child protection Flashcards
What is safeguarding?
Minimise risk of harm to children
-prevent abuse and maltx
-prevent harm to children’s health/development
-enable best outcomes
What are children’s rights 1989?
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
What does the government policy ‘working together to safeguard children’ say?
1. Prevent abuse and neglect
2. Improve multiagency working and communication
3. Encourage early intervention
What is the evidence base for health professionals?
NICE clinical guideline 89
when to suspect child maltx
GDC says to follow local procedures
PHE 2019 have safeguarding in GD practice
What are the 4 types of abuse?
Physical
Emotional
Sexual
Neglect
How do you recognise physical abuse?
Regular injuries
Pattern to injuries
Explanation doesn’t match
Delay in presentation
Where are some questionable places to get injuries?
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
When are bruises suggestive of abuse?
Non mobile infants
Soft tissue areas
Imprint of implement
Large, multiple, in clusters
When are burns and scalds suggestive of abuse?
Frequently multiple
Clear demarcated
Shape matching implement
Back, shoulders, buttocks
Scalds- bilateral/symmetrical (glove or stocking)
When are fractures suggestive of abuse?
Accidental- 85% seen in 5+ years
Abusive- 80% in <18 months, may not be accompanied w bruising, multiple at different stages of healing
When are oral injuries indicative of abuse?
Lips most common site- cuts/bruises
Non mobile baby
Torn frenum
Consider context
What diseases can be mistaken for physical abuse?
Birthmarks
Infections
Unintentional injuries
Bruise easily-
Osteogenesis imperfecta
Bleeding disorders
How can you recognise emotional abuse?
Lack self assurance
Struggle to control emotions
Difficultly w relationships
Acts in way inappropriate for age
What are the impacts of emotional abuse?
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
How can you recognise sexual abuse?
Might not think it’s wrong
Direct allegation
STI
Pregnancy
Emotional/behavioural signs
Secretive about what they’re doing online
How can you recognise neglect?
Poor appearance/hygiene
Wrong clothing
Repeated accidental injury
Missed appts
Untx injuries
Unsuitable home environment
Left alone for long time
Change in behaviour
What is the impact of neglect?
Problems w brain development
Risk taking
Dangerous relationships
Relationship difficulties
Mental health problems
What are neglect stats?
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
What is dental neglect?
Persistent failure to meet a child’s basic OH needs resulting in serious impairment of child’s oral/general health/development
What is the prevalence of abuse?
2018-2022
Neglect- 48%
Emotional- 38%
Physical- 7%
Sexual- 4%
Multiple- 3%
What are other types of abuse faced by young people?
Sexual exploitation
Child trafficking
Criminal exploitation
Female genital mutilation
Radicalisation
Domestic violence
What are some characteristics associated w abuse?
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
What is the role of the dentist?
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
How should you talk to the child?
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
What should you do if you suspect neglect?
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
When shouldn’t you tell the parents?
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
What should a good practice do?
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)
