Unexplained Injuries – Information for parents/carers

Unexplained Injuries – Information for parents/carers

This information leaflet explains what will happen to your baby or child if they are found to have an injury, such as a bruise or a fracture, which is unexplained.

Where the child requires medical attention for example, suspected fractures, bleeding, loss of consciousness, they should be taken to the nearest emergency department immediately.

Children’s Social Care (Worcestershire Children First) will be contacted by the health professional seeing your child if there is an injury that cannot be explained. As part of their legal duty, a member of Children’s Social Care will come and speak to you and ask for your perspective of, or an explanation for the injury. In some circumstances a medical assessment by a hospital Consultant Paediatrician may be required. A strategy meeting/discussion will be held to determine, in consultation with the Consultant Paediatrician, the need and timing for the assessment. A strategy meeting/discussion is where all the professionals involved with your child, share the information that has been gathered. If this meeting is to take place Children’s Social Care will inform you.

Sometimes the Social Worker will be required to involve the Police. Where a child is to be interviewed by Police and/or local authority Children’s Social Care, this interview should take place prior to a medical examination unless there are exceptional circumstances. Again you will be informed of this.

We know this can be upsetting but the only way of assessing an unexplained injury is to investigate every case when it occurs. You can be reassured however, that you will be treated with courtesy and sensitivity and your explanations will be listened to and discussed with you. You will also be kept informed at all times so that you know what is going on and why. You can ask questions at any time and you will be given the opportunity to discuss your concerns fully at every stage. The hospital staff, Social Worker, your child’s health visitor or school nurse will make sure you know how to contact them and will continue to support you.

As part of the medical assessment the Consultant Paediatrician will need to look for explanations for the injury and how it has happened. Doctors and Nurses first duty is to the child and will consider all causes including medical reasons and accidental and non-accidental injuries. If your child is old enough they will be asked what has happened to them. Appropriate tests will then be carried out where indicated in the best interests of your child.

We take all injuries seriously. We follow the recommendations of Worcestershire Safeguarding Children Partnership and our own Hospital Trust guidelines where a non-accidental injury is considered.

The Consultant Paediatrician will first listen to the medical history and perform a full physical examination of your child. They will ask for your consent to do this and ask you to sign a consent form. The Consultant Paediatrician will explain which tests are required in more detail and give you the results when they are available. The nurse will support you.

The results of the examination and the tests will be discussed with the Social Worker and Police if they are involved. A discharge plan will be agreed and discussed with you. Sometimes other professionals may need to be asked for another opinion. We cannot discharge any baby/child with an unexplained injury until a discharge plan from Children’s Social Care has been agreed. As health professionals we strive to always act in the best interest of your child and to keep you informed.

INVESTIGATIONS COMMONLY (BUT NOT ALWAYS) PERFORMED

BLOOD TESTS: The Consultant Paediatrician will explain which blood tests are required and why. We can use ‘magic cream’ or cold spray to make the blood sampling less uncomfortable and the play therapists may be available to help distract your child.

EYE EXAMINATION: An eye doctor may look at the back of the eyes. They may need to use special equipment to keep the eyelids open. This may cause slight discomfort but is not painful. Drops are usually put in to your child’s eye to help the doctor see into the eyes better. This can help us identify how an injury may have occurred. This will take between 30 and 60 minutes. This examination is mainly for children less than 12 months of age.

SKELETAL SURVEY: Two trained radiographers (x-ray staff) will obtain x-rays of all the bones in the body. This usually takes between 45-60 minutes to complete. Babies can become unsettled during this procedure so comforters/dummies can be used where possible. Unfortunately we are not able to have parents or carers in the x-ray room; however, you can accompany your child to the x-ray department. All x-rays are usually carried out within working hours so you may need to wait for some time for these investigations if you attend hospital at the weekend or on a bank holiday. We will need to repeat some of the x-rays. These will normally be arranged approximately 2 weeks later.

CT SCAN OF HEAD: If it is required, this is usually performed in young babies after feeding and then wrapping them in their blanket. Older children may need some sedating medicine to help them sleep during the scan. It is important that your baby/child lies very still for this test. It can take up to 5 minutes to perform the scan which looks closely at the brain and skull. Unfortunately as with the skeletal survey we are not able to have parents or carers in the CT scan room; however, you can accompany your child to the x-ray department. Sometimes we perform an MRI scan of the brain, either during their hospital stay or as an outpatient. The MRI is performed in the same way as a CT scan but takes almost 30 minutes. If you need any tests explained further please do not hesitate to ask your nurse or doctor.

CONSENT: You will be given a full explanation for the tests required by one of the paediatric team (usually the Consultant Paediatrician) who will then ask for your consent. If the medical team feel these tests are necessary they will appreciate your co-operation in consenting to them. If consent is not given the medical team may have to seek advice from Children’s Social Care, depending on the reason for this.

INFORMATION SHARING

We will share information about your child and family relevant to their diagnosis with other professionals who are directly involved in your child’s care. This will include your GP, and may include the community midwife, health visitor, school nurse, nursery and any other professionals involved in your child’s care. The Consultant Paediatrician may also need to share results/images with other professionals for a specialist opinion. Information is only shared if it is relevant to our investigation and if it is deemed to be the best interest of your child. The Consultant Paediatrician will complete a report for Children Social Services. The Social Worker will discuss the report with you. The Consultant Paediatrician will explain the results of medical investigations.

If your symptoms or condition worsens, or if you are concerned about anything, please call your GP, 111, or 999.

Patient Experience
We know that being admitted to hospital can be a difficult and unsettling time for you and your loved ones. If you have any questions or concerns, please do speak with a member of staff on the ward or in the relevant department who will do their best to answer your questions and reassure you. 

Feedback
Feedback is really important and useful to us – it can tell us where we are working well and where improvements can be made. There are lots of ways you can share your experience with us including completing our Friends and Family Test – cards are available and can be posted on all wards, departments and clinics at our hospitals. We value your comments and feedback and thank you for taking the time to share this with us.

Patient Advice and Liaison Service (PALS)
If you have any concerns or questions about your care, we advise you to talk with the nurse in charge or the department manager in the first instance as they are best placed to answer any questions or resolve concerns quickly. If the relevant member of staff is unable to help resolve your concern, you can contact the PALS Team. We offer informal help, advice or support about any aspect of hospital services & experiences.

Our PALS team will liaise with the various departments in our hospitals on your behalf, if you feel unable to do so, to resolve your problems and where appropriate refer to outside help.

If you are still unhappy you can contact the Complaints Department, who can investigate your concerns. You can make a complaint orally, electronically or in writing and we can advise and guide you through the complaints procedure.

How to contact PALS:
Telephone Patient Services: 0300 123 1732 or via email at: [email protected]

Opening times:
The PALS telephone lines are open Monday to Friday from 8.30am to 4.00pm. Please be aware that you may need to leave a voicemail message, but we aim to return your call within one working day.

If you are unable to understand this leaflet, please communicate with a member of staff.

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