17- Safeguarding Flashcards
Types of abuse
- Physical abuse
- Sexual abuse
- Emotional abuse
- Bullying
- Cyberbullying
- Neglect
- Fabricated and induced illness (FII)
Risk factors for abuse
- Drug and alcohol
- DV
- Parental mental health
- Child disability
- Carers learning
- Disability
- Single parents
Sources of stress for abusive parents
- Social exclusion
- Homelessness
- Poor housing
- Racism
- DV
- Mental illness
- Drug alcohol
- Intellectual disability of patients
Suspicious history
- Lack of explanation
- Inconsistent explanation
- Does not fit with developmental age of child
- Time delay without appropriate explanation
- Inappropriate child/ carer response
- Age of child
- Previous history of unusual injury
- Known to children’s social care
- Repeated attendance due to neglect or abuse
- Repeated DNAs
- Social history
when taking a history and examining a child always consider
- Are the injuries consistent with explanation
- Pattern of injuries
- Childs age and developmental level
- When and how was advice sought
- Childs behaviour
- Parent/ child interaction
- Medical and social history
- Differential diagnosis
- Delay in seeking help
what are child protection plans
- Plans created after
- Child protection case conference
- Categories
o Physical abuse
o Emotional abuse
o Neglect - May be downgraded to a child in need
Consequences of child abuse
- Attachment disorder
- Sexual dysfunction
- Emotional disorders
- Self harm
- Alcohol and drug misuse
- Antisocial personality
- Aggressive behaviour
- long term health problems
If you have concerns
- Document everything clearly in the patients notes. Clearly attribute who said what/when plus actions taken – including any discussions at handover
- Sign, date and time all entries
- Seek advice from senior colleague/consultant on how to proceed
- If you are unhappy with the advice given consult further – go up a level of seniority or contact the named doctor/nurse for safe guarding.
- Communicate with nursing staff
- Keep the child safe
- DON’T DO NOTHING
Responding to disclosure
- Try not to look shocked
- Let the child know you believe them
- Tell them they are not in trouble
- Listen to what they have to say, don’t make an excuse to leave
- Don’t ask leading questions – this may affect the case if it goes to court
- Don’t make promises you cant keep
- Be honest at all times
- Inform your senior
what goes wrong with child safeguarding
recognition
communication
procedures
note keeping
Recognition
Child abuse may go unrecognised if the professional is not looking for it, they lack the clinical skills and experience or it is an unusual presentation.
Communication
Often a number of different professional teams are involved with families where children are at risk. Failure to communicate between the teams is a common reason for why child protection cases are missed or poorly managed. All referrals to a different team regarding child protection concerns must be followed up in writing.
Different teams use different jargon which can further complicate communication. Reports should not contain jargon and test results should be explained.
Procedures
All health professionals working with children should be aware of and adhere to local child protection procedures to ensure children are efficiently and effectively managed.
Note keeping
It is essential all notes are documented correctly – date, time, patient details, clinicians details and clinicians signature should be present on all pages.
what is physical abuse
- Causing physical harm to a child
RF physical abuse
- <2 yo at highest risk
types of physical abuse
- Hitting
- Shaking
- Burning
- Drowning
- Suffocating
- Throwing
suspicious factors for non-accidental injury are
- Mechanism of injury was not compatible with the injury sustained
- The child’s developmental stage was inconsistent with the injury presented
o E.g. an immobilised baby cant get a bruise - The child sustained a significant injury with little or no explanation
- Inconsistent histories were given
- There was a delay in presenting the child to health care providers
- Recurrent injuries
- The parents reaction was not appropriate to the situation – too concerned, aggressive, elusive, vague.
- Finger tip bruising
- Bruising on shins in immobilise
- Bruising on back of legs
o Children tend to injury legs running into things - Bruises on ears
- Beware of congenital naevi (Mongolian)
types of injuyr: Non-abusive vs abusive bruising
Very uncommon in an immobile child. Photograph bruise since heal quickly.
Non abusive bruising
- Knees and shins (45% of walkers)
- Bony prominences e.g. forehead
Abusive bruising
- Head commonest site, face and buttock
- Soft tissue areas
- Occurs in clusters- can show imprint of implement
- Larger
types of injury: fractures
If trauma didn’t occur 97% of rib fractures are physical abuse
* Common site: rib, vertebrae and metaphyseal
* Type sof fractures which don’t correspond to mechanisms of injury
* Spiral fractures
* Healing fractures in conjugation with new ones
types of injury: head injury
Non accidental head injury e.g. shaken baby syndrome
* Commonest cause of death in physical abuse
* 1/3 die, 1/3 have permanent disability
* Can show little evidence of external injury- Subdural haemorrhage
presentation of head injury in infants
o Poor feeding
o Lethargy
o Convulsions
o Signs of raised intracranial pressure
o Retinal haemorrhages/ subconjunctival haemorrhage
o Resp difficulties
o May be no external signs of abuse
investigations for physical abuse
Bloods
- coagulation screen e.g. bleeding disorder
- FBC e.g. malignancy
- bone biochemistry e.g. fractures
Imaging
- full skeletal survery
- CT scan
Expert opthalmological examination e.g. shaken baby
types of injury: burns and scalds
- Burns involving the creases, are symmetrical, involve glove and stocking area or buttock are bhighly suspicious of NAI
- Cigarette shaped
types of injury: bites
- Can be nursery bites e.g. from another child
Non-accidental
Face
Size of bite marks
types of injury: mouth
- Ripped frenulum
o Non-accidental
Punch
Drink being forced in mouth - Chronic scaring of inner lip- non-accidental
types of injury: fabrication induced injury (FII)/ perplexing presentation
- Old protocol was not to make parents aware that FII was being investigated as might place child in greater danger
- New protocol to involve parents explaining that the child appears to have medically unexplained symptoms which require further investigations
- Section 47 case review
neglect background
“the persistent failure to meet the childs basic physical or psychological needs that is likely to result in the serious impairment of the childs health or development”
- Commonest form of abuse
- Can be life-threatening
- Can be associated with poverty, but also happens in affluent families
- Long term affects emotionally, physically and socially
presentation of neglect
- Medical: unimmunised, failure to attend appointments, failure to seek appropriate medical advice
- Nutrition: faltering growth due to insufficient diet, obesity
- Emotional
- Educational: poor school attendance
- Physical- inadequate hygiene, severe or persistent infections, inappropriate clothing for weather or size
- Failure to supervise
o Frequent a and e attendees
o Injury to sun burns, scalds and burns, falls
o Ingestion of harmful substances
emotional abuse background
“Persistent, non-physical, harmful interactions with the child by the care-giver”.
- Hard to diagnose
presentation of emotional abuse
sexual abuse background
“physical contact, including penetrative and non-penetrative acts, exposure to sexually explicit material and child sexual exploitation”
sexual abuse presentation
Presentation
Children having been sexually abused present in the following ways:
- Allegation – a child may disclose abuse to anyone at any time
- Pregnancy
- STI
- Ano-genital injury
- Unexplained vaginal bleeding
- Unexplained rectal bleeding
- Recurrent vaginal discharge
- Soiling, bowel problems, enuresis
- Behavioural difficulties
- Any child in close proximity with an adult identified as a risk to children
- When the perpetrator is a child
