Child Protection

Question 1

What features of the history should increase the clinicians suspicion of non-accidental injury (NAI)?

Answer 1

Mechanism of injury was not compatible with the injury sustained

The child’s developmental stage was inconsistent with the injury presented

The child sustained a significant injury with little or no explanation

Inconsistent histories were given

There was a delay in presenting the child to health care providers

Recurrent injuries

The parents reaction was not appropriate to the situation – too concerned, aggressive, elusive, vague.

Question 2

What investigations of physical abuse should be carried out if a child is bruised.

Answer 2

Coagulation screen

Full blood count

Question 3

What investigations of physical abuse should be carried out if a child is fractured.

Answer 3

Full skeletal survey
CT scan

Bone biochemistry

Question 4

What investigations of physical abuse should be carried out if a child is less than 2 years.

Answer 4

Full skeletal survey
CT head

Expert ophthalmological examination

Coagulation screen

Question 5

Define neglect.

Answer 5

The persistent failure to meet the Childs basic physical or psychological needs that is likely to result in the serious impairment of the Childs health or development

Question 6

How might neglect present?

Answer 6

Medical
Unimmunised
Failure to attend appointments
Poor compliance with medication
Failure to seek appropriate, timely medical advice

Nutritional
Faltering growth due to failure to provide an appropriate and or sufficient diet
Obesity due to failure to control diet and lifestyle

Educational
poor school attendance

Physical
inadequate hygiene- dirty and smelly
severe and or persistent infestations/infections
inappropriate clothing for the childs size and weather

Question 7

How is emotional abuse defined?

Answer 7

persistent, non-physical, harmful interactions with the child by the care-giver

Question 8

Name some symptoms of emotional abuse in infants.

Answer 8

Developmental delay
Poor sleep

Feeding difficulties

Persistent

Crying

Irritable

Apathetic

Question 9

Name some symptoms of emotional abuse in a toddler.

Answer 9

Difficult/violent behaviour

Delayed social and language skills

Question 10

Name some symptoms of emotional abuse in school age children.

Answer 10

Poor attendance
Truancy

Antisocial behaviour

Academic failure

Question 11

Name some symptoms of emotional abuse in adolescents.

Answer 11

Depression
Self harm

Relationship difficulties

Substance abuse

Criminal activity

Eating disorders

Aggressive behaviour

Question 12

How is sexual abuse defined?

Answer 12

physical contact, including penetrative and non-penetrative acts, exposure to sexually explicit material and child sexual exploitation

Question 13

How might children who have been sexually abused present?

Answer 13

Allegation – a child may disclose abuse to anyone at any time
Pregnancy
STI
Ano-genital injury
Unexplained vaginal bleeding
Unexplained rectal bleeding
Recurrent vaginal discharge
Soiling, bowel problems, enuresis
Behavioural difficulties

Question 14

What does HEADDSSS stand for?

Answer 14

Home, Education/Employment, Activities, Drugs, Sex and relationships, Self harm and depression, Safety and abuse

Question 15

Name 4 categories pf life limiting conditions.

Answer 15

1. Life- threatening e.g. Cancer
2. Premature death e.g. CF
3. Progressive conditions e.g. Batten disease
4. Susceptibility e.g. cerebral palsy