physical abuse should be suspected if a child presents with signs of a spinal injury (injury to vertebrae or within the spinal canal) in the absence of major confirmed accidental trauma. Spinal injury may present as:
a finding on skeletal survey or magnetic resonance imaging
cervical injury in association with inflicted head injury
thoracolumbar injury in association with focal neurology or unexplained kyphosis (curvature or deformity of the spine)
for the purposes of this guideline, NICE state that to suspect child maltreatment means a serious level of concern about the possibility of child maltreatment but is not proof of it
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