{
  "abstract": "Why did you do this work? Immobile babies feature highly in child safeguarding practice reviews. Under 1s have a high mortality from inflicted injury compared to other age groups, and babies presenting with abusive injuries are highly likely to have had previous presentations with injuries. As a result an ‘immobile baby policy’ is almost universal in UK hospitals. How this is applied however, differs between units and this may be due to multi-agency pathways. Bradford is a busy district general, which performs a high volume of child protection medicals annually (>500). Recent changes to our policy reinforces the importance of multi-agency decision making when discharging immobile babies presenting with injuries. This review reflects practice in our unit, but also allows benchmarking alongside other units & comparison findings with current data on injuries in this age group.What did you do? We reviewed 12 months (post-pandemic) of child protection medicals referred as per our immobile baby policy between Jan-Dec 2023, this included 81 infants.What did you find? The majority of referrals were made acutely from within the trust (84%), and approximately half of these were referred and performed out of hours. Ten were referred by social care and police. None of the babies had undergone previous CP medicals. At the time of assessment, 17% of referrals no longer had an injury. One child was referred for rapidly enlarging head circumference, who was found to have significant chronic abusive head trauma. Figure 1 details patient demographics.Abstract 8366 Figure 131 infants were referred with bruising (38%). Figure 2 details clinical findings of medical reviews.Abstract 8366 Figure 2Further investigations as per RCPCH investigations for occult injuries were performed in 37% of cases and evidence of abusive head trauma was found in 3 infants.The majority of injuries (48) were thought to be accidental in origin but 6 cases (7.4%) were highly suggestive of abuse. There were 12 reports where the opinion was uncertain and NAI could not be excluded. 5 cases highlighted poor supervision and 3 evidenced neglect.We reviewed numerous ACEs in the background. Twelve patients were exposed to domestic violence, for 58% of these there were concerns of abuse. Seven infants lived with an adult with a mental health disorder, 57% of these were concerning cases. 7 infants lived amongst substance misuse.What does it mean? Reassuringly, when referred according to the immobile baby policy, the protocol was followed, critically most clinicians are aware of need for multi-agency decision making in the safeguarding process. However, this does not highlight children not referred.We need to be mindful of the appropriateness of referrals and performing CP medicals out of hours. There is a clinical impact on patients and a wider impact on families. 17% of referrals did not have injuries at the time of examination. 46% of referrals were minor accidental injuries with no safeguarding concerns at paediatric review.The importance of awareness of non-obvious presentation of abusive injury, specifically abusive head trauma, which carries the highest mortality in abusive presentations, has been highlighted in this review. Those presenting with significant injury, highly suggestive of abuse had not presented previously, but many had recognised risk factors. These play an important part in the risk to children of abuse & neglect and reinforces the need to support these families at earlier stages to prevent harm to children.",
  "authors": [
    {
      "affiliations": [
        "Bradford Teaching Hospitals NHS Foundation Trust"
      ],
      "name": "Olivia Bradshaw"
    },
    {
      "affiliations": [
        "Leeds Teaching Hospitals Foundation Trust"
      ],
      "name": "Mayokun Taiwo"
    },
    {
      "affiliations": [
        "Bradford Teachings Hospitals NHS Foundation Trust"
      ],
      "name": "Lauren Hill"
    }
  ],
  "title": "8366 A review of the Bradford immobile baby policy for safeguarding",
  "uid": "e1d34048-b90a-5839-8415-d036489b2a35"
}