Child Abuse

Question 1

Physical - define

Answer 1

Child is severely and/or persistently injured through use of excessive physical force or administration of drugs/alcohol - e.g. hitting, beating, shaking, strangulation.
(aka Inflicted or non-accidental injury).

Question 2

Sexual - define

Answer 2

Child is exposed and/or subjected to sexual behaviours that are exploitative and/or inappropriate for their age and developmental level which they are unable to comprehend or consent to - e.g. sexual touching, exposure to pornographic content.

Question 3

Emotional - define

Answer 3

Child is repeatedly treated or spoken to in ways that damage their ability to feel and express emotions, including exposure to FDV - e.g. threatening, bullying, isolation.

Question 4

Neglect - define

Answer 4

Child suffers injury or developmental harm as a result of the caregiver’s failure to meet basic needs, including developmental, educational, environmental, medical, emotional and supervisory - e.g. malnourishing, failing to enrol in school, leaving unsupervised at home.

Question 5

Risk factors

Answer 5

1. Pre-term infants
2. Disabilities or chronic illness
3. FDV
4. Alcohol or substance abuse
5. Mental illness
6. Low-SES, homelessness or unemployment

Question 6

Physical/Sexual - signs

Answer 6

1. Physical - ANY injury to pre-mobile infant, injuries to protected surfaces, multiple injuries, injuries covering large areas, patterned injuries, injuries to genitalia, STIs or pregnancy.
   *Note - physical signs not present for MOST cases of child sex abuse.
2. Behavioural - fearful of caregiver, high pain tolerance, overly compliant, guarding, inappropriate sexual knowledge, lack of boundaries, problematic sexual behaviours.
3. Background - unexplained injury or inconsistent explanation, mechanism incompatible with child’s development, unreasonable delay seeking treatment, Hx unwitnessed trauma or FDV, contact with known CSO.

Question 7

Neglect/Emotional - signs

Answer 7

1. Physical - poor general health, recurrent infections or un-immunised, malnutrition or vitamin deficiencies, poor growth, oral/dental problems, excessive or inadequate healthcare visits, poor hygiene/cleanliness.
2. Developmental - delayed developmental milestones, poor academic attendance/achievement, lack of peer engagement.
3. Emotional - lack of secure attachment, feelings of being unsafe/unloved/unworthy, emotional dysregulation, mental health issues, poor body image.
4. Background - unstable residence or homelessness, exposure to environmental hazards, parental absence, exposure to drugs/alcohol, FDV.

Question 8

Disclosure (child) - response

Answer 8

1. Respond calmly
2. Use age-appropriate language
3. Ask them to use their own words and take time to explain what happened
4. Reassure child - i believe you, you did the right thin, it’s not your fault.
5. Explain what will happen next - who needs to be told, what will happen to keep them safe.
6. Report to senior clinician
7. Document disclosure verbatim ASAP

Question 9

Suspected physical - response

Answer 9

1. Examination and documentation of physical injuries/signs (incl. descriptions, photos and explanations)
2. Specific investigations (with CPU/paediatrician) - XR, blood test, head CT/MRI
3. Provide urgent treatment for injuries
4. Consult - senior clinician, CPU/SPOCC.
5. Report any immediate threat to safety to WA police
6. Child protection concern referral form
   * Other - safety net meetings, power to keep children (<6) for 48hrs (s40(2)).

Question 10

Suspected sexual - response

Answer 10

1. Examination and documentation of findings (incl. full-body, STI/pregnancy screen, genito-anal scope)
2. Forensic assessment within 72hrs -
3. Provide urgent treatment for injuries
4. Report - senior clinician, CPU/SPOCC.
5. Mandatory reporting - s124A/B

Question 11

Suspected neglect/emotional - response

Answer 11

1. Document evidence
2. Assess psychosocial situation
3. Intervene to remediate impact of neglect - e.g. nutrition/hydration.
4. Consult - senior clinician, CPU/SPOCC.
5. Involve social worker
6. Offer resources - e.g. parenting programs, family education, drug/alcohol services, referrals to specialists (e.g. dietician, psychologist)
7. Child protection concern referral form

Question 12

Disclosure (parent) - response

Answer 12

1. Communicate in non-judgemental manner
2. Do NOT ask leading or direct questions
3. Avoid emotional expressions
4. Empathise with poor coping but do not support abusive behaviour
5. Keep informed about treatment/condition
6. Disclose any mandatory reporting requirements