Paediatric hypopharyngeal perforation: child abuse until proved otherwise?

A case of paediatric hypopharyngeal perforation in a 7-month-old infant is reported. The diagnosis was delayed because it was not considered. It later transpired that the injury had been inflicted by one of the child's parents. Criminal proceedings were successfully brought against both parents and the child and his siblings were taken into foster care. A review of the available literature on paediatric hypopharyngeal perforation, excluding iatrogenic and external trauma mechanisms of injury suggests that non-accidental injury is by far the most common aetiology. Suspected child abuse remains one of the most sensitive and challenging areas in medicine. Awareness that non-iatrogenic paediatric hypopharyngeal perforation in the absence of external trauma is highly suggestive of a non-accidental injury is critical, and may save a child from subsequent abuse.