Learning briefing: Harley – Non-accidental injury

The Incident

• Harley is a baby who was seen by their GP and then sent to hospital. They were found to have multiple fractures of differing ages.
• The injuries were thought to be non-accidental.
• Prior to this Harley was found to have a burn on their face. This was treated in hospital and a referral was made to MASH. A strategy meeting was held, and an assessment undertaken by a social worker.

Good Practice

• The GP acted appropriately when injuries were presented. They recognised the injuries and referred Harley to the hospital. Actions were taken to safeguard Harley and their sibling.
• The Midwife had asked mother whether she had experienced domestic abuse.
• A robust Family Needs Assessment was undertaken by the health visitor including asking about domestic abuse.

Messages for Practitioners

•  Research has shown that children who present with a severe non- accidental injury have often been seen earlier with bruising or another injury. These injuries are known as sentinel injuries and can provide an opportunity to prevent the child suffering a more serious injury or being killed. Where there is a concern of a sentinel injury then Early Help support should be put in place.
• Midwifery services to create a process that ensures that community midwives and health visitors are aware of the postnatal admission of mothers so that support can be offered to those caring for babies and any siblings.
• Agencies to work with fathers/partners to ensure they are given support and essential messages on safe sleep and coping with crying.
• Children Social Care service managers to have oversight of strategy meeting outcomes where injuries have been identified to ensure the quality and consistency of decision making.
• Hospital Trusts will work with Paediatricians to ensure timelier referrals to MASH/out of hours services – referrals should be made using the online make a request for support form. All referrals from practitioners should be confirmed in writing, by the referrer, within 48 hours.
• Devon SCP to carry out an audit on all physical injuries in children aged 0-3 in the last six months to ensure that thresholds and decisions made are correct.

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