AB229. SOH21AS059. The benefit of ‘Sniper’s Eyes’ in child abuse

Background: Child abuse is rarely encountered in Otorhinolaryngology Head & Neck (ORL-HNS) practice but it still behoves clinicians to be alert for such an eventuality. A Systematic Review on child abuse by Rees et al. [2017] outlines the features associated with this relatively common circumstance in any community but highlights the dearth of information on the subject in the ORL-HNS literature.

Methods: A case of child abuse realised at our department which was subsequently successfully prosecuted is presented with a review of the literature involving paediatric non-accidental injury in our specialty.

Results: We wish to add our learning points to the dissertation by Rees et al. [2017] from a case which in the first instance supports the evidence that a laceration to the pinna in a 5-year-old male is suspicious for paediatric non-accidental injury. Furthermore, the history did not seem entirely plausible as he allegedly injured his ear while falling off a table but also that he was noted on external nasal examination to have columellar retraction indicative of previous trauma. The combination of these four factors; a questionable reason for the accident, a finding not consistent with the alleged incident, an infrequent type of paediatric injury and signs of previous separate trauma lead to the reporting of our concerns to the relevant Consultant Paediatrician. Regular abuse including the wilful fracture of the child’s arm across a radiator by his father was uncovered at follow-up investigation. This ultimately led to a conviction with a contemporary newspaper headline at the time of ‘I hope my daddy gets arrested for 100 years’.

Conclusions: ‘Eyes (and ears) wide open’ or ‘Sniper’s eyes’ as suggested by some of our NCHDs most likely prevented a tragedy but certainly helped in a safe outcome for this child.

Keywords: Child abuse; non-accidental injury; otorhinolaryngology