Accidents, poisoning and child protection Flashcards
What environmental factors increase the risk of accidents, poison and abuse?
Poverty
Poor quality, overcrowded homes
Lack of safe environment for play
Poor parenting skills (psychiatric illness, drugs, alcohol, violence, lack of social support)
Are burns more serious in children?
Children are scalded at a lower temperature than adults, as their skin is thinner
How would you assess a burn?
ABCDE Any smoke inhalation? Depth of the burn Surface area of the burn Involvement of special sites
How do you calculate the surface area of a burn?
Should use a surface area chart.
The palm and adducted fingers cover about 1% of the body surface.
Which special sites should be assessed after a burn?
Burns to the face.
Those to the mouth may compromise the airway from oedema
Hands/joints may cause functional loss from scarring
How would you manage a burn?
Relieve pain (analgesics)
Treat shock with IV fluids
Provide wound care (covered in plastic wrapping to reduce pain from contact with cold are and reduce the risk of infection)
What is the prognosis of near drowning?
Up to 30% of fatalities can be prevented by skilled on-site resuscitation. Even unconscious, fixed-dilated pupil children can survive. Children who have inhaled water should be admitted into hospital.
Why should children who have swallowed water in a near drowning event be admitted to hospital?
To be observed for signs of respiratory distress from pulmonary oedema after 1-72 hours from secondary surfactant.
How would you manage wound management in a dog bite?
Copious wound irrigation, toilet and debridement
Removal of foreign bodies
delayed wound closure, especially on limbs, due to increased incidence of infection
Raise and immobilise limb
Regular wound review
Tetanus booster
Prophylactic antibiotics (Co-amoxiclav)
What are the sub-groups poisoning can be caused by?
Accidental (majority)
Deliberate self-harm
NAI
Iatrogenic
What age is accidental poisoning most common?
Young children, peak age of 30 months. Inquisitive toddlers are unaware of the danger of taking medicines, household products and eating plants.
What are some potentially harmful poisons in children?
Alcohol, acids and alkalis, bleach, digoxin, batteries, iron, paracetamol, petrol, salicylates and tricyclic antidepressants
What are the different types of child abuse?
Physical abuse, emotional abuse, sexual abuse, neglect and fabricated illness
What does physical abuse consist of?
Hitting, shaking, throwing, poisoning, burning or scalding, drowning, suffocating, or otherwise causing physical harm to a child
What does emotional abuse consist of?
Persistent emotional maltreatment of a child resulting in severe and persistent adverse effects on the child’s emotional development.
How does emotional abuse make the child feel?
That they are worthless or unloved, inadequate, or valued only insofar as they meet the needs of the other person.
What does sexual abuse consist of?
Forcing or enticing a child or young person to take part in sexual activities, including prostitution, whether or not the child is aware of what is happening.
What does neglect consist of?
Persistent failure to meet a child’s basic physical and/or psychological needs, likely to result in the serious impairment of the child’s health or development.
What might the parent or carer fail to provide in neglect?
Adequate food and clothing
Shelter, including exclusion from home
Protection from physical and emotional harm or danger
Adequate supervision, including the use of inadequate caregivers
Access to appropriate medical care or treatment
What is fabricated illness?
A broad term used to describe a group of behaviours by parents or carers but usually the mother (80%) which cause harm to children
What are the types of fabricated illness?
Verbal fabrication
Induction of illness
What is verbal fabrication?
Parents fabricate symptoms and signs in the child, leading to the doctors treating and causing harm to the child when they’re not ill
What is the induction of illness?
It is when the parent or carer makes the child ill
(suffocation, administration of noxious substances, excess administration of ordinary substances [salt], excess use of medication)
What are the risk factors for child abuse
Child: failure to meet parental expectations, resulted from forced, coercive or commercial sex
Parent/carer: mental health problems, parental indifference, alcohol/drugs
In the family: step-parents, domestic violence, multiple/closely spaced births, social isolation, young parental age
Environment: poverty, poor housing, unsavoury neighbourhood
In what situations should the possibility of neglect be considered?
Consistently misses important appointments
Lacks needed medical or dental care, immunisation or glasses
Seem ravenously hungry
Is dirty
Is wearing inadequate clothing in cold weather
Is abusing alcohol or other drugs
Says there is nobody at home
In babies, what behaviour may point towards emotional abuse?
Apathetic, delayed development, non-demanding
Described by the mother as ‘spoiled, attention seeking, in control, not loving her’
In toddlers and preschool children, what behaviour may point towards emotional abuse?
Violent, apathetic, fearful
In school children, what behaviour may point towards emotional abuse?
Wetting, soiling, relationship difficulties, non-attendance, anti-social behaviour
In adolescents, what behaviour may point towards emotional abuse?
Self-harm, depression, oppositional, aggressive and delinquent behaviour
What sort of fractures are more likely to be inflicted?
Any facture in a non-mobile child Rib fractures Multiple fractures Multiple fractures at different ages Sometimes: skull fracture in young child, long bone fractures in a young but mobile child
What sort of bruises are more likely to be inflicted?
In the shape of a hand or object
On the neck that look like strangulation
Around the wrists or ankles that look like ligature marks
Bruise to the buttocks in a child less than 2 years or any age without a good explanation
Sometimes: bruising to the trunk with a vague history
What sort of burns are more likely to be inflicted?
Any burn in a child who is not mobile
A burn in the shape of an implement (cigarette, iron)
A ‘glove or stocking’ burn consistent with forced immersion
What sort of bites are more likely to be inflicted?
Bruising in the shape of a bite thought unlikely to be caused by a young child
What are the physical symptoms of sexual abuse?
Vaginal bleeding, itching, discharge
Rectal bleeding
What are the behavioural symptoms of sexual abuse?
Soiling, secondary enuresis
Self-harm, aggressive or sexualised behaviours, regression, poor school performance
What are the medical conditions that should be excluded in an overly bruised child?
Coagulation disorders
Mongolian blue spots on the back or thighs
What are the medical conditions that should be excluded in a child that suffers from repeat fractures?
Osteogenesis imperfecta, type 1 is autosomal dominant so there may be a family history
What are the medical conditions that should be excluded when a scald or cigarette burn is suspects?
It may be misinterpreted bullous impetigo or scalded skin syndrome
