SOUTH TEES LSCB

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SOUTH TEES LSCB
INTER-AGENCY TRAINING AND DEVELOPMENT INFLICTED
HEAD OR BRAIN INJURIES Janet Aitken, Senior Nurse
Child Protection
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OBJECTIVES

• By the end of the session participants will
• Know where to access the inter-agency procedures
• Understand what is meant by Babies or young
  children with possible inflicted head or brain
  injuries and other terms used
• Understand their own and others responsibilities
  in response to suspected or confirmed head or
  brain injuries in babies
• Know from where to seek further guidance

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AVAILABILITY
Available to download from South Tees LSCB
website at www.redcar-cleveland.gov.uk/childprot
ection www.mgrid.org.uk/go/childprotec
tion
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• Staff should
• Comply with the procedure
• Take into account other information contained
  within the procedure to promote evidence based
  practice

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Meaning of Shaken Baby Syndrome

• This is a collective term for internal head
  injuries a baby or young child sustains from
  being violently shaken. It is a descriptive term
  of how injuries may have occurred and not a
  medical diagnosis. It may also be referred to as
  

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• Meaning cont.
• Inflicted Traumatic Brain Injury
• Battered Child Syndrome
• Inflicted Head Injury
• Shaken Impact Syndrome
• Shaking Injury
• Whiplash-Infant Syndrome
• Whiplash-shaking injury

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Background

• Not new syndrome, but the ability to diagnose is
  new. Particularly with the advent of CT MRI
  Scanners which show trauma in the skull in a way
  not possible before.

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Background cont.

• Shaken baby syndrome is a potentially fatal form
  of child abuse. It occurs when a baby is
  forcefully shaken leading to damage within the
  child's skull.

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Prevalence

• Approximately 13000 babies
• 10 will die as a result of their injuries
• 78 will suffer permanent disability
• 25 will have permanent visual damage
• Babies with acute SBS are often found to have
  evidence of old injuries

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Prevalence

• Unknown although estimates are thought to be
  improving all the time
• 150-200 cases annually in UK
• Estimated one third to half die, majority of rest
  suffer long term problems, often severe

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Recent research concludes

• As little as two or three violent shakes may be
  enough to cause brain damage
• A critical issue is the amount of rotational
  movement the brain is subject to.

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How does shaking cause injuries?

• Infants more vulnerable than adults/older
  children
• Most common method grip around torso and shake
  baby backwards and forwards
• May cause rib fractures, limbs will flail around
  causing fractures
• Sometimes gripped around ankle or legs

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How does shaking cause injuries? cont.

• Adult head 2 total body weight neck muscles well
  developed
• Infant head 10 total body weight neck muscles
  underdeveloped
• Infant little ability to resist motion in shaking
  and the head whiplashes backwards and forwards

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Initial Possible Signs of SBS

• Lethargy
• Irritability
• Abnormal movements/seizures
• Drowsiness

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cont.

• Increased/decreased muscle tone
• Vomiting
• Poor feeding
• Irregular breathing
• Collapsed state
• Apnoea (stopping breathing)

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Ambulance Staff

• Assess situation based on
• presentation history

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Community Health Staff

• Ensure direct referral to hospital
• Consider the safest most appropriate means of
  transport (supervision)
• Record history/explanation given including any
  inconsistencies
• Immediate referral to SSD/Police
• Remember all referrals must be followed up in
  writing within 48 hours

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Parents/Carers

• When injuries follow genuine accidents a child is
  generally presented promptly and with a clear
  explanation/history
• When injuries are non-accidental there may be a
  delay in seeking medical advice history may be
  vague or unwitnessed

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AE/Hospital Staff

• Immediate medical examination
• Urgent medical opinion by paediatrician
• Review previous AE attendance for child/siblings
• Record history/explanation given and any
  inconsistencies along with any other observations
  

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AE/Hospital Staff cont.

• Check if child/siblings is/are subject to a
  Child Protection Plan
• Protect any possible forensic material e.g.
  clothing, nappies, bedding
• Immediate referral to Social Services/Police
• Remember all referrals must be followed up in
  writing within 48 hours

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Social Services Police

• Strategy Meeting
• SSD Child Protection Enquiries and Police
  Investigation (Section 47 enquiries)
• Immediate future safety welfare of child and
  siblings to be planned (inter-agency)
• If child dies, Sudden unexpected Child deaths
  procedures to be followed

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Strategy meeting

• Attendance as a minimum
• SSD team manager/EDT
• Consultant Paediatrician
• Police Child Protection/duty inspector
• Other relevant professionals

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Other useful information

• Legislation (Appendix 1.)
• Suggested model for good practice for medical
  practitioners, including NICE Guidelines
  (Appendix 2. )
• Police Aide Memoir (Appendix 3.)
• Glossary (Appendix 4.)

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Elijahs Story
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• Questions?
• - evaluation