This page provides parents with additional information of what to expect when you or someone else has noticed a previously unidentified/unusual/unexplained mark, injury, or bruise on your baby/infant/child that requires further investigation.
General information
Bruising or unidentified/unusual/unexplained marks are rare on a baby/infant/child who is non-mobile – non-mobile meaning they are not able to significantly move themselves. Bruising and other marks can be related to a health condition which has not been previously identified, such as a birthmark or a blood disease. Birthmarks often come from birth or soon afterwards, and usually the presentation of these are clear. Health professionals can usually be confident these are a birth mark and when noticing them will document them in your red book.
Very occasionally a baby/infant/child might develop a mark that is either an unusual presentation for a birthmark or is the result of an unknown physical condition. Parents generally can explain the history of the mark in these cases, but if the mark has not previously been recorded or is unusual in its presentation it is really important to get the baby/infant/child seen by a medical doctor, as they require medical assessment and possibly treatment. In this situation we would talk to your GP in the first instance and ask if they can see you that day. If they can’t, we will ask a hospital paediatrician – a doctor who has specialised knowledge of children – to see you instead.
It is also possible that sometimes a parent might cause an injury accidentally and be able to describe its origin.
You may feel you are having to explain the reason for your baby/infant/child having an unidentified/unusual/unexplained mark or a bruise and we appreciate this can feel challenging and uncomfortable and can be frightening. In these situations, it is important to get your baby/infant/child seen by a paediatrician for assessment of injuries and treatment. We will support you with this. At the same time as referring to the paediatrician we are also required to undertake a request for support to the multiagency safeguarding hub (MASH). This allows other factors to be considered alongside the medical assessment. Unfortunately, there are times when a person (not always the parent) might cause the injury/mark or bruise to a baby/infant/child on purpose but then describe it as an accidental injury. For this reason, we have to assess unidentified/unusual/unexplained marks or bruises two ways – medically and from a safeguarding viewpoint. We recognise this can be upsetting for a parent, but we will support you through this and aim to support you once the assessment and treatment is also over.
What should I expect?
Our aim is to support you through this experience. In the first instance the practitioner will explain why they need to make the referral. They will also explain what the process is. This is in two parts.
The Hospital assessment
First, you will be asked to attend your local hospital – we will ensure they know you are coming. A paediatrician – a doctor specialising in children – will assess the presenting unidentified/unusual/unexplained mark/injury and will identify any other health concerns that could indicate a medical need. They do this through undertaking a full medical examination which will include undressing your baby/infant/child. They will ask for your consent at the time. Dependant on their assessment they may want some additional investigations to be undertaken. While this can be difficult for parents all of this ensures the health and wellbeing of your baby/infant/child is prioritised. You are a crucial support for your baby/infant/child at this time.
Other investigations that might be felt to be necessary include blood tests, x-rays, CT scan, skeletal survey or MRI scan.
The hospital staff will ensure you are aware of the outcome of all of these tests. Your baby/child/infant will be with you at all times where possible.
What is a CT scan and an MRI scan?
A CT scan of the brain and skull is the most common scan performed and is relatively quick, although your baby/infant/child will need to lie very still. If you are pregnant you will not be allowed to stay with your baby/infant/child during this period.
In some cases, a CT scan of the chest or an MRI scan your baby/infant/child’s brain and spine may be needed. The MRI study can take up to an hour and is quite noisy.
The hospital staff will ensure you are cared for at this time and will discuss with you how your baby/infant/child will be supported through this.
What is a skeletal survey?
This forms a two-part investigation and is done over two visits, two weeks apart. It involves taking x-rays of the whole body. If this scan is required, the hospital would talk you through the procedure and support you and your baby/infant/child through this at the time.
At the same time running alongside this a referral to multiagency safeguarding (MASH) will be placed.
What does the Multiagency safeguarding hub referral involve?
Details of your baby/infant/child and your household situation, alongside the presenting injury will be shared with a children’s social worker. They will consider whether you have received any support from them in the past and may ask for information from your GP, your health visitor and if you have any children within education settings also from them. They may also contact the police to ask them to assist with any additional information. They will talk to yourselves as parents also.
Whilst some parents can feel this is a suggestion of wrongdoing, it is a systematic way to ensure that we fully assess injuries in every baby/infant/child. The only way of picking up serious causes of injury to children is to investigate every case the same.
Please be reassured that you will be treated with courtesy and sensitivity and your explanations will be listened to and discussed with you. You will be kept informed throughout the process. Once the process has been completed and the cause and treatment agreed a full record will be kept and your GP and Health Visitor will be made aware of this – so that they can support you after the experience also if needed. Please do ask any questions throughout this time.
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