The bleeding child; is it NAI?

As a paediatric haematologist, the question of whether a child has been abused or whether they might have a bleeding diathesis is a question that I am regularly asked. When I first became a consultant, I would often find that not enough information was available; for example, incomplete histories had been taken or investigations were incomplete and difficult to interpret. This inevitably led to delays in confirming the cause of the bleeding and meant that if parents or carers contested a diagnosis of abuse, excluding a bleeding disorder was extremely difficult. I was also aware that carers of several of my patients with haemophilia or other bleeding disorders had initially been under suspicion of abuse, most usually at the time of the first few presentations. By highlighting important questions in history taking, having a specific haematological screen for children being investigated for bleeding in the context of non-accidental injury, and encouraging discussion of abnormal results with a haematologist, these difficulties can, for the most part, be avoided.