Non-accidental injury

Sir, we wish to highlight a confirmed case of non-accidental injury in a 3-month-old boy who was bought to the attention of social services by the oral and maxillofacial surgery team at Central Manchester and Children's University Hospitals NHS Trust after presenting through the Paediatric Emergency Department. On examination the patient had a semi-lunar, scarred ulcerated lesion on the floor of his mouth which raised concerns of thermal or traumatic injury. There were no other marks or bruises on his body. With written consent from the patient's mother, a full child protection assessment was undertaken. A number of unexplained skeletal injuries were disclosed through radiographic examination including skull, vertebral, rib and tibia fractures. The patient did not have any clinical signs of osteogenesis imperfecta or other bone disorders.

Various studies have shown that as many as 50-75% of all cases of child abuse involve trauma to the mouth, face and head. Consequently, dentally trained professionals are ideally situated to identify cases of non-accidental injury and should feel supported in raising their suspicions. Victoria Climbié and Peter Connelly ('Baby P') are well known cases of child abuse that may have been preventable had the relevant bodies been more vigilant and reported their concerns.

The warning signs of abuse should be considered every time an injured patient is seen. Repeated injuries, multiple bruises, or injuries with uncertain explanations may signal instances of abuse. If there is any concern about a child patient's safety, all dental practices/hospitals should have a child protection policy in place and protocol for prompt referral to the local social services child protection team.