CHAPTER 33a: Multi-Professional Bruising Protocol for Immobile Infants

NOTE

This protocol has been developed as a result of a Serious Case Review.

It was added to the manual in March 2012.

1. Introduction and Context

Accidental bruising on non-independently mobile infants is rare and should therefore always warrant further investigation. The younger the child, the greater the risk that bruising is non-accidental. There is a substantial and well-founded research base on the significance of bruising in children (CORE INFO Welsh Child Protection Systematic Review Group website).

Bruising is the most common presenting feature of physical abuse in children. Recent Serious Case Reviews and individual child protection cases across Berkshire have indicated that staff and volunteers have sometimes underestimated or not recognised the potential for physical abuse, of the presence of bruising in children who are not independently mobile ( i.e. those not yet crawling, cruising or walking independently).

As a result there have been a number of cases where bruised children have suffered significant abuse that might have been prevented if action had been taken at an earlier stage.

NB Health professionals are advised to refer to the following documents:

2. Definition of Terms used in this Procedure

Not Independently Mobile: a child who is not yet crawling, bottom shuffling, pulling to stand, cruising or walking independently; includes all children under the age of six months.

Bruising: blood in the soft tissues; producing a temporary, non-blanching discolouration of skin however faint or small with or without other skin abrasions or marks. Colouring may vary from yellow, through green, to brown, or purple.

3. Process

Bruising in immobile infants is rare and must always result in an immediate consultation with Children's Social Care.

A bruise will never be interpreted in isolation and will always be assessed in the context of medical and social history, developmental stage and explanation given. Assessments will be led by Children's Social Care and a lead medical professional.

All telephone referrals should be followed up in writing within 48 hours. Children's Social Care will co-ordinate multi-professional information sharing and assessment.

A bruise/injury must always be assessed in the context of medical and social history, developmental stage and explanation given. Children's Social Care and local acute or community Paediatrician will determine whether bruising is consistent with the explanation provided or is indicative of non-accidental injury.

For Children's Social Care please contact:

Bracknell: 01344 352020;
Reading: 0118 937 3641;
Slough: 01753 690898 / 875591;
West Berkshire: 01635 503090;
Windsor and Maidenhead: 01628 683150;
Wokingham: 0118 908 8002.

For Emergency Duty Team, please contact:

Between 5.00 p.m. and 9.00 a.m. and on weekends and Bank Holidays; the Emergency Duty Team (which covers the whole of Berkshire) can be contacted on 01344 786543.

4. Involving Parents or Carers

As far as possible, parents or carers should be included in the decision-making process, unless to do so would jeopardise information gathering (e.g. information could be destroyed) or if it would pose a further risk to the child.

In particular staff and volunteers should explain at an early stage why, in cases of bruising in not independently mobile children, additional concern, questioning and examination are required. The LSCB will be producing an information leaflet for parents/carers that you may wish to refer to.

If a parent or carer is uncooperative or refuses to take the child for further assessment, this should be reported immediately to Children's Social Care Services. If possible the child should be kept under supervision until steps can be taken to secure his or her safety.

Click here to view Multi-Professional Bruising Protocol for Immobile Infants Flowchart.

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