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Y4 Paediatrics > 7 - Safeguarding > Flashcards

7 - Safeguarding Flashcards

1
Q

What are the four types of child abuse?

A
  • Physical
  • Emotional
  • Sexual
  • Neglect
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2
Q

What is the legal framework for child safeguarding?

A

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.

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3
Q

What are some risk factors for child abuse?

A
  • 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
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4
Q

What is the commonest form of child abuse?

A

Neglect

Number one reason for child protection plan

Definition is important

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5
Q

Which children are at high risk of physical abuse?

A

Under 2’s

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6
Q

What are some parts of a history that suggest a child has a non-accidental injury (NAI)?

A
  • 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
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7
Q

What might you find on examination of a child that suggests a NAI?

A
  • Injuries of varying ages
  • Presence of burns or scalds
  • Bruises on arms, legs or face consistent with gripping
  • Subconjunctival haemorrhage
  • Human bite marks
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8
Q

What investigations should you do if you suspect a NAI?

A

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

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9
Q

What are some causes of bruising and fractures in children not due to NAI?

A

Do clotting, FBC and blood film, Von Willebrand Factor

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10
Q

What rib fracture is more common in NAI?

A

Posterior due to squeezing

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11
Q

How may neglect present?

A
  • Medical
  • Nutritional
  • Emotional
  • Physical
  • Educational
  • FAILURE TO SUPERVISE (multiple A and E visits)
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12
Q

How may emotional abuse present?

A
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13
Q

What is the definition of sexual abuse and how may it present?

A
  • 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
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14
Q

What are some of the consequences of child abuse in general?

A

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
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15
Q

If you have a concern there may be child maltreatment, what is your responsibility?

A
  • 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
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16
Q

If a child discloses to you that they are being abused, how should you respond?

A
  • 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
17
Q

What are some measures that can be put into place for families with safeguarding concerns?

A
18
Q

What investigations are done for suspected NAI in under 2’s?

A
19
Q

What are some examples of adverse childhood experiences?

A

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
20
Q

What are some causes of sudden unexplained infant death?

A
21
Q

What needs to be done in A and E after a sudden unexplained infant death?

A
  • 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
22
Q

What are some risk factors for SIDS?

A
  • Premature baby
  • Previous baby with SIDS
  • Co-sleeping
  • Parental smoking
23
Q

What measures can be taken to reduce the risk of SIDS?

A
  • 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
24
Q

What medical conditions does Birun currently have?

A

Situs invertus
Tourette’s

25
Q

What are risk factors of child abuse?

A
26
Q

What fractures are highly specific to NAI?

A
27
Q

Which fractures have low specificity for NAI?

A
28
Q

What is a section 17 and section 47?

A

Section 17: family in need of support

Section 47: child protection

29
Q

What is the triangle to assess a child’s welfare?

A
  • Child needs
  • Parents
  • Environment
30
Q

If there is a neonatal stroke what do you need to investigate?

A

If mother is using IV cocaine

31
Q

If you suspect NAI in a child under 2 what investigations do you have to do?

A
  • CT Head
  • Fundoscopy
  • Skeletal survery

DO ALL 3 NOT JUST 1

32
Q

If you suspect a child is being neglected due to failure to thrive what do you need to investigate?

A

Need to rule out other causes

  • Coeliac’s
  • Hypothyroid
  • Metabolic issues
33
Q

What is the triad of shaken baby syndrome?

A
  • Retinal Haemorraghes
  • Subdural haematoma
  • Encephalopathy

Y4 Paediatrics (32 decks)

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