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'Em's turn.' The toddler was by her side in an instant. 'Want torch.'
'Please,' her mother prompted automatically.
'Pees.' The little girl reached out to grab the ophthalmoscope and Keely whipped out a pen torch. 'This one's for Em. Em, look at the teddy and Keely look at Em.'
Quickly, knowing that she didn't have time to waste, she examined the child's eyes.
'Does your head hurt, Em?'
'Em hurt. Rick push Em.'
Keely stopped what she was doing and her eyes met the mother's. 'Someone pushed her?'
'No.' Mrs Barrett swept the toddler into her arms. 'No one pushed her. My boyfriend was walking past and knocked into her, but it was an accident.'
Keely's instincts were on full alert but she knew better than to alienate the mother at this stage.
'That happens so easily with toddlers.' She held out her arms. 'Em come with Keely?'
Em slipped easily into her arms and she strolled up to the trolley and sat her down.
'I just need to finish examining her, Mrs Barrett.'
She slipped the little girl's dress over her head and tickled the child's stomach until she gurgled with laughter.
The mother stared at her suspiciously. 'Why are you undressing her when she banged her head?'
'Because toddlers fall for a number of reasons,' Keely said smoothly. 'Sometimes it's because they're unsteady on their feet and sometimes it could be because they have an infection of some sort which can affect their balance. We always do a full check with a head injury. I'll want to check her ears and throat as well.'
Zoe stepped over, her expression friendly. 'Mrs Barrett, can I just get you to fill out this card for me with Emily's details?'
As the child's mother followed Zoe without question, Keely was able to examine the child thoroughly, which had obviously been the staff nurse's intention. Blessing her quick thinking, Keely examined the child, frowning slightly as she saw the faint yellow bruises on her upper arms.
Her. lower legs were covered in bruises, too, but these were less concerning because children of Emily's age fell over so frequently.
Taking a quick look at her back, she saw faint marks that made her feel decidedly uneasy. Could it be what she suspected? It was so difficult to tell in children of this age who were frequently covered in bruises.
'Well done, Em.' She slipped the dress back over the little girl's head and glanced at Zoe.
'I just need to talk to Mr Jordan and then we'll sort out that head.' She turned to the mother with a relaxed smile. 'Mrs Barrett, Emily has a nasty bump on the head and we may well need to admit her to our paediatric ward for twenty-four hours' observation.'
The mother looked uneasy. 'I thought she could go straight home.'
'I don't think so.' Keely wrote carefully on the notes, documenting everything she'd found. 'Head injuries can be deceptive in small children. I just need to talk to one of our consultants.'
She walked briskly down the corridor and found Zach examining a young woman with chest pains.
'Can I see you when you have a minute?'
He gave a nod, finished his examination and then handed over to Adam.
'Problems?' He walked with her into the corridor and she bit her Up.
'Maybe. I've got a two-and-a-half-year-old in Paediatric Casualty with a bang on the head. Mother says she tripped and banged her head on the table but the toddler says she was pushed. I've examined her thoroughly and she has marks consistent with old bruising on her upper arms and back.'
'Children of that age are always covered in bruises,' Zach reminded her, his gaze quizzical. 'Phoebe's the same.'
Keely nodded. 'I know that. But these bruises aren't in the common places.'
