Safeguarding in pediatric practice: Identification of non-accidental head injury in a child with cerebral palsy

Abstract

Objective: To highlight the importance of early recognition of safeguarding concerns in pediatric patients presenting with neurological emergencies, particularly when clinical findings are disproportionate to the reported history. Methodology: This is a case-based analysis of a 3-year-old child with a known diagnosis of cerebral palsy who presented with active seizures and reduced consciousness. Clinical assessment included neurological examination, Glasgow Coma Scale (GCS) evaluation, and urgent neuroimaging with CT scan. Caregiver history was compared with clinical findings to assess consistency. Results: The child presented unconscious with ongoing seizures, poor GCS, and a dilated, non-reactive pupil suggestive of raised intracranial pressure. Examination revealed brisk reflexes. An urgent CT brain demonstrated a subdural hematoma. The severity of findings was inconsistent with the caregiver’s account of a routine seizure episode, raising strong suspicion of non-accidental injury. The patient was stabilized with seizure control measures and management of raised intracranial pressure. Safeguarding protocols were initiated, and the case was referred for medico-legal documentation with notification of appropriate authorities. Conclusion: Early identification of red flags such as inconsistent history and unexplained neurological deterioration is critical in suspected child abuse.