GPs need to be able to recognise non-accidental injuries, as if left unrecognised, these could result in serious consequences for the patient, a doctor has claimed.

According to Dr Eithne Doorley, a GP based in Clane in Kildare, non-accidental injury (NAI) is an ‘uncommon but serious presentation in general practice'.

"Recognition of NAI is an important task for GPs, as unrecognised, it results in serious morbidity and occasionally, mortality," Dr Doorley said.

She pointed out that while NAI is uncommon, it is ‘not rare'.

Young children, specifically those under the age of three, ‘are most likely to be physically abused, with children younger than one experiencing the highest rate of abuse'.

"Prevalence of abuse is increased among immigrant children, asylum seekers and internationally adopted children. Lower socio-economic status also has a greater association with physical abuse," Dr Doorley noted.

The most common type of NAI is bruising. The pattern of accidental bruising in infants is strongly associated with their mobility. For example, non-mobile infants are least likely to sustain innocent accidental bruises. Once children start moving independently, ‘bruising increases incrementally'. In fact, accidental bruising can jump by more than 50% when a child starts to walk.

Accidental bruises are found on the front of the body and around places where bones are prominent.

"Non-accidental bruises occur on the head, ear, neck and cheeks. Bruising on forearms, upper limb and adjoining area of trunk, or outside thigh, may indicate defensive bruising, where the child has tried to protect themselves from blows," Dr Doorley said.

She pointed out that many people are surprised to hear that the age of bruises cannot be estimated from colour. Different colours can appear in a bruise at the same time.

Meanwhile, Dr Doorley also noted that around a third of abused children suffer fractures, ‘many of which are not clinically evident'.

Some 80% of abusive fractures occur in children aged less than 18 months and rib fractures ‘have the highest probability for abuse'.

When it comes to burns, figures are unclear.

Accidental scalds in young children are often ‘pull-over' scalds, where a child has pulled down a container of hot liquid on themselves, such as a pot of boiling water.

Intentional burns are mainly hot water immersion scalds involving lower limbs, and/or buttocks. The hands and feet - ‘glove and stocking' burns - also indicate intention.

"In 83% of intentional scald injuries, parents cite tap water as the causative agent. The incidence of true accidental scald injuries being caused by tap water is 16%," Dr Doorley said.

She noted that other indicators of NAI include a delay in seeking help, vague details or a lack of consistency in relation to the accident, the injury is blamed on siblings, ‘or the account is not compatible with the injury observed'.

She emphasised that while child abuse is uncommon, the perpetrator(s) will often be a patient of the GP, ‘so it is important to understand what factors may anticipate or provoke this situation'.

"GPs, like society in general, struggle with NAI. An awareness of social risk and prompt recognition of patterns of injury are essential to trigger probing for inconsistencies in the history. It is important to recognise potential risk factors, and to be aware of the options available for intervention," she added.

Dr Doorley made her comments in Forum, the Journal of the Irish College of General Practitioners.