🎙️ Deep Dive: Non-Accidental Injury (NAI) – Safeguarding the Vulnerable
🧠 A powerful, high-yield episode to help you revise this critical safeguarding topic for the MSRA. Learn the signs, know the red flags, and understand the steps needed to protect vulnerable children.
📌 What Is Non-Accidental Injury (NAI)?
• NAI = deliberate harm or neglect inflicted on a child, usually by a caregiver
• Includes physical, sexual, emotional abuse, and neglect
• A serious safeguarding emergency with long-term consequences
• Often hidden – recognising it early can save lives
📊 Causes & Risk Factors
• Multifactorial causes: parental mental illness, stress, social isolation
• Substance abuse, domestic violence, parental history of abuse
• Risk ↑ with young parents, low SES, lack of support
🔑 Mnemonic: SINS – Stress, Isolation, Neglect, Substance abuse
🧠 How It Presents
• Unexplained bruises, especially on torso, ears, neck, buttocks
• Burns with clear lines (e.g., immersion burns)
• Fractures in non-mobile infants or at various stages of healing
• Neglect: malnutrition, poor hygiene, untreated illness
• Emotional abuse: withdrawal, anxiety, fear of caregivers
🔎 Consider the “5 I’s” Red Flags:
Inconsistent history
Injury not matching the story or age
Infant injury
Impaired caregiver bonding
Involvement with social services
🩺 Differential Diagnosis
• Bleeding disorders (e.g. haemophilia)
• Osteogenesis imperfecta
• Accidental trauma
• Nutritional deficiencies
• Always rule out medical mimics before concluding NAI
🔬 Investigations
• Full history from caregivers and the child (if possible)
• Physical exam – head-to-toe assessment
• Imaging: X-rays, CT head, full skeletal survey in <2 years
• Eye exam (ophthalmology): check for retinal haemorrhages
• Bloods: FBC, clotting screen
• Always coordinate with safeguarding teams
⚠️ Early reporting and documentation is crucial
🛡️ Management
• Multidisciplinary team: medical, safeguarding, social care, mental health
• Ensure safety first – removal from home if at risk
• Treat injuries, provide psychological support
• Family support: parenting programmes, therapy
• Document concerns, share info even without consent if safety is threatened
🧠 Key principle: Child safety overrides confidentiality
📈 Prognosis & Complications
• Early intervention improves outcomes
• Long-term risks: PTSD, anxiety, attachment disorders
• Physical: chronic pain, disability
• Increased future risk of violence and abuse cycle
• Abuse can affect development well into adulthood
🎓 NAI MSRA Learning Resources
📘 Revision Notes
https://www.passthemsra.com/topic/non-accidental-injury-revision-notes/
🧠 Flashcards
https://www.passthemsra.com/topic/non-accidental-injury-flashcards/
📋 Accordion Q&A Notes
https://www.passthemsra.com/topic/non-accidental-injury-accordion-qa-notes/
📝 Rapid Fire Quiz
https://www.passthemsra.com/topic/non-accidental-injury-rapid-quiz/
🧪 Full Quiz
https://www.passthemsra.com/quizzes/non-accidental-injury/
📚 MSK Course (includes NAI)
https://www.passthemsra.com/courses/msk-for-the-msra/
✅ Be the safeguard. Know the signs. Take action.
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