Clinical Review Lesson of the week

When “NAI” means not actually injured

BMJ 1999; 318 doi: https://doi.org/10.1136/bmj.318.7191.1127 (Published 24 April 1999) Cite this as: BMJ 1999;318:1127
  1. Clifford Mayes, specialist registrar,
  2. Calum Macleod, consultant paediatrician. (Heather.Houston@uh.n-i.nhs.uk)
  1. Department of Paediatrics, Antrim Hospital, 45 Bush Road, Antrim BT41 2RL
  1. Correspondence to: Dr Macleod Heather.
  • Accepted 23 October 1998

Non-accidental injury is a diagnosis that must be kept in mind by all health professionals who deal with children. The characteristic features of non-accidental injury are well known.1 We describe a previously unreported case of congenital melanocytic naevi presenting as scalp bruising in an infant with features in the history suggestive of abuse. This case emphasises the need for a cautious, open minded approach to this difficult subject even when the initial history and examination are highly suspicious.

Case report

JD presented to his general practitioner at the age of 3 months with a one week history of bruising to both parietal areas of the scalp. The doctor initially reassured the mother and sent her home. An anonymous telephone call to social services resulted in a second visit that same day with a social worker in attendance, and an urgent referral to a consultant paediatrician was arranged with a suspected diagnosis of non-accidental injury. The mother was insistent that she had not harmed the child in any way and was clearly distraught that such an allegation had been made. In hospital the mother stated that the bruises had been caused by the infant rolling his head from side to side in an unpadded car seat. She could not, however, describe a …

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