child protection

Question 1

What is safeguarding?

Answer 1

Minimise risk of harm to children
-prevent abuse and maltx
-prevent harm to children’s health/development
-enable best outcomes

Question 2

What are children’s rights 1989?

Answer 2

ARTICLE 19
Protect children from all forms of physical/mental violence, injury/abuse, neglect, maltx or exploitation

ARTICLE 24
Children have right to enjoyment of the highest attainable standard to health and facilities for tx of illness and rehab of health

Question 3

What does the government policy ‘working together to safeguard children’ say?

Answer 3

1. Prevent abuse and neglect
2. Improve multiagency working and communication
3. Encourage early intervention

Question 4

What is the evidence base for health professionals?

Answer 4

NICE clinical guideline 89
when to suspect child maltx
GDC says to follow local procedures
PHE 2019 have safeguarding in GD practice

Question 5

What are the 4 types of abuse?

Answer 5

Physical
Emotional
Sexual
Neglect

Question 6

How do you recognise physical abuse?

Answer 6

Regular injuries
Pattern to injuries
Explanation doesn’t match
Delay in presentation

Question 7

Where are some questionable places to get injuries?

Answer 7

Ears (pinch marks)- both sides
Triangle of safety- ears, side of face, neck, top of shoulders
Inner aspect of arms
Back and side of trunk
Black eyes esp bilateral
Soft tissue of cheeks
IO injuries
Forearms
Chest and abdomen
Groin/genital
Inner aspect of thighs
Soles of feet

Question 8

When are bruises suggestive of abuse?

Answer 8

Non mobile infants
Soft tissue areas
Imprint of implement
Large, multiple, in clusters

Question 9

When are burns and scalds suggestive of abuse?

Answer 9

Frequently multiple
Clear demarcated
Shape matching implement
Back, shoulders, buttocks

Scalds- bilateral/symmetrical (glove or stocking)

Question 10

When are fractures suggestive of abuse?

Answer 10

Accidental- 85% seen in 5+ years

Abusive- 80% in <18 months, may not be accompanied w bruising, multiple at different stages of healing

Question 11

When are oral injuries indicative of abuse?

Answer 11

Lips most common site- cuts/bruises
Non mobile baby
Torn frenum
Consider context

Question 12

What diseases can be mistaken for physical abuse?

Answer 12

Birthmarks
Infections
Unintentional injuries

Bruise easily-
Osteogenesis imperfecta
Bleeding disorders

Question 13

How can you recognise emotional abuse?

Answer 13

Lack self assurance
Struggle to control emotions
Difficultly w relationships
Acts in way inappropriate for age

Question 14

What are the impacts of emotional abuse?

Answer 14

BEHAVIOURAL- clingy, not caring how they act, want people to dislike them, risky behaviour

EMOTIONAL- lack confidence, anger problems, relationship problems

MENTAL HEALTH- depression, anxiety, suicidal thoughts, EDs

Question 15

How can you recognise sexual abuse?

Answer 15

Might not think it’s wrong
Direct allegation
STI
Pregnancy
Emotional/behavioural signs
Secretive about what they’re doing online

Question 16

How can you recognise neglect?

Answer 16

Poor appearance/hygiene
Wrong clothing
Repeated accidental injury
Missed appts
Untx injuries
Unsuitable home environment
Left alone for long time
Change in behaviour

Question 17

What is the impact of neglect?

Answer 17

Problems w brain development
Risk taking
Dangerous relationships
Relationship difficulties
Mental health problems

Question 18

What are neglect stats?

Answer 18

Typical-
- <1 year deprived of food/drink
- older child not supervised

At least one child is killed a week
<1 year most likely to be killed
Most commonly by step/parent

Higher levels of decay in neglected kids
Hx of abuse 8x more likely untx caries

Question 19

What is dental neglect?

Answer 19

Persistent failure to meet a child’s basic OH needs resulting in serious impairment of child’s oral/general health/development

Question 20

What is the prevalence of abuse?

Answer 20

2018-2022

Neglect- 48%
Emotional- 38%
Physical- 7%
Sexual- 4%
Multiple- 3%

Question 21

What are other types of abuse faced by young people?

Answer 21

Sexual exploitation
Child trafficking
Criminal exploitation
Female genital mutilation
Radicalisation
Domestic violence

Question 22

What are some characteristics associated w abuse?

Answer 22

Domestic abuse
Parent substance abuse/mental issues
Kids w physical/neuro disabilities
Kids missing from education
Babies and toddler- physical a
Teenagers- sexual a
Poverty
Social isolation

Question 23

What is the role of the dentist?

Answer 23

Skilled at examining head and neck
Head and neck frequent site in physical a
Untx dental decay- neglect
Kids attend dentist regularly
Often tx more than one family member

Question 24

How should you talk to the child?

Answer 24

Ask about cause
Allow them to talk
Avoid asking leading Qs
Respond calmly and kindly w/o judgment
If they ask to keep secret- say that you can’t and why and to who

Question 25

What should you do if you suspect neglect?

Answer 25

Discuss w an experienced colleague
Refer to local child services (telephone and follow up in writing)
Inform parent (being open and honest has better outcomes)
Confirm referral has been received and acted on
Arrange dental follow up
Talk through w trusted colleague
May need report for case conference

If no concerns- keep full clinical records, monitor

Question 26

When shouldn’t you tell the parents?

Answer 26

May put child at greater risk
May impede police investigation/social work enquiry
Sexual/organised/multiple abuse
Fabricated/induced illness
Parent/carers are violent/abusive- put you or others at risk
Can’t contact parents w/o causing undue delay

Question 27

What should a good practice do?

Answer 27

1. Identify member of staff for child protection
2. Have a policy
3. Hand step by step guide if concerns
4. Have best practice record keeping
5. Have regular training
6. Have safe staff recruitment (DBS)