7 - Safeguarding Flashcards
What are the four types of child abuse?
- Physical
- Emotional
- Sexual
- Neglect
What is the legal framework for child safeguarding?
Children Act 1989 and 2004
A child is need refers to a child that is likely to need supportive services to maintain their health and development, or is disabled.
What are some risk factors for child abuse?
- Domestic violence
- Unwanted pregnancy
- Low birth weight
- Previously abused parent
- Mental health problems
- Emotional volatility in the household
- Social, psychological or economic stress
- Disability in the child
- Learning disability in the parents
- Alcohol misuse
- Substance misuse
- Non-engagement with services
- Criminal record of parents
What is the commonest form of child abuse?
Neglect
Number one reason for child protection plan
Definition is important
Which children are at high risk of physical abuse?
Under 2’s
What are some parts of a history that suggest a child has a non-accidental injury (NAI)?
- Mechanism of injury not compatible with injury sustained
- Child’s developmental stage inconsistent with injury presented
- Little or no explanation
- Inconsistent histories given
- Delay in presenting to healthcare
- Recurrent injuries
- The parents reaction was not appropriate to the situation
What might you find on examination of a child that suggests a NAI?
- Injuries of varying ages
- Presence of burns or scalds
- Bruises on arms, legs or face consistent with gripping
- Subconjunctival haemorrhage
- Human bite marks
What investigations should you do if you suspect a NAI?
Skeletal Surgery through radiology to look for:
- Rib fractures
- Skull fractures
- Metaphyseal corner fractures (occur due to a twisting/pulling motion)
- Finger fractures
- Clavicle fractures
If under 2 do CT head and senior ophthalmological review too for retinal haemorrhages
Consider clotting screen if extensive bruising
What are some causes of bruising and fractures in children not due to NAI?
Do clotting, FBC and blood film, Von Willebrand Factor
What rib fracture is more common in NAI?
Posterior due to squeezing
How may neglect present?
- Medical
- Nutritional
- Emotional
- Physical
- Educational
- FAILURE TO SUPERVISE (multiple A and E visits)
How may emotional abuse present?
What is the definition of sexual abuse and how may it present?
- 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
- Unusually sexualised behaviours
What are some of the consequences of child abuse in general?
The severity of these consequences is influenced by:
- The type and form of abuse
- The childs developmental stage at the time of the abuse
- Duration and frequency of abuse
- Relationship to the perpetrator (bigger effect in a relationship of trust)
- The support the child receives following disclosure
If you have a concern there may be child maltreatment, what is your responsibility?
- Document everything clearly in the patients notes including any discussions at handover
- Take photos of injuries
- Inform your senior then
- Refer to safeguarding lead who will refer to social services
- Communicate with nursing staff
- Keep the child safe
If a child discloses to you that they are being abused, how should you respond?
- 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 are some measures that can be put into place for families with safeguarding concerns?
What investigations are done for suspected NAI in under 2’s?
What are some examples of adverse childhood experiences?
4 or more ACEs then increased risk of CVD, Type 2 DM, crime
- Parent’s splitting up
- Parent with a mental health disorder
- Someone in the house in prison
- Bullying
- Losing a parent
- Poverty
- Homeless
What are some causes of sudden unexplained infant death?
What needs to be done in A and E after a sudden unexplained infant death?
- Document all interventions, venepuncture sites, and marks on the baby.
- Keep all clothing and the nappy
- Explain clearly to parents that despite your best efforts, the baby has died
- Explain the baby must have a post-mortem (this is a coroner’s case)
- Contact the consultant on call, the police, child protection team, and the coroner at once
What are some risk factors for SIDS?
- Premature baby
- Previous baby with SIDS
- Co-sleeping
- Parental smoking
What measures can be taken to reduce the risk of SIDS?
- Do not co-sleep
- Do not overheat baby’s bedroom
- Use a grow-bag so baby cannot slip under blanket
- Avoid heaters, hats, hot water bottles when sleeping
- Place baby on back
Go and do deck 4 of GP!!!!
What are risk factors of child abuse?
What fractures are highly specific to NAI?
Which fractures have low specificity for NAI?
What is a section 17 and section 47?
Section 17: family in need of support
Section 47: child protection
What is the triangle to assess a child’s welfare?
- Child needs
- Parents
- Environment
If there is a neonatal stroke what do you need to investigate?
If mother is using IV cocaine
If you suspect NAI in a child under 2 what investigations do you have to do?
- CT Head
- Fundoscopy
- Skeletal survery
DO ALL 3 NOT JUST 1
If you suspect a child is being neglected due to failure to thrive what do you need to investigate?
Need to rule out other causes
- Coeliac’s
- Hypothyroid
- Metabolic issues
What is the triad of shaken baby syndrome?
- Retinal Haemorraghes
- Subdural haematoma
- Encephalopathy
