ABSTRACT
An injury that leaves a bruise over the abdomen would have needed more force than a child themselves would exert by falling. Need medical and possibly surgical management and full child protection investigations, which should be led by the paediatricians. Non-accidental injury is therefore likely and full investigations should be initiated to look for intracranial injury, fractures and retinal haemorrhages. The chest X-ray shows multiple old rib fractures. These are most likely to have been caused by abuse. The child needs investigation for other signs of abuse with Computed tomography head, skeletal survey and eye examination. A torn hymen can be caused by accidental injury if there is an appropriate history but it would not be gaping. This situation must be dealt with by an experienced paediatrician so that the chain of evidence is maintained. Self-harm is a common presentation of sexual abuse.
