1) Child Safeguarding Flashcards
What is child abuse?
- Maltreatment of a child (<18yrs)
- Infliction of harm OR
- Failing to act to prevent harm
- ‘Significant harm’
What is classified as ‘Significant harm’?
- Ill-treatment or impairment of health or
development - Legal justification for LA intervention in family life
What are the 4 categories of child Abuse?
- Neglect
- Physical
– Including FII (Fabricated or induced illness) /perplexing presentations
– Including FGM - Sexual
- Emotional
What is neglect?
- 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.
What is neglect?
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.
Neglect: History taking
- 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
Neglect: Examination
- Poor nutritional status/poor growth
- Dental decay
- Signs of recurrent/chronic infection or infestation
- Dirty/unkempt/smelly
What is physical abuse?
- 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
Physical abuse: History
- 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
Physical abuse: Examination
- Unexplained bruising in vulnerable child
- Unexplained fractures/burns/scalds/head injury
- Patterns: Implement/sparing/bites
- Injury not consistent with history/developmental age
What is sexual abuse?
- 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.
What does CSE stand for?
Child sexual exploitation
What is Child sexual exploitation (CSE)?
- 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.
Sexual abuse: History
- Disclosure
- Pregnancy/signs of sexual activity in child under 13yrs
- STIs
- Anogenital injury/unexplained bleeding
- Recurrent vaginal discharge
- Soiling/wetting - differential diagnosis
- Behavioural change
Sexual abuse: Examination
- Immediate health needs are paramount
- Referral to Social Care - Forensic assessment undertaken at specialist Sexual Assault Referral Centre by staff with appropriate skills & expertise
What is emotional abuse?
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.
Examples of emotional abuse
– Rejecting
– Isolating
– Terrorising
– Ignoring
– Corrupting
– Cyberbullying
Emotional abuse: History
- 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,
Emotional abuse: Examination
Growth (underweight)
Emotional signs (non-specific)
Behavioural (wide range)
Development (failure to achieve milestones, academic failure)
Identify some other forms of abuse
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
What are the risk factors for child abuse?
- ‘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
What does ACEs stand for?
Adverse Childhood Experiences
What are ACEs?
– Physical abuse & neglect
– Sexual abuse
– Emotional abuse & neglect
– Domestic violence
– Mental ill-health
– Incarceration
– Substance misuse
– Parental separation
What to do when you are concerned about a child?
- Concerns about a child
- Referral to Local Authority (Social Care / MASH)
- Reasonable cause to suspect that a child who lives or is found in their area is suffering, or is likely to suffer, significant harm
- Duty to make enquiries under Section 47(1) of the Children Act 1989
Describe the ACE model
- Adverse childhood experiences
- disrupted neurodevelopment and allostatic load
- Social, emotional and cognitive impairment
- Adoptions of high risk behaviours and crime
- disease, disability, social problems and low productivity
- early death
Interventions and support for child abuse
- Universal services
- Early Help
- Child in Need – consent required. Section 17 Children Act 1989
- Child Protection – consent not required. Section 47 Children Act 1989
What to do when we recognise abuse?
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
Key Messages
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.
What to do if you have concerns?
- 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.
Why review child deaths?
- 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
Who is involved in the Child Death Review process?
- 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,
List some statistics of child abuse in Leicester
*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,
