Child Abuse: NICE Guidelines Flashcards
1
Q
What are some situations where you should consider neglect?
A
- Severe and persistent infestations (e.g. Scabies or head lice)
- Parents who do not administer essential prescribed treatment
- Parents who persistently fail to obtain treatment for tooth decay
- Parents who repeatedly fail to attend essential follow-up appointments
- Parents who persistently fail to engage with child health promotion
- Failure to dress the child in suitable clothing
- Animal bite on an inadequately supervised child
2
Q
What are some situations where you should suspect neglect?
A
- Failure to seek medical advice which compromises the child’s health
- Child who is persistently smelly and dirty
- Repeat observations that:
- Poor standards of hygiene that affects the child’s health
- Inadequate provision of food
- Living environment that is unsafe for the child’s development stage
3
Q
What are some situations where you should consider sexual abuse?
A
- Persistent dysuria or anogenital discomfort without a medical explanation
- Gaping anus in a child during examination without a medical explanation
- Pregnancy in a young women aged 13-15 years
- Hepatitis B or anogenital warts in a child 13-15 years.
4
Q
What are some situations where you should suspect sexual abuse?
A
- Persistent or recurrent genital or anal symptoms associated with a behavioural or emotional change
- Anal fissure when constipation and Crohn’s disease have been excluded as the cause
- STI in a child younger than 12 years (where there is no evidence of vertical or blood transmission
- Sexualised behaviour in a prepubertal child
5
Q
What are some situations where you should consider physical abuse?
A
- Any serious or unusual injury with an absent or unsuitable explanation
- Cold injuries in a child with no medical explanation
- Hypothermia in a child without a suitable explanation
- Oral injury in a child with an absent or suitable explanation
6
Q
What are some situations where you should consider suspect physical abuse?
A
- Bruising, lacerations or burns in a child who is not independently mobile or where there is an absent or unsuitable explanation
- Human bite mark not by a young child
-
One or more fractures if there is an unsuitable explanation, including:
- Fractures of different ages
- X-ray evidence of occult fractures
- Retinal haemorrhages with no adequate explanation
7
Q
A child comes to talk to you, in confidentiality, about abuse she thinks she is getting. What should you tell her?
A
- Advice the child that you may be unable to maintain confidentiality.
- Speak to experienced colleague (child safeguarding lead)
- Explore concerns about sharing the information.
- Reassure that they will be kept informed about who the information will be shared with & action taken.
8
Q
What is the difference between considered abuse and suspected abuse?
A
- Consider means maltreatment is one possible explanation for the alerting feature or is included in the differential diagnosis.
- Suspect means serious level of concern about the possibility of child maltreatment but not proof of it.
9
Q
What are some alerting features in the child-parent relationship that should cause you to suspect abuse?
A
- Negativity or hostility towards a child or young person
- Rejection or scapegoating of a child or young person
- Developmentally inappropriate expectations of or interactions with a child, including inappropriate threats or methods of disciplining
- Exposure to frightening or traumatic experiences, including domestic abuse
- Using the child to fulfil the adult’s needs (for example, in marital disputes)
- Failure to promote the child’s appropriate socialisation (for example, not providing stimulation or education, isolation or involving them in unlawful activities).
- Emotional unavailability and unresponsiveness from the parent or carer towards a child (in particular towards an infant) (emotional neglect).
- Parent or carer prevents you or another healthcare professional from speaking to the child or young person alone when it is necessary for the assessment of the child or young person.
- Parents or carers punishing a child for wetting despite professional advice that the wetting is involuntary.
10
Q
What are some alerting features in the relationship between the child and parent that would make you suspect child abuse.
A
- Persistent harmful parent– or carer–child interactions (emotional abuse).
- Persistent emotional unavailability and unresponsiveness from the parent or carer towards a child (in particular towards an infant) (emotional neglect).
11
Q
What are some clinical presentations that should make you consider child maltreatment.
A
- Unusual pattern of presentation to and contact with healthcare professionals, or frequent presentations or reports of injuries.
- Poor school attendance that the child’s parents or carers know about that is not justified on health (including mental health) grounds, and home education is not being provided.
- Bleeding from the nose or mouth in an infant who has an apparent life-threatening event and a medical explanation has not been identified.
- Hypernatraemia if a medical explanation has not been identified.
- A near-drowning incident that suggests a lack of supervision.
12
Q
What are some clinical presentations that should make you suspect child maltreatment.
A
- Repeated apparent life-threatening events in a child, if the onset is witnessed only by one parent or carer and a medical explanation has not been identified.
-
Poisoning in a child in any of the following circumstances:
- Deliberate administration of inappropriate substances, including prescribed and non-prescribed drugs
- Unexpected blood levels of drugs not prescribed for the child
- Reported or biochemical evidence of ingestions of one or more toxic substances
- The child could not access the substance independently
- Repeated presentations of ingestions of substances in the child or other children in the household
- There is an absent or unsuitable explanation.
- Child has a near-drowning incident with an absent or unsuitable explanation.
