Below is a flowchart setting out the response for Bruising, skin mark or injury in non-mobile babies. Please also refer to the full Bruising and Injuries to Non-Mobile Children procedures.

Response Flow Chart

In situations where a non-mobile baby has a bruise, skin mark, or injury, consider the following and take the appropriate action.

Professional is aware that skin mark or injury has been recognised and is documented as being due to a medical condition, birth injury/trauma or birth mark.

Document on significant events, progress notes and PCHR if available. Flow chart ends as actioned.

Health Professional has used professional judgement and is satisfied that the skin mark or injury is due to a medical condition, a birth mark, or fits with parent/carer explanation and does not pose risk.

Document on significant events, progress notes and PCHR if available. Flow chart ends as actioned.

Health professional is unsure of origin of skin mark or if it is a bruise or injury, but feels there are indicators to suggest a birth injury, birth mark or medical condition that has not been recorded/or has only just developed. No indications in history/presentation of abuse. PHN (awaiting name) leaflet to be shared with parents.

Is professional identifying injury/bruise or unidentified mark able to arrange same day GP review?

• If yes – Health professional to book GP appointment. Document outcome, confirm attendance*.
• If no – Health professional to refer to Paediatrician for same day review. Document outcome, confirm attendance*.

In either situation, does the GP or Paediatrician rule out safeguarding cause due to clinical presentation?

• If yes – No further action. PHN to follow up outcome and document on significant events and PCHR if available.
• If no –
  • GPs to phone call MASH referral and same day referral to Paediatrician for child protection medical*
  • Paediatricians to phone call MASH referral and child protection medical

* Dependant on your professional assessment of risk will depend if you await confirmation of appointment and then confirm family have arrived at hospital, or if you confirm with parent that they have attended hospital and agree what support they need once outcomed.

Professional suspects origin of a bruise, injury, or skin mark that has not been sufficiently explained suggesting a possible safeguarding concern. PHN (awaiting name) leaflet to be shared with parents.

Make a MASH Referral

PHN to phone MASH consultation line on 0345 1551071 and ask to speak to duty social worker (not referral coordinator) to discuss case. Follow their guidance and document this in notes. There may be several different actions from this discussion

MASH advise you to complete a multiagency safeguarding referral.

Usual process:

• Advise parents of referral process which will support identification of cause through medical examination. Pathway includes a multiagency safeguarding referral being made in case medical cause is not clear.
• You submit a multiagency safeguarding referral.
• MASH will contact paediatrician and arrange family’s attendance. MASH will follow up if family do not attend.
• Document on significant events and progress notes, upload MASH referral to Dart.

Useful numbers and information

• MASH Consultation line: 0345 1551071
• Safeguarding Nurses contact details
• Torbay and South Devon NHS Foundation Trust Switchboard: 0300 456 8000 or 01803 614567
• RD&E Hospital Switchboard: 01392 411611
• Plymouth Hospital NHS Trust Switchboard: 0175202082
• North Devon Health Care NHS Trust switchboard: 01271322577

Hospital Trust Injury or bruising in non-mobile baby parent information links:

• Torbay and South Devon NHS Foundation Trust
• RD&E NHS Trust
• North Devon Health Care NHS Trust
• Devon Multi-Agency Safeguarding Hub information for parents and carers

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