as it had been adopted after being taken into care. The couple had brought their six-week-old baby to hospital after noticing bleeding in the child’s mouth. Doctors discovered bruises and healing fractures and called Social Services who took the child away and following a Family Court ruling, had the baby adopted. The couple was charged with child cruelty, however, expert medical evidence revealed the child was suffering from a blood disorder called Von Willebrands II, which causes a person to bruise easily, as well as vitamin D deficiency and infantile rickets.
The Prosecution dropped their case against the couple when one of their own medical experts determined that there may not have been any fractures present at all.
Justice Baker, in the case of Re JS  EWHC 1370 (Fam), provided a summary of the law and approach of the Court in fact finding hearings and stated:
‘Whilst the courts always have to be vigilant to guard against the proliferation of experts in family proceedings, the court must, in my judgment, always have available to it the necessary expertise to make the right findings in these important and difficult cases.”
Correctly identifying NAI is crucial to protecting children not only from abuse but also being wrongly removed from their parents if medical professionals get things wrong. Not only has the Coronavirus pandemic put families under strain, doctors and nurses have also come under intense pressure during the past 15 months. Therefore, judges involved in NAI prosecutions and care proceedings over the next year or two will require the independent opinion of medical experts more than ever to ensure children are protected and miscarriages of justice do not occur.
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