G300(P) In a child with a significant injury with no other features of abuse, what is the risk of further harm?

Aims We were interested to find out if children aged 2 years or younger previously discharged from a Paediatric ward with a diagnosis of accidental fracture had subsequently suffered harm sufficient to warrant further interventions from Social Care. Methods We searched the electronic databases of our hospital and community paediatrics services to determine if the children of our cohort were seen after their discharge until August 2014 with Safeguarding concerns. Following this, we asked our local Social Care department to crosscheck their databases to see if these children were known to them with regards to Safeguarding. Results 50 children aged 2 years and younger were admitted in a three year period in the local Paediatric ward with fractures. Of the 45 children whose fracture was diagnosed as accidental or/and due to organic causes, 34 were still living locally, 6 years after their initial admission. None had attended the local hospital for subsequent injuries and none had subsequent encounters with local Social Care or Community Paediatricians with regards to Safeguarding concerns. Eleven children had left the borough and no follow-up data was available for them. Conclusion Most research on diagnosis of child abuse attempts to answer the question, what is the likelihood that this injury was inflicted? We have attempted to answer a different question, ie In a child with a significant injury with no other features of abuse, what is the risk of further harm? Although Social Care involvement is a relatively crude indicator of potential child abuse, it is indicative of ongoing Safeguarding concerns. Despite no follow-up data was available for 11 children who left the borough, we feel that our results are broadly reassuring and suggest that our current practice of clinical judgement alongside multidisciplinary family assessment might be effective at reducing the risk of serious further harm. This study may be useful in informing medical reports for children with isolated fractures and uncertainty about the mechanism of injury where an opinion is being sought as to the potential Safeguarding risk this may poses for the future