Abuse and NAI Flashcards
What Act (UK) states that the Childs welfare is always paramount?
The Childrens Act
In the UK parents only have a right to do what is right for their child
In A&E this is 1% of their work
What is this the definition of:
deliberate infliction of harm to a child or failure to prevent harm
may be physical, sexual, emotional, bullying and online abuse or neglect
Child abuse
What is the following a definition of:
persistent failure to meet a child’s basic physical or psychological needs that is likely to result in serious impairment of the child’s health and development
it is the definition of neglect
What is it called when a parent fabricates alarming symptoms in their child to gain attention via unnecessary interventions?
Munchausen’s by proxy
What fractures are associated with child abuse?
radial
humeral
femoral
What is the presentation of NAI?
ask: do the injuries fit with the story?
& do they fit with the developmental age?
e.g. bruises on forehead are normal when learning to walk but not normal when 3m
a broken arm maybe normal when a baby can roll over (6m) but not when 3m old
What are the red flags for NAI?
DELAYED px of injury
INCONSISENT hx with injuries sustained or with childs development or unexplained injuries
MULTIPLE ED attendances
How may a caregiver act “abnormally” to suggest NAI?
aggressive
vague
how may a childs interaction with adult be abnormal to suggest NAI?
“frozen watchfulness”
What things should be looked for in examining an NAI?
site of injury
patter of injury
particular clinical features such as coincidental previously undiagnosed #’s
What are intracranial bleeds, vitreous / retinal bleeds signs of in babies w/NAI?
Shaken baby
Where on the body is it uncommon to get bruise sites in real accidents?
face
back
perineum
buttocks
What injuries may an infant who has been squeezed get?
metaphyseal (growth plate)
or posterior rib fractures
what would fingertip damage on the skin look like?
sharply defined bruising
What are warnings of patter of injury?
large injuries in child not yet walking
multiple bruises of different ages
multiple burns e.g. cigarette tip
signs of suffocation
What eye problems may shaking or choking give?
conjunctival haemorrhage
What are the risk factors for NAI?
Child factors: birthweight <2.5kg (low), young age, disability and demanding personality
Carer factors: mother < 30 yrs, unwanted pregnancy, stress, alcohol, drugs and postnatal depresion
social factors: poverty/social deprivation and unemployment
What investigations should be done for suspicion of NAI?
inspection
whole body XR = skeletal survey OR radionuclide scans
CT/MRI if suspected head injury
opthalmology review (retinal haemorrhages)
What other causes should be excluded in ?NAI cases?
predisposition to fractures: copper deficiency and osteogenesis imperfecta
osteoporosis
SO do: Vitamin D, skeletal survey
clotting disorders if spontaneous bruising
SO do:
Clotting profile, platelets
How do you manage child abuse/NAI?
Escalate to: seniors, local authority childrens services, the NSPCC, police
What place of safety orders are there?
police protection order 24h
emergency protection order 48h
social services – assessment order
care order (under care of the local authority)
What is physical child abuse?
non accidental injuries
What is emotional child abuse?
childs behaviour and emotional development are severely affected by parents neglect, rejection or mental cruelty –> feelings of worthlessness, anxiety and scared of abandonment
What is neglect?
lack of physical care giving and failure to provide for the childs cognitive and physical developmental needs –> failure to thrive, developmental delay, poor hygiene, poor emotional attachment with caregiver (bad attendance at school and doctors appointments)
What is sexual child abuse?
a child or adolescent being made to interact in sexual activities they do not fully understand or consent to e.g. exposure of genitalia, fondling, genital, anal or oral sexual activity and pornography
How may sexual abuse present?
Physical: accusations from the child unexplained pregnancy trauma e.g. anal bleeding infection Behaviour: abnormal sexual behaviour change in behaviour Psychological: psychological upset crisis e.g. OD
Who does the examination for a child with suspected sexual abuse?
2 skilled paediatricians in the presence of a trusted adult
if it is an adolescent (~13y/o) then need their permission
What does the examination for suspected sexual child abuse involve?
normally only detailed external genital exam rather than internal
if attach <72 hrs before = forensic swab
physical findings are only found in <30% of cases (bruising and tears of genitalia/anus)
who does the responsibility for a childs protection lie with?
all members of staff
what should happen if sexual abuse is suspected?
follow the procedures of the local safeguarding childrens committee
may be able to gain further information by a joint interview of a member of the police and social worker
psychological support is likely to be required
how should cases of child abuse be managed in the immediate term?
Be sensitive - stress that everyone is working together in the best interests of the child
the dr should disclose suspected harm to a person of statutory agency e.g. police/social services/NSPCC –> the child will be referred to social services who will organise a case conference
if there is immediate danger then can get an emergency protection order (48h)
and/or housed in a temporary foster home
Who attends a case conference?
organised by social services upon referral and is attended by a # of professionals including social workers, health visitors, police, GP, teachers, drs and lawyers - also the parents if they wish to attend
What happens at a case conference?
the case of abuse is discussed in detail and they decide whether to place the childs name on the child protection register, make an application to the court to protect the child and follow up if needed
What happens if a child is on the child protection register?
the child is given
(1) a child protection plan and
(2) a key social worker
What is a child protection plan?
A plan that aims to involve professionals and parents to prevent further abuse e.g. attendance at a family centre
What is a key social worker?
they monitor the wellbeing of the child and ensure the child protection plan is being effective
when is a child removed form the child protection register?
when it is agreed at a case conference
