Standards for radiological investigationsof children under 2 years of age
presenting with an injury/injuries
Revised April 2010
Careful clinical examination and judgement are of paramount importance in assessing injured children. For the child who may have suffered physical injury imaging maybe essential if patterns of trauma that are consistent with NAI are to be detected.
On the one hand, suspicious patterns of injury and/or suspicious history need to be identified, and where these are present a skeletal survey is appropriate. Under IRMER (which is a legal requirement) reasons justifying the skeletal survey should be documented.
If non-accidental injury is not suspected on the basis of an examinationand detailed clinical history, then a skeletal survey is not normally indicated, and again reasons for the decision should be clearly documented.
In both of the above cases, clinical judgement and experience are very important. If there is doubt, then colleagues should be consulted in order to arrive at a consensus. In all cases, whether the decision is to perform a skeletal survey or not, the reasons for the decision should be recorded.
Specific guidelines
Babies under 1 year
A child under 1 year of age presenting with an injury is in itself a suspicious circumstance which should be borne in mind in the clinical assessment and history taking. If there is concern over NAI, then a skeletal survey and CT brain scan are indicated because of the risk of abusive injury. In this age group, the threshold for performing a skeletal survey is therefore lowered but clinical judgement still needs to be exercised and decisions need to be documented whether a skeletal survey is undertaken or not.
Any child under the age of one where there is evidence of physical abuse, then a brain scan should be performed. Babies and toddlers are most susceptible to non-accidental head injury.
Children between 1 and 2 years of age
Similar criteria should also apply to children between 1 and 2 years whilst accepting that, in a mobile child. the probability of accidental injury versus non-accidental injury is higher.
Whether or not a decision to perform a skeletal survey is taken, the justification and decision making process should always be recorded in the notes.
If there are encephalopathic or focal neurological signs or haemorrhagic retinopathy, then a brain scan should be performed.
Note: There is sound evidence that a skeletal survey has a high yield of revealing abusive fractures in children less than two years of age. Children with disabilities are at increased risk of abuse.
Children over 2 years
The decision to perform imaging will depend on clinical examination and clinical judgement. If there is suspicion of non-accidental injury then skeletal survey should be performed. Whether or not a skeletal survey or other imaging is performed, full documentation of the decision making and justification should be made.
If there are encephalopathic or focal neurological signs or haemorrhagic retinopathy, then a brain scan should be performed.
Dr K N AgrawalDr Matthew TrewhellaDr Santosh Gupta
Consultant Paediatrician &Consultant Radiologist &Consultant Paediatrician &
Named Doctor Safeguarding ChildrenClinical Director RadiologyNamed Doctor Safeguarding
S:\QIPS\Nursing and Clinical Quality\Alex Giles\SAFEGUARDING CHILDREN\Full Paediatric Assessment - Children CP Plan\KA6159 Standards for radiological investigations of children under 2 years of age.doc
21 September 2018