Introduction Head injury in children is a common presentation to emergency departments (ED). Specific age groups are difficult to assess, particularly children Methods A retrospective audit of all children Results Study population was 403, 96 of which were admitted. The median age was 3 months. The most common mechanism of injury was fall from a bed/couch/mat (26%) followed by fall from a carrier seat unrestrained (21.8%). 13 had a CT head (CTH) all meeting NICE criteria. 8 had a skull x-ray (SXR), 5 of which required CTH. 2 additional infants met criteria for CTH but didn’t have one (as GCS rapidly improved). All CTH were abnormal with skull fractures identified. 3 required neurosurgical intervention. All 13 were followed in neurosurgical clinic. Neuro-observations ranged from 4–24 hours in patients not requiring CTH. Initial CPC were raised in 9 cases with medical social work (MSW) involvement in all cases. 6 Skeletal surveys (SS) were performed; 4 Non-accidental injury (NAI) work-up and 2 following a dangerous mechanism of injury. 11 patients represented with a further head injury. In 2, CPC were noted with MSW involvement, with one further SS. Discussion With no indications for CTH or CPC, neuro-observations are performed up to 24hours. With early senior involvement this can be as short as 4hours. Although NICE gives no specific duration for neuro-observations, with our consistently good outcomes and low representation rates, it may be safe to shorten admissions. ED staff recognised CPC in all cases, made a MSW referral and flagged this to the admitting teams. 5 referrals progressed to a full NAI workup with no additional injuries or concerns noted on MSW assessment. No admitted cases proceeded to CP case conference. This indicates that our paediatric ED staff are aware of and are looking for potential CP red flags. Further prospective study of patients discharged following observation in ED is indicated.