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Paediatrics > 1: Child Psychiatry - Abuse + Neglect > Flashcards

1: Child Psychiatry - Abuse + Neglect Flashcards

1
Q

Define child abuse

A

Deliberately causing harm to child or failure to prevent harm to a child

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2
Q

How can risk factors for child abuse be divided

A
  1. Parental
  2. Socio-economic
  3. Child
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3
Q

What are the three socio-economic factors that increase risk of child abuse

A

Poverty
Poor Housing
Chronic Stress

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4
Q

What are 5 parental factors increasing risk of child abuse

A
  1. Substance abuse
  2. Mental Health
  3. Domestic abuse
  4. Parent’s abused
  5. Anger-management problems
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5
Q

What are 4 parental risk factors fo continuing abuse

A
  1. Substance abuse
  2. Mental health conditions
  3. Chronic stress
  4. Parent does not engage with social services
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6
Q

What are child 4 risk factors for abuse

A
  1. Foster-Care
  2. Infants under 5
  3. Home-tutored
  4. Previous Abuse
  5. Disabled
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7
Q

What are the four types of child abuse

A
  1. Neglect
  2. Physical Abuse (NAI)
  3. Emotional Abuse
  4. Sexual Abuse
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8
Q

What is a sub-type of physical child abuse

A

Muchausen-by-proxy

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9
Q

What is the most common form of child abuse

A

Neglect

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10
Q

Define neglect

A

Failure to not meet child’s physical or emotional needs likely to impair their physical or emotional development

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11
Q

Antenatally how can neglect manifest

A

Substance-abuse during pregnancy

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12
Q

Once the child is born, how may neglect manifest

A
  • Failure to provide food
  • Failure to take to medical appointments
  • Inadequate supervision
  • Failure to protect from physical harm
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13
Q

What are 5 signs of physical neglect

A
  1. Growth faltering
  2. Unhygienic environment
  3. Recurrent head-lice
  4. Child steals and hits food
  5. Child is persistently dirty
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14
Q

What are 3 signs of neglect due to inadequate supervision

A
  1. Injuries that should not occur if supervised (burns ingestion)
  2. Abandon child
  3. Poor school attendance
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15
Q

What are 2 signs of neglect due to poor medical care

A

Lack of immunisations

Failure to attend developmental appointments

Dental cavities

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16
Q

Define physical abuse

A

Activity that causes physical harm to a child

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17
Q

What is included in physical abuse category

A

Fabricated illness

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18
Q

What does physical abuse involve

A

Kicking
Burning
Hitting
Shaking

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19
Q

How may physical abuse present

A
  • Bruises
  • Burns
  • Scars
  • Bite marks
  • Fractures
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20
Q

What features of bruises are suspicious of NAI

A
  • 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
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21
Q

What features of burns are suspicious of NAI

A
  • Perfectly round bruise (cigarette)
  • Immersion bruising (Gloves + Stockings)
  • Unusual sites
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22
Q

What features of a fracture are always suspicious of NAI

A

Child under 1-year with a fracture!

Long-bone fractures in infants. Posterior rib fractures. Several fractures of different ages in bones.

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23
Q

Define emotional abuse

A

Persistent, emotional mal-treatment of a child likely to result in stunted emotional devlopment

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24
Q

How may emotional abuse manifest

A

Altered behaviour of the child not in-keeping with developmental age

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25
Q

What is the difficultly with emotional abuse

A

Subtle - can only be detected through child’s behaviour or interaction between parent

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26
Q

What behaviour of a child may suggest emotional abuse

A
  • Recurrent nightmares
  • Extreme distress
  • Aggressive
  • Habitual body rocking
  • Clinginess to strangers
  • Substance mis-use
  • Self-harm
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27
Q

What factors between a child and parent may indicate abuse

A

Child is withdrawn or aggressive to parent

Parent is hostile, rejects young person, threatens abuse, punishes child for enuresis. Uses child in marital disputes

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28
Q

Define sexual abuse

A

Encouraging a child to partake in sexual activities knowingly or non-knowingly. This may include penetrative or non-penetrative acts.

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29
Q

How can sexual abuse present clinically

A
  • PV bleed
  • STI
  • Pregnancy
  • Behaviour changes
  • Enuresis
  • Faecal soiling
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30
Q

What behaviour changes may occur in post-pubertal child

A

Withdrawan
Agressive
Self-harming
Suicidal ideation

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31
Q

What behavioural changes may occur in pre-pubertabl child

A
  • 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
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32
Q

what is an acute sign of sexual abuse in girls

A

Torn Hymen
PV bleed
Hand-marks
Genital bruising

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33
Q

what is an acute sign of sexual abuse in boys

A

Bruising

Torn frenulum

34
Q

what are chronic signs of sexual abuse in girls

A

Tear in posterior fourchette

Tear in posterior hymen

35
Q

What is the way to assess child with suspected sexual abuse

A
  • Observe interaction between child and carer
  • Talk to child alone with T.E.D. approach
  • Growth chart
  • Assess neurodevelopment
  • Photograph visible injuries
36
Q

What is a good approach to when discussing abuse with children

A

T.E.D

Tell me what happened

Explain to me what you mean

Describe what went on

37
Q

If suspecting sexual abuse how should the child be examined

A

Child should be examined by safe-guarding lead and another practitioner. If in 72h - requires forensic swabs

38
Q

If suspecting NAI in a child what three investigations should be ordered

A

Skeletal Surgery

Coagulation profile: to check for causes of bruising

Ophthalmoscopy: check for retinal haemorrhages sign of NAI

39
Q

If suspecting safe-guarding concern who should be contacted first

A

Safe-Guarding Lead

40
Q

Who will the safeguard lead contact

A

Local Authorities Child Protection Services

41
Q

Who will local authority of children’s social care dispatch the case to

A

social worker

42
Q

what act do social workers have the right to assess under

A

Section 47 of the Children’s Act (1989)

43
Q

what do social workers decide

A

If immediate protection is required

44
Q

should parent’s be told if referral to local authority of children’s social care

A

Parent’s should be informed of referral unless likely to result in further harm to child.

Do not need parent’s permission for referral

45
Q

prior to assessment, what should the social worker organise

A

Strategy discussion meeting

46
Q

who does a strategy discussion involve

A

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)

47
Q

if an assessment is made under section 47 of the children’s act in what time frame should the assessment be conducted

A

45d

48
Q

following an assessment what should the social worker organise

A

Child protection conference

49
Q

what is the aim of the child protection conference

A

Family is invited - decide on best method of safeguarding child

50
Q

what is a child placed on following the child protection conference

A

child protection register

51
Q

what is the outcome of child protection conference

A

child protection plan is put in place

52
Q

when is a child reviewed following the child protection conference

A

child is reviewed 3m following first child protection plan and then 6m intervals

53
Q

If a child is in immediate harm what should the LA, NSPCC or Police put in last

A

Emergency protection order

54
Q

What does the GMC state is a doctor’s responsibility if they suspect neglect or abuse

A

If a doctor suspects abuse or NAI it is there responsibility to refer to social services, NSPCC or police

55
Q

Where should the safe guarding lead refer cases of child protection to be handled

A

Multi-agency safeguarding hub (MASH)

56
Q

how do the multi-agency safeguarding hub (MASH) assess cases

A

Using the assessment framework to establish environmental factors, parental capacity and child needs they produce a continuum of needs (windscreen)

57
Q

In the continuum of needs what colour are all children

A

white

58
Q

In continuum of needs what colour are children with additional needs and what will they receive

A

green - receive common assessment and targeted services

59
Q

In continuum of needs what colour are children with multiple needs and what will they receive

A

orange - receive specialist assessment and specialist services

60
Q

In continuum of needs what colour are children in need of immediate protection and what will they receive

A

red - receive specialist assessment and specialist services

61
Q

What act outlines safeguarding of children

A

The Children’s Act (1989)

62
Q

What is section 17 of the children’s act called

A

Children in Need

63
Q

Outline section 17 of the children’s act

A

Children whose vulnerability means they are unlikely to maintain satisfactory development without provision of services

64
Q

What is section 47 of the children’s act called

A

Children at risk or suffering harm

65
Q

Outline section 47 of the children’s act

A

Children at risk of harm from physical, sexual or emotional abuse or neglect. LA have a duty to investigate

66
Q

What is police protection order (PPO)

A

Emergency order placed by police to remove child from current environment to location of safety.

67
Q

How long is a police-protection order

A

72h

68
Q

What is an emergency protection order

A

Put in by LA or NSPCC - removes child if immediate danger

69
Q

How long is an emergency protection order

A

8d

70
Q

What is a child assessment order

A

Put in by LA if parents are un co-operative

71
Q

What is interim care order

A

Applied for by NSPCC or lA - giving parental responsibility to LA for 8W

72
Q

What do the GMC say about sharing information about NAI with parents

A

GMC: should ask consent of parent’s before sharing information unless by doing so are delaying information or increasing risk of harm to child

73
Q

Which countries is female genital mutilation more common

A

Sudan
Ethiopia
Sierre Leon
Somalia

74
Q

What is a risk factor for FGM

A

Parents had FGM

75
Q

What is type I FGM

A

Removal of clitoral hood and part of clitoris

76
Q

What is type II FGM

A

Removal of clitoris, inner labia

± Outer labia

77
Q

What is type III FGM

A

Removal clitoris, inner labia, outer labia and sew inner labia together with small hole

78
Q

What is type 4 FGM

A

Any other type of injury:

- Burning, Scalding, Picking, Piercing.

79
Q

What are short-term complications of FGM

A

Infection
Bleeding
Pain
Fractures

80
Q

What are long-term complications of type I FGM

A

Dyspareunia
Tight in clitoral area
Incontinence
Loss of sexual pleasure

81
Q

What are long-term complications of Type 2 FGM

A 
Tears
Bleeding
UTI
Thrush 
Anxiety, Depression
82
Q

What are long-term complications of Type 3 FGM

A
  • Infertility
  • PID
  • Sexual intercourse is not-possible

Paediatrics (61 decks)

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