NSPCC advice to help professionals spot head and spinal injuries

The NSPCC today (Tuesday 14 April) launches advice  to help doctors, social workers, police officers and other professionals recognise signs of inflicted head and spinal injuries in children.

Each week at least three babies and toddlers are hospitalised due to deliberate head injuries including bruises, burns, fractures of the skull and facial bones and brain injuries but others may remain hidden (1).

Many children with head and spinal injuries have also suffered previous physical abuse. Injuries to the brain or internal bleeding are among the most serious form of physical child abuse.

Up to 45 per cent of those who survive head or spinal injuries experience life long damage including cerebral palsy, visual problems, epilepsy, learning and behavioural problems.

Among recent child death cases, the Baby P tragedy shows that even serious injuries can be missed. Baby P was repeatedly seen by medical staff with head injuries during the last 10 months of his life. The paediatrician who saw him the day before his death failed to spot his broken spine. A post mortem examination revealed a broken back, ribs and severe head injuries.
 
NSPCC director of training and consultancy Enid Hendry said: "Babies and toddlers are an extremely vulnerable group; they are fragile and need to be handled with care. Shaking and throwing a baby can cause irreparable harm to a child.  If their injuries are not picked up they won't get the immediate treatment which could save their life."

The NSPCC Core Info leaflet is a summary of what is currently known about head and spinal injuries by the Welsh Child Protection Systematic Review Group.  It will help GPs, paediatricians, accident and emergency staff, health visitors, social workers and other professionals to recognise the signs and take the most appropriate action.

Paediatrician, Dr Alison Kemp said: "Signs like swelling of the lower back or bruising to the head or neck are visible injuries. In many cases however, the spinal or head injury may not be immediately apparent so doctors should also look out for less obvious symptoms. These could include irritability, poor feeding or excessive crying or impaired neurological function. Inflicted head injuries are the most serious form of physical abuse and are the leading cause of death and disability among children who have been abused.

"A full skeletal survey including lateral X-rays of the spine for every child under two must be carried out if there are any suspicions of physical abuse to avoid more tragic consequences. A head CT scan should be strongly considered if these infants are under the age of a year. Professionals working with children are a vital link in the child protection chain."

Head and spinal injuries is the fifth in the CORE-INFO series, produced by the NSPCC in partnership with the Department of Child Health, Cardiff University.  Previous leaflets covered thermal injuries, bites and oral injuries, bruising, and fractures.

Ends

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Notes to editors
(1) Hospital Episode Statistics (HES), Information Centre for Health and Social Care. (NHS Information centre). Count of admissions to hospital for deliberate (assault) injuries for children (0-17): last year of 5871 children taken to hospital with deliberate injuries 318 were 2 or under and 177 of these had head injuries.
The top 5 diagnoses for children aged 2 and under are maltreatment syndromes*, superficial injury of head, intracranial injury, fracture of skull and facial bones, and other and unspecified head injuries. *Maltreatment syndromes include neglect or abandonment, physical abuse, sexual abuse, psychological abuse and unspecified others.

• You can order up to five free copies of this leaflet by sending an A5 self-addressed envelope plus £1.30 in stamps to NSPCC Publications. For more than five copies, please go to
  www.nspcc.org.uk/core-info for price details.
• Head and spinal injuries in children is the fifth in a series of CORE-INFO: leaflets, which have been produced to summarise the key points from systematic reviews. Previous leaflets examined thermal injuries, bruises, fractures and oral injuries and bites. All the leaflets are available from www.nspcc.org.uk/core-info