Does the story fit?
A 4-month-old cries whenever their left leg is moved, and the thigh is swollen. An X-ray shows a broken femur. The carer says the leg got caught in the cot bars. The baby isn't crawling yet.
What should you do?
Pick what you would do
Need a clue?
Think about what a 4-month-old can actually do. Does the explanation fit the injury?
Show the answer
Tell a senior or the safeguarding lead
- What's going on
- A fracture in a baby who isn't mobile yet, with an explanation that may not fit. That is a reason to think about non-accidental injury (NAI).
- Why it matters
- NICE says to suspect maltreatment when a child has a fracture and the explanation is missing or doesn't fit.
- Tests
- Children under 2 with suspected physical abuse have a skeletal survey: a set of X-rays that looks for other hidden fractures.
- What to do
- Tell your supervising doctor or the named safeguarding lead, and write down exactly what you saw and heard.
- Remember
- You don't need proof, and it isn't your job to investigate. Raising a concern is not the same as accusing anyone.
Go further
Tap a question to check your answer.
What does NAI stand for?
Non-accidental injury.
Why does it matter that the baby isn't crawling?
The injury has to fit what the baby can actually do. If it doesn't, think NAI.
What X-rays would the team want?
A skeletal survey, to look for other hidden fractures.
Who do you tell?
Your supervising doctor or the named safeguarding lead.
Harder: which fracture had the highest probability of abuse in a big review?
Rib fractures (71%), once major trauma was ruled out.
Source: NICE CG89 · Royal College of Radiologists, 2018 · Kemp et al, BMJ 2008
Everything on this page is for learning, not medical advice. Each fact links to where it came from, so you can read further.
