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ICA > 1) Child Safeguarding > Flashcards

1) Child Safeguarding Flashcards

1
Q

What is child abuse?

A
  • Maltreatment of a child (<18yrs)
  • Infliction of harm OR
  • Failing to act to prevent harm
  • ‘Significant harm’
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2
Q

What is classified as ‘Significant harm’?

A
  • Ill-treatment or impairment of health or
    development
  • Legal justification for LA intervention in family life
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3
Q

What are the 4 categories of child Abuse?

A
  • Neglect
  • Physical
    – Including FII (Fabricated or induced illness) /perplexing presentations
    – Including FGM
  • Sexual
  • Emotional
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4
Q

What is neglect?

A
  • The persistent failure to meet a child’s basic physical and / or psychological needs
  • likely to result in the serious impairment of the child’s health or development.
  • May occur during pregnancy as a result of maternal substance abuse.
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5
Q

What is neglect?

A

Failure to…
* Providing adequate food, clothing, shelter (including exclusion from home or abandonment)
* Protect a child from physical and emotional harm or danger
* Ensure adequate supervision (including the use of inadequate care-givers)
* Ensure access to appropriate medical care or treatment
* It may also include neglect of, or unresponsiveness to, a child or young person’s basic emotional needs.

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6
Q

Neglect: History taking

A
  • Recurrent non-attendance at appointments/non-adherence to medication
  • Missed routine screening/immunisations
  • Faltering growth
  • Delay in development
  • Recurrent infestations/infections/injuries
  • Poor school attendance
  • History of injury where explanation suggests inappropriate supervision
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7
Q

Neglect: Examination

A
  • Poor nutritional status/poor growth
  • Dental decay
  • Signs of recurrent/chronic infection or infestation
  • Dirty/unkempt/smelly
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8
Q

What is physical abuse?

A
  • May involve hitting, shaking, throwing, poisoning, burning or scalding, drowning, suffocating or otherwise causing physical harm to a child.
  • Physical harm may also be caused when a parent or carer fabricates the symptoms of, or deliberately induces, illness in a child
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9
Q

Physical abuse: History

A
  • Lack of or inadequate explanation for injury
  • Delay in seeking medical attention / inappropriate response
  • Inconsistent accounts
  • Presence of multiple risk factors/Child or family known to Social Care
  • Direct disclosure
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10
Q

Physical abuse: Examination

A
  • Unexplained bruising in vulnerable child
  • Unexplained fractures/burns/scalds/head injury
  • Patterns: Implement/sparing/bites
  • Injury not consistent with history/developmental age
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11
Q

What is sexual abuse?

A
  • Forcing or enticing a child or young person to take part in sexual activities, not necessarily involving high levels of violence, whether or not the child is aware of what is happening.
  • May involve physical contact (including assault by penetration or non-penetrative acts)
  • May be non-contact activities (involving children looking at or producing sexual images, watching sexual activities, encouraging children to behave in sexually inappropriate ways, grooming.
  • Can take place online, and technology used to facilitate offline abuse.
  • Perpetrators not solely adult males.
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12
Q

What does CSE stand for?

A

Child sexual exploitation

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13
Q

What is Child sexual exploitation (CSE)?

A
  • An individual or group takes advantage of power imbalance to coerce, manipulate or deceive a CYP (<18 yrs) into sexual activity
    a) In exchange for something the victim needs / wants,
    and / or
    b) For financial advantage / increased status of the perpetrator.
  • Victim may have been exploited even if sexual activity appears consensual.
  • Does not always involve physical contact – can occur through use of technology.
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14
Q

Sexual abuse: History

A
  • Disclosure
  • Pregnancy/signs of sexual activity in child under 13yrs
  • STIs
  • Anogenital injury/unexplained bleeding
  • Recurrent vaginal discharge
  • Soiling/wetting - differential diagnosis
  • Behavioural change
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15
Q

Sexual abuse: Examination

A
  • Immediate health needs are paramount
  • Referral to Social Care - Forensic assessment undertaken at specialist Sexual Assault Referral Centre by staff with appropriate skills & expertise
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16
Q

What is emotional abuse?

A

Emotional abuse
* Persistent emotional maltreatment of a child causing severe and persistent adverse effects on the child’s emotional development.
* May involve:
– Conveying worthlessness/unloved/inadequate
– Deliberately silencing or making fun of child’s voice
– Imposing age/developmentally inappropriate expectations on children
* Overprotection & limiting of exploration or learning
* Preventing participation in normal social interaction
– Serious bullying/exploitation/corruption
* Some level involved in all types of abuse, but may occur
alone.

17
Q

Examples of emotional abuse

A

– Rejecting
– Isolating
– Terrorising
– Ignoring
– Corrupting
– Cyberbullying

18
Q

Emotional abuse: History

A
  • Infants:
    – Feeding difficulties, crying, poor sleep patterns, delayed development.Described in negative terms.
  • Toddler/preschool:
    – Behavioural spectrum from overactive to apathetic, noisy to quiet, dev delay
  • School aged:
    – Wetting & soiling, relationship difficulties, poor school performance, non- attendance, antisocial behaviour
  • Adolescents:
    – Depression, self-harm, substance misuse, eating disorders, oppositional,
19
Q

Emotional abuse: Examination

A

Growth (underweight)
Emotional signs (non-specific)
Behavioural (wide range)
Development (failure to achieve milestones, academic failure)

20
Q

Identify some other forms of abuse

A

The wider context of safeguarding
* Online abuse & grooming
* Child Criminal exploitation/County lines
* Trafficking
* Radicalisation
* Modern slavery
* Female genital mutilation/cutting
* Forced marriage
* Honour based violence
* Discriminatory abuse

21
Q

What are the risk factors for child abuse?

A
  • ‘Triad of vulnerability’:
    – Domestic abuse
    – Mental illness of parent or carer
    – Parental drug and / alcohol misuse
  • Under 2 years
  • Pre-verbal babies & children
  • Those with additional needs/disability
  • Vulnerable/marginalised young people
22
Q

What does ACEs stand for?

A

Adverse Childhood Experiences

23
Q

What are ACEs?

A

– Physical abuse & neglect
– Sexual abuse
– Emotional abuse & neglect
– Domestic violence
– Mental ill-health
– Incarceration
– Substance misuse
– Parental separation

24
Q

What to do when you are concerned about a child?

A
  1. Concerns about a child
  2. Referral to Local Authority (Social Care / MASH)
  3. Reasonable cause to suspect that a child who lives or is found in their area is suffering, or is likely to suffer, significant harm
  4. Duty to make enquiries under Section 47(1) of the Children Act 1989
25
Q

Describe the ACE model

A
  1. Adverse childhood experiences
  2. disrupted neurodevelopment and allostatic load
  3. Social, emotional and cognitive impairment
  4. Adoptions of high risk behaviours and crime
  5. disease, disability, social problems and low productivity
  6. early death
26
Q

Interventions and support for child abuse

A
  • Universal services
  • Early Help
  • Child in Need – consent required. Section 17 Children Act 1989
  • Child Protection – consent not required. Section 47 Children Act 1989
27
Q

What to do when we recognise abuse?

A

Key learning from Child Safeguarding Practice Reviews
* Interagency communication & information-sharing.
* See the bigger picture & have a family focus
– Risk of normalisation
* Listen to & see the child
– Disguised compliance
– Voice of the child
– Overreliance on parental accounts
* Following up missed appointments & linking incidents
* Recognising abuse
* Processes for escalation/challenge

28
Q

Key Messages

A

Nothing is more important than children’s welfare.
Safeguarding is everyone’s business.
If you’re concerned that a patient is at risk of harm, seek advice, always.

29
Q

What to do if you have concerns?

A
  • If a child discloses abuse or you are concerned
    for their welfare:
    – Don’t ask leading questions.
    – Document verbatim what was said.
    – Don’t promise confidentiality.
    – Talk immediately to one of the professionals you are working with – they will escalate appropriately.
30
Q

Why review child deaths?

A
  • To establish, where possible, a cause or causes of child deaths (with the coroner)
  • To identify any potential contributory & modifiable factors
  • To provide ongoing support to the family
  • To learn lessons in order to reduce the risk of
    future child deaths
31
Q

Who is involved in the Child Death Review process?

A
  • Health (ICB) & Local Authority funded
  • CDR Team: Designated Dr, Nurses, Manager, Admin
  • Immediate response:
    – Health, Social Care, Police
  • Review process: all agencies involved in the care of the
    child in life or investigating the death
    – Hospital specialities, Community specialities, Allied Health Professionals, GP, Midwife/Health Visitor/School Nurse, Hospice, School/Nursery, Early Help, Social Care, Public Health, Police, Educational Psychology, Ambulance Service, voluntary organisations,
32
Q

List some statistics of child abuse in Leicester

A

*Leicester, Leicestershire & Rutland: Average 70 cases per year
– 2/3‘Expected’,1/3 ‘Unexpected’.
– 62% in first year of life
* Top 3 categories of death:
– Perinatal/neonatalevents (28.2%)
– Chromosomal/genetic abnormalities (22.5%)
– Suddenunexpected unexplained death (10%)
* ‘Modifiable factors’ identified in 37%
* Thematic workstreams
‘More than 1 in 5 deaths might be avoided if children living in the most deprived areas had the same mortality risk as those in the least deprived’.
Child Mortality & Social Deprivation,

ICA (10 decks)

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