Child Abuse Flashcards
Define maltreatment
the abuse and neglect that occurs to children, including all types of physical and/or emotional ill-treatment, sexual abuse, neglect, negligence and commercial other exploitation, which results in actual or potential harm to the child’s health, survival, development or dignity in the context of a relationship
of responsibility, trust or power (WHO)
What are the types of child abuse
Neglect
Emotional abuse
Sexual abuse, including sexual exploitation
Physical abuse
Fabricated or induced illness e.g. Munchausen’s
Define neglect
The persistent failure to meet the child’s/young person’s basic physical and/or psychological needs that is likely to result in serious impairment of the child’s/young person’s health and development.
e.g. adequate supervision, food, clothing, or shelter; or failing to protect them from physical or emotional harm
Define emotional abuse
Persistent maltreatment which results in adverse effects on a child’s/young person’s emotional, behavioural, social or cognitive development
This could include conveying to a child/young person that they are worthless, unloved, inadequate, or a burden
It could also include expectations beyond a child’s/young person’s developmental age, overprotection, limiting of exploration and learning, and disregarding the child’s individuality
Define sexual abuse
Involves forcing or tempting a child/young person to take part in sexual activities, which can include prostitution. The child/young person may or may not be aware of it. The activities could include physical contact (including penetrative or non-penetrative acts), but could also involve non-contact activities such as involving a child/young person in the production of, or looking at, online sexual images, or encouraging them to behave in sexually inappropriate ways.
Define physical abuse
Involves causing physical harm to a child/young person which may include shaking, hitting, throwing, poisoning, burning or scalding, drowning, or suffocating. Fabrication of symptoms or deliberate induction of illness in a child/young person by the parent/carer may also cause physical harm to the child/young person.
What are the risk factors for child abuse
Child: failure to meet parental expectations and aspiration e.g. disabled, wrong gender, difficult child | born after forced, coercive, commercial sex | living in the care system
parent/carer: PMHx mental health issues | parental indifference | alcohol | drug abuse | Hx domestic abuse/sexual violence/malteratment | emotional volatility | Hx violent offending | poor education or lack of parenting knowledge
Family: step-parents | DV | multiple/closely spaced births | social isolation | lack of social support
Environment: low SES | poor housing
When should you suspect child maltreatment
Marked changes in child’s behaviour or emotional state
Frequent attendance or unusual pattern of presentation to healthcare
Injury or injuries with features that would suggest maltreatment
Harmful interaction between parent and child/young person
Child or young person appears neglected e.e persistent infestations, smelly, dirty, FTT
What are the common presenting features for victims of child abuse
Faltering growth
Mild developmental delay
Unkempt child
Missed appointments
Chaotic living circumstances
Concerning interaction between parent and child
What are the reassuring factors in suspected child maltreatment
Child has been brought in
Acknowledgement of concerns and insight into the situation
Engagement with health visitor or follow up appointments
Evidence of local social support e.g. family or friends
Weight gain and developmental progression at follow up appointments
How do you manage suspected child neglect where parent is stressed
Discuss concerns with them
Ensure health visitor support
Discuss with senior GP at a practice meeting
Written advice e.g. NHS start4life
Follow up
How do you manage suspected child abuse
Discuss with safeguarding lead
Discuss with social care ± safeguarding referral
Consider hospital admission
Skeletal survey
Formulate a child protection plan
What bruising patterns suggest child abuse
Bruising in children who are not independently mobile
Bruising in babies (especially <6 months)
Bruises that are seen away from bony prominences
Bruises to the face, back, abdomen, arms, buttocks, ears, and hands
Multiple bruises in clusters
Multiple bruises of uniform shape e.g. hand, teeth, grip
Bruises that carry the imprint of implement used or a ligature
What are the signs of sexual exploitation in children
Going missing for periods of time or regularly returning home late
Skipping school or being disruptive in class
Appearing with unexplained gifts or possessions that can’t be accounted for
Experiencing health problems that may indicate a STI
Having mood swings and changes in temperament
Drugs and/or alcohol use
Displaying inappropriate sexualised behaviour e.g. over-familiarity with strangers, dressing in a sexualised manner, sending sexualised images by phone
Signs of unexplained physical harm e.g. bruising, cigarette burns
What are the physical signs of sexual exploitation in childrren
Gaping anus
Genital/anal symptoms without explanation (bruising, laceration, swelling, abrasion)
Dysuria or ano-genital discomfort
Foreign bodies in the vagina/anus
Anogenital warts
