1.1 Child Safeguarding and Child Death Reviews Flashcards
What is child abuse?
- Maltreatment of a child (<18years old)
- Infliction of harm
- Failing to act to prevent harm
What is significant harm?
Ill-treatment or impairment of health or devlopment
Legal justification for intervention in family life
What are the 4 categories of child abuse?
Neglect
Physical
-Including FII (fabricated induced illness)
-Including FGM
Sexual
Emotional
What is neglect?
Persistent failure to meet a child’s basic physical and/ or psychological needs
Likely to result in serious impairment of child’s health or development
When can neglect begin?
May occur during pregnancy due to substance abuse
What are some examples of neglect?
Failure to:
* Provide adequate food, clothing, shelter (including exclusion from home or abandoment)
* Protect a child from physical and emotional harm or danger
* Ensure adequate supervision (including inadequate care-givers)
* Ensure access to appropriate medical care or treatment
* Unresponsiveness to a child or young person’s basic emotional needs
What should you put on a child’s patient record if they do not attend
WAS NOT BROUGHT
Did not attend suggests its the child’s fault
Recurrent was not brought can be an indication of neglect
What would be on a history of neglect?
- 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 suggesting inappropriate supervision
What would you find on examination of a child with neglect?
- Poor nutritional status/poor growth
- Dental decay
- Signs of recurrent/chronic infection or infestation
- Dirty/unkempt/smelly
What can physical abuse involve?
- Hitting
- Shaking
- Throwing
- Poisoning
- Burning or scalding
- Drowning
- Suffocating
- Fabrication of symptoms in child or deliberately induces illness/symptoms in child
What history would be indicative of physical abuse?
- 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
What examination findings would suggest physical abuse?
- 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
May involve physical contact (including assault by penetration or non-penetrative acts)
May be non-contact activities, children looking at or producing sexual images, watching sexual activities or encouraging children to behave in sexually inappropriate ways, grooming
What is child sexual exploitation?
Individual or group takes advantage to coerce, manipulate or decieve child into sexual activity
In exchance for something the victim needs/wants
For financial advantage of perpetrator
May appear consensual, does not always involve physical contact, can occur through use of technology
What signs on a history would indicate sexual abuse/CSE?
- Disclosure
- Pregnancy
- Signs of sexual activity under 13
- STIs
- Anogenital injury/unexplained bleeding
- Recurrent vaginal discharge
- Soiling/ wetting
- Behavioural change
What signs on examination would indicate sexual abuse/CSE?
Immediate health needs are paramount e.g. if bleeding or have STI deal with this first
Referral to social care- forensic assessment undertaken at specialist sexual assault referral centre by staff with skills & expertise
What is emotional abuse?
Persistent emotional maltreatment of a child causing severe and persistent adverse effects on childs emotional development
What can emotional abuse involve?
- Conveying worthlessness/ unloved/ inadequate
- Deliberately silencing or making fun of childs voice
- Imposing age/ developmentally inappropriate expectations on children, overprotection or limiting of exploration or learning, preventing participation in normal social interaction
What may be indicative of emotional abuse on a history?
Infants
-Feeding difficulties, crying, poor sleep patterns, delayed development
Toddler
Behavioural spectrum from overactive to apathetic, noisy to quiet, developmental delay
School-aged
Wetting & soiling, relationship difficulties, poor school performance, non-attendance, antisocial behaviour
Adolescents
Depression, self-harm, substance misuse, eating disorders, oppositional, agressive, delinquent behaviours
What may indicate emotional abuse on clinical examination?
Non specific:
* Growth (underweight)
* Emotional signs
* Behavioural
* Development
What is the wider context of child safeguarding?
To prevent:
* Online abuse & grooming
* Child Criminal exploitation/County lines
* Trafficking
* Radicalisation
* Modern slavery
* FGM
* Forced marriage
* Honour based violence
* Discriminatory abuse
What is the triad of vulnerability?
Domestic abuse
Mental illness of parent or carer
Parental drug and /alcohol misuse
What are some risk factors of child abuse?
- Triad of vulnerability
- Under 2
- Pre-verbal babies and children
- Additional needs/disability
- Vulnerable/ marginalised young people
What is an adverse childhood experience?
Experience which severely impacts a child emotionally or physically
– Physical abuse & neglect
– Sexual abuse
– Emotional abuse & neglect
– Domestic violence
– Mental ill-health
– Incarceration
– Substance misuse
– Parental separation
Picture showing consequences of adverse childhood exposures
What are some key learning points from child safeguarding practise reviews?
- Interagency communication & information-sharing
- See the bigger picture & have a family focus, risk of appearing normal
- Listen to and see the child, disguised compliance, voice of child, overreliance on parental accounts
- Following up missed appointments and linking incidents
- Recognising abuse
- Processes for escalation/challenge
What is a key message of child safeguarding?
If you’re concerned a patient is at risk, seek advice, always
Nothing is more important thatn child welfare, everyone’s business
What do you do if you have concerns?
If a child tells you about abuse or you’re concerned:
-Don’t ask leading questions
-Document word for word what is said
-Don’t promise confidentiality
-Escalate immediately
Why do we review child deaths?
All children from 17 years 365 days and under are reviewed
To establish cause of death
Identify potential contributory or modifiable factors
Provide ongoing support to family
Learn lessons to reduce risk
Who is involved in a child death review process?
- Local authority
- CDR team :desiganted Dr, nurses,manager, admin
- Immediate response : police and social care
- All agencies involved in care of child in life
How many child death cases are there per year in Leicester, Leicestershire and Rutland?
70 cases, 2/3 expected 1/3 unexpected
62% first year of life
What are the top 3 categories of death?
Perinatal/neonatal events
Chromosomal/genetic abnormalities
Sudden unexpected unexplained death
1/5 deaths might be avoided if deprived areas had same mortality risk
