1: Child Psychiatry - Abuse + Neglect Flashcards
Define child abuse
Deliberately causing harm to child or failure to prevent harm to a child
How can risk factors for child abuse be divided
- Parental
- Socio-economic
- Child
What are the three socio-economic factors that increase risk of child abuse
Poverty
Poor Housing
Chronic Stress
What are 5 parental factors increasing risk of child abuse
- Substance abuse
- Mental Health
- Domestic abuse
- Parent’s abused
- Anger-management problems
What are 4 parental risk factors fo continuing abuse
- Substance abuse
- Mental health conditions
- Chronic stress
- Parent does not engage with social services
What are child 4 risk factors for abuse
- Foster-Care
- Infants under 5
- Home-tutored
- Previous Abuse
- Disabled
What are the four types of child abuse
- Neglect
- Physical Abuse (NAI)
- Emotional Abuse
- Sexual Abuse
What is a sub-type of physical child abuse
Muchausen-by-proxy
What is the most common form of child abuse
Neglect
Define neglect
Failure to not meet child’s physical or emotional needs likely to impair their physical or emotional development
Antenatally how can neglect manifest
Substance-abuse during pregnancy
Once the child is born, how may neglect manifest
- Failure to provide food
- Failure to take to medical appointments
- Inadequate supervision
- Failure to protect from physical harm
What are 5 signs of physical neglect
- Growth faltering
- Unhygienic environment
- Recurrent head-lice
- Child steals and hits food
- Child is persistently dirty
What are 3 signs of neglect due to inadequate supervision
- Injuries that should not occur if supervised (burns ingestion)
- Abandon child
- Poor school attendance
What are 2 signs of neglect due to poor medical care
Lack of immunisations
Failure to attend developmental appointments
Dental cavities
Define physical abuse
Activity that causes physical harm to a child
What is included in physical abuse category
Fabricated illness
What does physical abuse involve
Kicking
Burning
Hitting
Shaking
How may physical abuse present
- Bruises
- Burns
- Scars
- Bite marks
- Fractures
What features of bruises are suspicious of NAI
- Bruises of different ages
- Bruises in children <1
- Bruises on soft-tissues unusual places (stomach, face)
- Bilateral bruising around the eye
- Distinct patterns of bruising eg. hand marks
What features of burns are suspicious of NAI
- Perfectly round bruise (cigarette)
- Immersion bruising (Gloves + Stockings)
- Unusual sites
What features of a fracture are always suspicious of NAI
Child under 1-year with a fracture!
Long-bone fractures in infants. Posterior rib fractures. Several fractures of different ages in bones.
Define emotional abuse
Persistent, emotional mal-treatment of a child likely to result in stunted emotional devlopment
How may emotional abuse manifest
Altered behaviour of the child not in-keeping with developmental age
What is the difficultly with emotional abuse
Subtle - can only be detected through child’s behaviour or interaction between parent
What behaviour of a child may suggest emotional abuse
- Recurrent nightmares
- Extreme distress
- Aggressive
- Habitual body rocking
- Clinginess to strangers
- Substance mis-use
- Self-harm
What factors between a child and parent may indicate abuse
Child is withdrawn or aggressive to parent
Parent is hostile, rejects young person, threatens abuse, punishes child for enuresis. Uses child in marital disputes
Define sexual abuse
Encouraging a child to partake in sexual activities knowingly or non-knowingly. This may include penetrative or non-penetrative acts.
How can sexual abuse present clinically
- PV bleed
- STI
- Pregnancy
- Behaviour changes
- Enuresis
- Faecal soiling
What behaviour changes may occur in post-pubertal child
Withdrawan
Agressive
Self-harming
Suicidal ideation
What behavioural changes may occur in pre-pubertabl child
- Sexual knowledge
- Sexual activity with peers
- Oral or genital contact with toys
- Requesting to be touched in genital area
- Putting objects in other children’s vagina or anus
what is an acute sign of sexual abuse in girls
Torn Hymen
PV bleed
Hand-marks
Genital bruising
what is an acute sign of sexual abuse in boys
Bruising
Torn frenulum
what are chronic signs of sexual abuse in girls
Tear in posterior fourchette
Tear in posterior hymen
What is the way to assess child with suspected sexual abuse
- Observe interaction between child and carer
- Talk to child alone with T.E.D. approach
- Growth chart
- Assess neurodevelopment
- Photograph visible injuries
What is a good approach to when discussing abuse with children
T.E.D
Tell me what happened
Explain to me what you mean
Describe what went on
If suspecting sexual abuse how should the child be examined
Child should be examined by safe-guarding lead and another practitioner. If in 72h - requires forensic swabs
If suspecting NAI in a child what three investigations should be ordered
Skeletal Surgery
Coagulation profile: to check for causes of bruising
Ophthalmoscopy: check for retinal haemorrhages sign of NAI
If suspecting safe-guarding concern who should be contacted first
Safe-Guarding Lead
Who will the safeguard lead contact
Local Authorities Child Protection Services
Who will local authority of children’s social care dispatch the case to
social worker
what act do social workers have the right to assess under
Section 47 of the Children’s Act (1989)
what do social workers decide
If immediate protection is required
should parent’s be told if referral to local authority of children’s social care
Parent’s should be informed of referral unless likely to result in further harm to child.
Do not need parent’s permission for referral
prior to assessment, what should the social worker organise
Strategy discussion meeting
who does a strategy discussion involve
Social Worker
HCP
Police
Nursery/School teacher
The meeting decides whether the family should be assessed under section 47 of the children’s act (1989)
if an assessment is made under section 47 of the children’s act in what time frame should the assessment be conducted
45d
following an assessment what should the social worker organise
Child protection conference
what is the aim of the child protection conference
Family is invited - decide on best method of safeguarding child
what is a child placed on following the child protection conference
child protection register
what is the outcome of child protection conference
child protection plan is put in place
when is a child reviewed following the child protection conference
child is reviewed 3m following first child protection plan and then 6m intervals
If a child is in immediate harm what should the LA, NSPCC or Police put in last
Emergency protection order
What does the GMC state is a doctor’s responsibility if they suspect neglect or abuse
If a doctor suspects abuse or NAI it is there responsibility to refer to social services, NSPCC or police
Where should the safe guarding lead refer cases of child protection to be handled
Multi-agency safeguarding hub (MASH)
how do the multi-agency safeguarding hub (MASH) assess cases
Using the assessment framework to establish environmental factors, parental capacity and child needs they produce a continuum of needs (windscreen)
In the continuum of needs what colour are all children
white
In continuum of needs what colour are children with additional needs and what will they receive
green - receive common assessment and targeted services
In continuum of needs what colour are children with multiple needs and what will they receive
orange - receive specialist assessment and specialist services
In continuum of needs what colour are children in need of immediate protection and what will they receive
red - receive specialist assessment and specialist services
What act outlines safeguarding of children
The Children’s Act (1989)
What is section 17 of the children’s act called
Children in Need
Outline section 17 of the children’s act
Children whose vulnerability means they are unlikely to maintain satisfactory development without provision of services
What is section 47 of the children’s act called
Children at risk or suffering harm
Outline section 47 of the children’s act
Children at risk of harm from physical, sexual or emotional abuse or neglect. LA have a duty to investigate
What is police protection order (PPO)
Emergency order placed by police to remove child from current environment to location of safety.
How long is a police-protection order
72h
What is an emergency protection order
Put in by LA or NSPCC - removes child if immediate danger
How long is an emergency protection order
8d
What is a child assessment order
Put in by LA if parents are un co-operative
What is interim care order
Applied for by NSPCC or lA - giving parental responsibility to LA for 8W
What do the GMC say about sharing information about NAI with parents
GMC: should ask consent of parent’s before sharing information unless by doing so are delaying information or increasing risk of harm to child
Which countries is female genital mutilation more common
Sudan
Ethiopia
Sierre Leon
Somalia
What is a risk factor for FGM
Parents had FGM
What is type I FGM
Removal of clitoral hood and part of clitoris
What is type II FGM
Removal of clitoris, inner labia
± Outer labia
What is type III FGM
Removal clitoris, inner labia, outer labia and sew inner labia together with small hole
What is type 4 FGM
Any other type of injury:
- Burning, Scalding, Picking, Piercing.
What are short-term complications of FGM
Infection
Bleeding
Pain
Fractures
What are long-term complications of type I FGM
Dyspareunia
Tight in clitoral area
Incontinence
Loss of sexual pleasure
What are long-term complications of Type 2 FGM
Tears Bleeding UTI Thrush Anxiety, Depression
What are long-term complications of Type 3 FGM
- Infertility
- PID
- Sexual intercourse is not-possible
